Journal of Traumatic Stress, Vol. 23, No. 5, October 2010, pp. 645–648 (C ?2010)
B R I E F R E P O R T
Prazosin Treatment of Trauma Nightmares and Sleep
Disturbance in Soldiers Deployed in Iraq∗
Jess Calohan, Kris Peterson, Elaine R. Peskind, and Murray A. Raskind
Madigan Army Medical Center and VA Northwest Network Mental Illness
Trauma nightmares and sleep disturbance impair combat soldiers’ functioning. The alpha-1 adrenoreceptor
antagonist prazosin has been demonstrated effective for these symptoms in Vietnam veterans. Thirteen soldiers
seeking relief from distressing trauma nightmares impairing military function in northern Iraq in 2006 received
prazosin alone or in combination with other psychotropics. Mean prazosin dose was 4.1 (SD = 2.2) mg before
bed. Six soldiers improved markedly and 3 moderately on the Clinical Global Impression of Change Ratings of
distressing dreams decreased from an average of 7.0 (SD = 0.7) to 2.9 (SD = 3.0, p < .001) and those of
disturbed sleep from 6.7 (SD = 0.9) to 3.7 (SD = 2.4, p < .001). Prazosin appears effective and well tolerated
in the desert warfare environment.
Trauma nightmares and severe sleep disturbance are common
stress-induced symptoms in military personnel engaged in combat
operations in Iraq and Afghanistan (Ruff, Ruff, & Wang, 2009).
These distressing and difficult to treat symptoms of acute stress
disorder or posttraumatic stress disorder (PTSD) impair soldiers’
ment. It has been hypothesized that trauma nightmares and sleep
disturbance in PTSD result from excessive brain responsiveness to
released norepinephrine disrupting rapid eye movement (REM)
and other sleep stages (Mellman, Kumar, Kulick-Bell, Kumar, &
Nolan, 1995; Taylor et al., 2008). Prazosin is a generic nonsedat-
barrier and reduces the brain stress response to norepinephrine
in Vietnam War combat veterans with chronic PTSD (Raskind
et al., 2003, 2007) and in civilian trauma PTSD (Taylor et al.,
2008). Here we report encouraging clinical results with prazosin
∗This article was edited by the journal’s Editor-Elect, Daniel S. Weiss.
Center and VA Northwest Network Mental Illness, Research, Education and Clinical Center.
This work was supported by the Department of Veterans Affairs and Department of Defense
PR054292. The authors would like to acknowledge Susan Martin for manuscript preparation
and Steve Millard and Dan Morelli for statistical analysis.
The views expressed are those of the author(s) and do not reflect the official policy of the
Department of the Army, the Department of Defense or the US Government.
Correspondence concerning this article should be addressed to: Murray A. Raskind, VA Puget
Sound Health Care System, 1660 S. Columbian Way, S116 6 EAST, Seattle, WA 98108.
Published 2010. This article is a US Government work and is in the public domain in the
USA. View this article online at wileyonlinelibrary.com DOI: 10.1002/jts.20570
for distressing trauma nightmares and severe sleep disturbance in
soldiers conducting combat and combat support operations in the
dehydrating desert environment of Iraq.
Prazosin was prescribed and clinical observations were recorded
by an active duty army psychiatric nurse practitioner (Major J.C.)
in charge of a mobile Combat and Operational Stress Control
Team operating in Northern Iraq. There was no psychiatrist or
other physician assigned to the Combat and Operational Stress
Control Team. Soldiers engaged in combat operations traveled
from units throughout northern Iraq to receive evaluation and
treatment initiation for acute behavioral problems occurring in
the fluid and dangerous battlefield environment.
All soldiers seeking relief from persistent and distressing trauma
nightmares between the dates of February 10, 2007 and April
10, 2008 were prescribed prazosin. Soldiers included in this re-
port comprised a consecutive sample of those prescribed prazosin
whose geographic proximity to the Stress Control Team and cur-
rent mission status allowed follow-up evaluation (26% of the total
consecutive soldiers seeking nightmare relief). Although it is not
mares but not proximate enough to receive follow-up evaluation
by Major J.C. differed in nightmare severity, combat exposure, or
other variables from the 26% who could receive follow-up evalu-
ation, such differences were not apparent.
Thirteen soldiers (11 men; 2 women) had a follow-up evalua-
tion at their achieved maintenance prazosin dose by Major J.C.,