Diagnosis
PTSD associated nightmares
H&P:
Typical presentation: Patient with PTSD appropriately treated with SSRI + CBT with some improvement but still having nightmares and sleep disturbances.
DDx
Treatment
-Prazosin 1-6mg. Start with 1mg and increase as needed to treat nightmares.
-F/u in 4 weeks.
-PHQ-9:
-GAD-7:
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Prazosin is an alpha-adrenergic receptor antagonist.
Clonidine doesn’t have as much evidence behind it as prazosin but is an option that can be tried. The evidence is there, just sparse.
Further Reading / References
Mayo Clinic Proceedings. 2012;87(9):890-900. Treatment of Nightmares With Prazosin: A Systematic Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538493/
J Clin Sleep Med. 2010 Aug 15;6(4):389-401. Best practice guide for the treatment of nightmare disorder in adults.
https://www.ncbi.nlm.nih.gov/pubmed/20726290