Researcher pursues unexpected treatment for veterans' trauma nightmares
This story originally aired on October 20, 2018.
Nightmares happen to us all. For people with Post Traumatic Stress Disorder, nightmares can be debilitating, nightly experiences. “Trauma nightmares are almost [like playing] a video tape of a traumatic event,” says Dr. Murray Raskind. He’s a psychiatrist at the VA Puget Sound hospital in Seattle and a professor in the University of Washington School of Medicine, who’s been researching PTSD treatment since he started working with a support group for African American veterans of the Vietnam War, in 1994.
One of Raskind’s patients, Don, had a particularly bad case of traumatic nightmares. Don had accidentally killed a friend of his with friendly fire, and dreamed about the event almost nightly. He would wake with his heart racing, pouring sweat. Despite taking medication that was intended to help his PTSD symptoms, Don found that alcohol was the only reliable way for him to fight anxiety and fall asleep, so he self-medicated with handles of vodka.
Dr. Raskind understood that one cause of the nightmares might be an overabundance of the stress hormone norepinephrine. Raskind reasoned that if he could tamp down that chemical, that could offer Don and his other patients some relief. Fortunately, Raskind knew of a common and unexpected medication that did just that - an inexpensive blood pressure medication called Prazosin.
Don tried Prazosin, and soon began sleeping through the night undisturbed, something he hadn’t done since before fighting in Vietnam. He stopped thinking about suicide and stopped drinking.
Raskind was cautiously optimistic, suspecting it may have been a placebo effect. So he invited another patient to try Prazosin. For a second time, Raskind’s patient reported undisturbed, full nights of sleep. Raskind started to believe that he might be on to something.
Early studies of the drug were promising, and Prazosin caught on. Raskind estimates that about 100,000 veterans systemwide took the drug for PTSD symptoms.
The VA then tried to do a full, definitive study on the effectiveness of Prazosin. But his study failed to show that Prazosin was effective for most of the participants. Upon examination, Raskind and his colleagues realized that the big study they’d just completed left out the types of people like Don and Raskind’s other patients who’d found success with the medication: Namely, it excluded people with severe symptoms, people with alcohol addiction, and, importantly, people who had the characteristic "adernaline storm" of traumatic nightmares - the kind that jolted them awake in the middle of the night, drenched in sweat, heart pounding, unable to go back to sleep.
Today, Dr. Raskind believes Prazosin does work for some people, and his aim now is to home in on what kind of person it works for. Until then, he takes comfort in knowing it has helped some of his patients find restful sleep again.