March 29, 2009

Prazosin "Off Label" Use For PTSD

I have been experiencing some intrusive thoughts, extended periods of dissociation, attention difficulties, traumatic memories, avoidance strategies, numbing and hyperarousal. Yeah, I have PTSD. Anyway, it's getting to me so I did some research on drugs that may help and came across Prazosin. I had tried fluvoxamine two times a couple of months ago and could not tolerate the side effects. They made me feel heavy headed and faint, so I ditched them. Now, with therapy in progress I needed to get some symptom relief so I can concentrate again in school and in life.

Originally a drug for hypertension and now is used "off label" for PTSD symptoms including; nightmares, reexperincing, avoidance, numbing and hyperarousal. I couldn't have found one more perfect. I will have to see how well I tolerate the side effects, but the study that I read says the drug is well tolerated.

My doctor prescribed 1 mg titrated up to 2 mg over two weeks. I took my first dose tonight, so far the only side effect that I can discern is a massive headache, but to me I have those all the time. Acetaminophen took the headache away, so no problem. I will have to watch out for those over time.

Update: 1/15/2013 - I am still taking Prazosin, I am up to the maximum dosage for nightmares at 5mg. It still works today, still deal with the possibility of fainting but not as bad as when I first started taking it.

87 Comments:

I noticed you hadn't blogged about it since March 29th at least not that I have found. Any news on the medication's effects both at first and over time? I am 32 and while I have not served in the war my life has been it's own type of war. I have constant nightmares to the point where I really haven't slept more then 2 to 4 hours at a time for the past month or so. I am on anti-depressants and anti-anxiety but still nothing unless I take HIGH doses of Xanex to make me sleep which my Dr. will not give. I found information on this drug on CNN's health page but nowhere does it really tell what it does for the person. Some research said it caused people to have a dream/wake state which i already often have and causes severe panic attacks. I am pretty much giving up on sleep at the moment as it is just too much work. :( If you do have any information or see this you can contact me at lil_princess-di@hotmail.com. Any help you can give me is appreciated as I am uninsured, I can not get therapy, I am on disability, raising 2 autistic teen boys and ready to keel over from the amount of anxiety I have. :(

This drug has made a world of difference to me in treating my PTSD. It helps with the major symptoms during the day and affords me a more restful sleep at night. I have been taking Prazosin for about six months now and have had my dosage raised to 6mg, 2mg in the day and up to 4mg at night. Depending on my sleep patterns, stress level and social situations I will either decrease or increase the dosage within the 6mg a day range as needed.

One issue I have experienced with this medication has to do with my memory. When I take the higher doses, I cannot for the life of me remember anything, including names of people I associate with on a daily basis. So, I weigh the costs when taking the larger doses. Am I overly stressed? Did I not sleep well the night before? Do I have to write a paper for school, or have an exam?

Another issue is the dream/wake state that you described. At times I will think I am dreaming when awake or have a memory that I cannot distinguish from a dream or the waking world. During such times I will remind myself and contribute the symptom to the medication and in doing so the episode expires.

Benzodiapinzes (Xanax, Valium, etc.) do not mix well with PTSD and should not be prescribed to treat PTSD. They can increase certain symptoms during the day, along with having powerful addictive properties.

I am shocked that with you being on disability that you do not have insurance. I am assuming that since you do not, your disability was awarded recently or you do not have SSI or SSDI for yourself. Which you would probably be eligible with your medical history. On SSI you can receive Medicare immediately. On SSDI you can be eligible after two years. If you do not have benefits for your children then click here for information.

lil_princess-di, I emailed you at the address given and it came back as undeliverable. I would like to add to the above.

Further, I would like to stress that you can receive help from your nearest social services office within your community. Research services in your area, you can get help such as appropriate daycare services for your teens. If you cannot have some time for yourself you will implode eventually. This may be hard to consider, but consider this, if you do not take care of yourself first then you cannot take care of your sons. There are support groups for mothers with autistic children, find a meeting and go! Access resources in your community and this will take a great strain off of you that will eventually leave you broken if you do not.

I hope this finds you well and may God bless you.

Thank you for your service, I enjoy my freedom! I too am a sufferer of PTSD but for different reasons. I just thought I'd say thank you as I came across your blog while researching Prazosin. I will pray today that each and every Veteran finds peace as it is well deserved! I say this with tears in my eyes and mean it from the bottom of my heart, thank you!

Thank you Anonymous, Prazosin continues to be a Godsend to my sanity. I pray with you that we all find our way to peace.

Hello Scott, I came across your post and responses while researching a medication I was given for high blood pressure. I also want to thank you, not only for your service to your country, but for your service to the person(s) herein. You have a gift to offer others, it seems, and I was wondering whether you have considered working with/counseling others if you are not already. Hope all is still going well for you. JC Lamb

Hey JC, thanks for stopping by. Yes, I am in college studying social work and was going to be a trauma therapist. But, I have come to realize that I may not be able to do therapy because of my Mental Wounds of War.

What I find myself doing more and more is advising others in their time of need. I have helped hundreds of people over the last three years and contribute it all to my personal experience, a calling, my education and training.

I counsel several practitioners who had no experience with combat vets and one of those just recently received a directorship of a veterans program in her community.

It is a gift, as you say, I recognize it. My whole life people have come to me for advice and counsel. I just wrote a piece on it the other day, the gift of Cynosure.

I too suffer from various PTSD symptoms...nightmares, social isolation and avoidance..Started on the Prazosin 1mg last night and ended up in the ER all morning. Evidently, this medication caused extreme plummeting of my blood pressure which in turn caused major nausea, headache, racing heart, syncope and profuse sweating. Here it is 10:54am and I am still so nauseated I cant stand or move much. The Er doc suggested that I discontinue HCTZ that was previously RX'd in combination with Zestril for my HTN. If taking the Prazosin will end the nightmares I would like to continue but the thought of another night/day like this is frightening. I am wondering what you think?

First off, Prazosin is a blood pressure medicine. The side effects that are beneficial to a person with PTSD, such as reduced nightmares and major symptom relief, are only secondary to the original purpose of the medicine. If your doctor said no to you using the medicine, then maybe a second opinion would be prudent. Of course I am not that second opinion, but if I were without my Prazosin and it was causing me similar problems.

If Prazosin was causing me to have the negative symptoms you describe, the only way I would consider doing the medication was under strict doctors care while inpatient at a hospital. I would tell the doctor the benefits of the medicine are worth the risk as long as I would be inpatient and eventually receive the positive benefits of this drug.

I was inpatient at the VA when they started giving me Prazosin, my blood pressure had to go through an adjustment period. I take it religiously now, sometimes I even take it during the day when I am stressed out. I pray that you can find a way to still your racing heart, may God bless you.

Hello Scott,

Thanks for posting your experiences. I began taking Prazosin for severe combat related PTSD while inpatient at the VA in August. I am currently taking 5mg a day. (2mg at noon and 3mg before bed). I do have minor problems with dizzyness and become fatigued easily. However, I am hoping these side effects subside as my body adjusts.

Prazosin has made a world of difference in my PTSD symptoms. Not only am I able to sleep without nightmares, I do not awaken during the night and feel "hypervigilant". Before this med I would awaken from a nightmare and spend the rest of the night "on patrol", looking out windows for threats or standing at the end of my driveway searching for threats.

Now, I am much more relaxed during the day as well. I am able to overcome many of my "avoidance" issues and even went to the mall and grocery shopping by myself recently. I also don't experience the rages that used to keep me from falling asleep. I now have a sense of peacefulness and calm I never thought I would have again.

Before Prazosin I had been prescribed XANAX which turned out to be a total disaster and actually increased my rages, avoidance issues and hypervigilance. I would warn anyone suffering from PTSD to avoid benzos, especially if like me, they also suffer from TBI.

Prazosin isn't a magic pill. It doesn't "cure" PTSD. Flashbacks or "reremembering" still occur. However, it gives me the ability to deal with these issues effectively and overcome them. I would suggest that best results can be obtained by also avoiding alcohol or the abuse of other drugs as well.

These are merely my experiences. Thanks for letting me add them.

Randy G.

Hey Randy, thank you for the input! The symptom relief I felt was within a half an hour of taking the medicine. The negative side effects that I detailed above have mostly went away.

This drug is still not widely used to treat Combat PTSD at the VA. With all the benefits and few major side effects, it is a wonder that this is not used as a mainstay in pharmacological treatment of Combat PTSD.

Hi Scott

I'm a combat Vietnam Vet. I was a pointman while there in 1969.

I've had a WW2 Dr help me with my problems. I was turned down in 1985 for PTSD. So I would see this DR. off and on till 1997. He would give me some meds that were samples as I didn't have the money for the meds.

The Dr. told me he was about to retire and he said SSI or the Va should be paying for meds for me. He said, " Go fight them as hard as I fought in Nam for whats due you."

I did what he said and by persistance I got to 100% by SSI in 2001 and 70% by the VA for severe PTSD in 2003.

I had another Civilian Dr and also a VA Dr helping me. As I got to trust the Va more I finally found a sincere Va Dr that I trusted.

I'm not a pill takeing person, but, I went though several meds. Alot of them I dropped out of not knowing if they did anything.

I've been takeing 5mg Prazosin every night for a couple years. The dreaming changed. If I have a nightmare about Nam I wake up yet , but, the dream fades and I don't remember the dream. On rare occassions a couple are remembered. So I do like this pill. I do have some strange dreams and they drift away as I wake.

I take Trazodone 100 to 200 mg every night plus 1mg of Clonazpam.

I came across your blog looking to see if there were any bad reports on Prazosin. I just wish I could wean myself off of all these pills. If they are safe I probably will lose that thought.

Slate, you might want to reconsider taking Prazosin with Trazodone as it can cause priapism (an erection that won't go away--can be dangerous). Of course, I'm assuming you are male...

Slate, kuddos for getting your service-connection and SSI, AND for getting a trustworthy VA doctor. All huge!!

As long as you are giving feedback to your doctor and are not having negative reactions then decide on whether to continue the Prazosin.

Anonymous, priapism is indicated as one of the negative side effects which can easily be assessed (an erection lasting 4 hours).

I'm a veteran and with PTSD since 2007. Can't believe how Prazosin has changed my sleep patterns. All I can say is I've not had a nightmare since I started Prazosin (3 nights ago). It's a miracle to have a peaceful sleep and waking up not feeling tired. I'm so thankful for the VA neurologist who has prescribe Prazosin.

I am suppost to start taking it soon and now I think I will take one at the hospital and see how I tolorate it instend of going home and waiting until bedtime. I don't want to go through what you went thru especially when home by myself alone.

As with any medications, consult with your doctor and come to terms together. For me the benefits far outweighed the risks.

I was researching Prazosin for PTSD and came across your site. This has turn into the wonder drug of the year for my daughter. Seven years ago she was brutally rape at the age of 12. Blocking it from her memory until a few years ago. She has suffered night terrors since the night it happened. They were never ending for her. She was afraid to even go to bed. A week ago she was given Prazosin in the hospital. For the first time in seven years , she is sleeping and enjoying it. I wish we had known about this wonder drug before. Now she is ready to press charges I believe, she is stronger and more self assured. It is amazing what sleep can do for the body and mind.

Anony, thank God for Prazosin! It is a comfort to know that through this medicine has been able to sleep and begin to enjoy life again. May God bless you both.

I have PTSD, as well, and I'm on prazosin. I am up to 8mg now. My nightmares have finally...well, not gone away exactly, but I occasionally have a pleasant dream, and when I do have nightmares they don't affect me as much throughout the day. I am pretty sensitive to the side effects, or at least to the dizziness. I have passed out too many times--especially if I get up at night. But those, for me, have subsided as I have continued use of the drug. And honestly, it's well worth it, to me. It's made a huge difference in my life. (Though, I also have to attribute some of that change to CPT). Good luck!

Yeah, I fainted the other day and fell into the table and got a scrap on the arm, holy crap it hurts, lol. I still take it, because it gives me the secure feeling that my nightmares will not walk in the light of day. The more nightmares I have at night means the more visual hallucinations during the day. So, we faint if we up too fast or cough our heads off.

CPT was one of the most profound therapies I have experienced, it gives you a set of mental tools set in a way intimately familiar for a veteran whose training included drilling schematics into memory.

Lamictol xr plus valerian root plus exercise 1 - 2 hrs... Eventually... Start 20-30 min. Per day
Jess & jojo

The dream wake state was temporary for me, I have been taking this medication 3 years now.

I am walking at least an hour and a half a day up to 2 hours, I have never tried herbal remedies.

I'm having a hard time adjusting to Prazosin. I've been taking it for a few weeks, increasing the dose each week, and am now up to 3mg.

I was weaned off Zopiclone in order to start this new treatment. Zopiclone, an addictive sleeping pill, severely affected my short-term memory, and is not covered by my drug plan. I think it's illegal in the US, but not here in Canada. It effectively wiped out my nightmares because it doesn't allow REM sleep. I'd been taking it for 15 years, but my doctor said it was not a good drug to be on, so he switched me to Prazosin. It takes hours to fall asleep now, and having REM sleep for the first time is awful because of the vivid nightmares that come with it. But worst of all, the fainting spells aren't going away. I injured myself pretty bad in one fall, and am now crawling to the bathroom at night so that I'm less likely to hurt myself when I hit the ground. Even so, I will still faint twice in the 10 meters it takes to get to and from the bathroom. It's gotten to the point where I'm afraid of the day ending because my nights are so horrible, and it's very difficult to shake off the feelings of dread and depression in the morning.

I don't know if part of my problem is due to the withdrawal from the addictive Zopiclone. I wish I knew how long to expect to suffer before (or if) I start to see positive results from Prazosin.

Hi, Scott --

Thanks so much for this site and everything you put into it. I'm wondering what CPT is. I have PTSD and am just trying to come to grips with the scope of the problem, so would appreciate any info.

Allison

From what little I know of zopiclone from Wikipedia, it can take a long time to readjust to the new chemistry in the mind. It is some bad stuff to come off of, says that this should only be used in the short term. Not for years or decades. It may take many months for your body and mind to get back in sync, your mind has been effectively turned off at night.

Your mind is active again at night as it should be, Prazosin doesn't actually make us not dream. It distinguishes the memory of them. Take note of how long the dreams take to have no more form and no more power over your waking moment. As that time begins to shorten, you will note the Prazosin working.

Seems the fainting may be compounded by the withdrawal from the zopiclone. Prazosin is a blood pressure medicine, the feeling faint hasn't gone away completely. But getting up slowly, not turning your head abruptly and adjustments in other ways lessen the fainting spells. There is a medicine I take for vertigo, spinning called meclizine, used to treat motion sickness.

Cognitive Processing Therapy, is a belief and behavior modification tool used to identify trauma stuck points and work through them is a systematic and structured way. It is focused on resiliency, and reassessing and reframing the trauma. It's been the most effective therapy I have encountered and it works as a short term therapy too! Although for chronic PTSD it will probably take longer then brief therapies.

Hello Scott,

I went to a my shrink for depession that has returned after 5 years. She asked me hiw I was sleeping and I told her about the lifelong nightmares, startelling reflex, sleep talking, restlessness, and snoring! My husband wakes up every night due to these issues. I am hypervigalent, irritable, arguementative, angry,
sad, critical, tired and avoided sleep. I have Non combat related PTSD. A BIG improvement in my life came when I was treated for ADD these past 5 years. As an adult, the adderall calmef me down within 20 to 30 minutes after taking it. However, my doctor did not want to prescribe an antidepressant... instead gave me a "presciption" to go to bed every night for one month and improve my sleep habits. She gave me Prazosin for the nihhtmares. I became a new woman the first day!! It is now day 3 and i have had no nightmares or hypervigilance... No sleep talking, or waking up. Husband is enjoying his ability to get a good nights rest also. I am mellow, happy, rested, and no
Longer feel jacked up. I guess people with PTSD have a lot of adrenaline, and the Prazosin blocks the receptors for adrenaline.
My kids have noticed the difference also.. It is a miracle to feel this way! Anothet great change is that I no longer feel antsy and can sit and talk with someone, and remain focused ... I am a better listener and conversation flows more natually because i no longer have rhe sense of urgency... The "flight" instict.
Thank you for your blog, and thenopportunity to have a place to share my experience also. ALL OF THIS MAJOR CHANGE IN ONLY 3 Nights of taking PRAZOSIN. :)

Yo

Yo, I am happy to hear that you have improved your sleep by taking Prazosin. I no longer have the fear of going to sleep as I rarely have nightmares taking it. I told my doctor it's a miracle drug.

Hi Scott,
Sorry for all the typo's.... Today was daughters graduation party. Despite the huge amount of stress to put on a party for 30 teenagers, then dinner for 8 afterward... I remained positive, happy, and astonishingly.. No racing heart irritabity or mood swings. I look forward to seeing how much improvement in my life comes from getting a whole month of sleep without nightmares and hypervigilance. Another change is that I developed hives in 1988, but have not taken anything. I just lived with it... Ignoring it as much as possible. The Prazosin has suppressed the hives also...a two for one! Thanks for your site..
Karen

Karen, I appreciate you taking the time to share. Stress can do crazy things to our bodies, like the hives. I am happy to know that another person is helped by this medicine. Keep reading!

i've been taking 10 mg. of prazosin for about 10 years. It is the most effective drug the VA has ever given me. I sleep every night, once a commodity that was rare. Sleeping at night, and not remembering the dreams enough to interfere with the day is the keystone in PTSD treatment for me. I was in Hue before and after TET for the year of 1968, and i sleep like a baby.

Welcome home brother, today I have complete confidence in going to bed probably won't result in a nightmare or night terrors.

Hi Scott Lee and everyone here. I have noncombat PTSD and just started taking prazosin last night. I hope it works well for me.

I just wanted to say that I had been given Xanax for years and it did not help at all and in fact made things worse. Now the doctor that RX'd the prazosin is weaning me off of the benzo Xanax with Librium. I can't wait to get off of a benzo because I want my life back. I have also read that benzos can aggravate PTSD.

Thank you all for your service and this site. :)

PTSD and benzos can be a dangerous combination and should only be used in short term in conjunction with therapy under a doctors strict care. I am glad you found your new doctor and Prazosin, it will be difficult to not have to rely on the benzos. Brushing up on coping skills can help with the added stress.

You are welcome and thank you for reading.

Greetings, I'm a psychiatrist and commonly use prazosin. Please be careful during the titration, especially if you already have blood pressure in the lower range (100s/70s or lower). If you're on antihypertensives, you should definitely stop them the DAY BEFORE you begin your first 1mg dose of prazosin. Then reintroduce them day by. Restop them the day before any dose increase. Always stay hydrated, I can't stress this enough. The last thing I tell all my patients is when they wake up in the morning they need to sit up in bed for thirty seconds, dangle their feet over the bed for thirty seconds and then stand for thirty seconds before they start moving. Sit down and do it more slowly the next time if you get dizzy. Also, while dangling your legs begin to tense your calf muscles to get the blood flowing (gravity pools the blood in lower extremities well more with prazosin as this agent dilates the vasculature). Most dosing algorithms used are 9am, 3pm, 9pm, commonly with a 1:1:2 ratio (ie 1mg 9am, 1mg 3pm, 2mg 9pm). That is of course if you're targeting daytime symptoms too. Otherwise, just use night dosing. It's on the Target and WalMart $4 lists. Benzos cause much more global inhibition and have well more side effects than prazosin. I rarely if ever prescribe them. The withdrawal with benzos can be wretched and you need to be tapered off any GABA agent (ie benzodiazepines; also including zolpidem/ambien and eszopiclone/lunesta the "nonbenzodiazepines") over an extended period of time. This is especially true if you've been on them a long time, ie >1yr of continuous usage. Remember, most psychiatrists have never experienced benzodiazepine withdrawal and thus commonly underplay the risks of a quick taper.
From a paper published in JAMA, "No cases of first dose syncope were seen in over 1100 patients given only 1mg of prazosin at bedtime with avoidance of diuretics (lasix/furosemide, HCTZ/hydrochlorothiazide, bumetanide/Bumex, spironolactone) or other antihypertensive agents (beta blockers --> ends in -olol or -alol or -ilol, calcium channel blockers etc) on the day prior to initiation of therapy."
Always discuss stopping the meds ahead of time with your doctor. Some people can't just stop their antihypertensives or diuretics so it NEEDS to be discussed.

Scott, how often do you take prazosin as needed? Do you use it after you feel symptoms or do you ever preemptively take it when you're approaching environments that may trigger you?

Thanks so much for writing this blog post!

My 29 year old son was diagnosed with PTSD in mid July due to a car accident he was in with me right after Christmas. While it was a minor fender bender it all boiled up when he went to the ER June 29th. He is currently on Zoloft, Abilify, Buspar and Ativan and just went to his fourth counselling session. The last two he was so anxious he stood and would not sit down. He has a good counselor. Two weeks ago he started to realized that his anxiety and fear came from the auto accident and is trying to talk about it but gets really anxious. In the last 4-5 days he has not been able to sleep and is worried about not waking up and dieing and when his heart beats fast or his arm is sore he gets real anxious. I am trying to find out if Prazosin can be taken with the above meds and if it may help him sleep and have better control...Called the doc but no answer..concerned parents...Thanks.

I take Abilify with prazosin plus a small hand full of psych meds. Sounds like you guys are on track, I would suggest he augment his coping skills. You will find resources and other articles linked in the label cloud below.

Thank you doctor for stopping by and adding to the discussion. I take prazosin at night for night terrors and nightmares for the last 4 years. I have never taken it as a preemptive or had I been exposed to the possibility until now.

Hi to Scott and Karen,

I'm so glad that Prazosin has made a big difference to you both. I read this study recently (http://www.nature.com/npp/journal/v28/n8/full/1300222a.html) and, from what I understood, an alpha-1 adrenergic blocker could really cut away my depression, as it does PTSD sleep disturbances.

And now, reading what Karen has said, I just can't wait for my next shrink visit: the end might be in sight.

Anyway, maybe I'm being over-optimistic, but I am really happy that both of you are obviously making big strides.

Keep it up guys.

Tom

Scott thanks for your timely and caring response. The doctor prescribed a sleep aid and not Prazosin. So I am trying to campaign again for it and use some studies to back its use up...do you have anything current? Thanks.

Your welcome, to find peer-reviewed papers Google [ptsd prazosin filetype:pdf] without the brackets. You can add different words to narrow your search. The search term filetype:pdf is the key part, add words to it to get the results you want.

Tom, taking Prazosin can reduce depression symptoms, but it has not rid me of depression either. If I wasn't taking Prazosin my hijacked sleeping hygiene would crash straight into my depression.

Oh right. I'm actually bipolar - can get overexcited, even about little things.

Sorry to hear that you're still suffering from depression Scott. Is that something you had before the incident(s) that caused the PTSD, if I might ask?

Either way, you seem to be doing lots in your life, which I definitely applaud.

Tom

I am mostly a recluse and better at giving advice than taking it, my struggle is everyday. Like lately, I have 2 degenerative disk's that have been kicking my ass and exacerbating my ability to keep it together. But, I do have some insight into my condition that seems to help others. Yeah, you could say my depression is still alive too. I was diagnosed with dysthymia, or chronic depression after my service and was not depressed before combat.

AH, apologies Scott. I totally misread between the lines. I'm a semi-recluse myself. Thank goodness for the internet and forums.

Do hope things pick up for you. Take care.

Tom

Hey, thanks for blogging about Prazosin. I've struggled with sleep problems since my early teens due to chronic nightmares, waking up screaming, vivid dreams, etc... due to repeated childhood trauma. I just thought everyone had nightmares, and that mine were somehow worse than the norm. I had no idea how abnormal I was. I was taking Ambien to sleep, and it truly did help me sleep, but I still had the nightmares sometimes, which would wake everyone in the house. One day I mentioned to my Doctor about the nightmares, while affirming that the Ambien truly did help me sleep, and he ended up prescribing Prazosin at 3 mg. I feel like a different person now. I also wonder if my Hypothyroidism was maybe due in part to my adrenal glands wearing out my thyroid gland. Maybe it all fits together? Anyway, thanks for blogging.

I am glad you found Prazosin for the nightmares. You are not abnormal, your abnormal experiences just make you feel abnormal.

Chronic and repeated traumatization can cause the body to fight itself through chronic pain and illnesses indirectly related to our trauma.

Your welcome and have a blessed day.

No need for apologies, I have bouts of frenzied creative activity, my last of which was in October and August. I'm hoping to have the money in January to take a painting class to continue the creative aspect of healing through the arts.

my tharpast has sucjusted i start cpt has it helped alot i thke 5mgs prazosin helps a lot thanks

CPT is a great therapy for helping with PTSD, it is the one therapy that has helped me the most in 7 years of therapy.

Adrenalin Blocking Medicine and PTSD Nightmares
A Caution if you are on Propranolol

I just want to mention that Prazosin works by crossing the blood brain barrier and blocking norepinephrine (adrenalin) acting in the brain. This is what makes it so helpful in stopping our PTSD nightmares. It is called an alpha blocker.
Some of us have been on Propranolol too which blocks adrenalin effect a different way and is called a "Beta Blocker" which means it works on different receptors.
The problem with propranolol in PTSD nightmares is it makes them much worse. Some unsuspecting doctors, thinking to stop our adrenalin response use propranolol at night by mistake. While Propranolol is great during the day--stops adrenalin inspired tremor, fast heart rate, sweating, and rage reaction, etc--it is not good for PTSD people who have nightmares at night.One of the adverse effects of propranolol, is vivid dreams and sleep disturbance

Minipress or Prazosin, blocks the brains adrenalin more safely when we have PTSD nightmares.
Trauma nightmares, by the way, are different than bad dreams in many ways as we know. The difference between a normal bad dream and a trauma nightmare is that trauma nightmares are extremely realistic and are reenactments of the trauma situation that happened. The trauma nightmares are true-life situations, and they are accompanied by an adrenaline storm which does not happen with bad dreams. The PTSD person experiences a rapid heartbeat, sweating, and rapid breathing, and needs to get out of bed to check the environment for danger.

Unlike normal dreams during rapid eye-movement sleep, in which the body's muscles are essentially paralyzed, trauma nightmares are often accompanied by muscle activity that can be dangerous to a bed partner.
PTSD nightmares are so bad the body becomes mobile and active. In bad dreams the brain holds the body still.
Prazosin was first used for PTSD in 1995 and the doctor who first used it pushes the dose as high as 15-20 mg or even higher, going very slowly. Most of us never are on doses higher than 4 mg but much higher doses are possible in the right hands.

My doctor recommends up to 5mg for nightmares. I still deal with the risk of fainting. I fainted yesterday and fell out of an office chair and bruised my arm and hurt my back. With all the risks, I still take Prazosin for nightmares.

Iraq war vet here. Been on prazosin for a couple months due to ptsd nightmares. Up to ten mg. Nightmares have gone down alot. But under my eyes burn about an hour after I take it and I've noticed more blood flow to the genitals. Not bad being a man. Decided to man up and get help after years of self-medicating with booze and drugs. Nice reading your posts. Ill keep u guys updated

Anony, welcome home brother. I'm glad you decided to get some help. Keep making your appointments and if you don't like your doctor or therapist. You can always fire them! Make sure you tell you doctor about the side effects, even the good ones. Keep reading and working towards healing.

Thanks for the support!!! Thinking about firing the doc now. Hahaha. I appreciate the advice. Keep doing what you are doing. U seem to be helping more than a few people

You are welcome, sometimes you gotta fire the doctor to find the good ones. They are there, but we may need to sift through the pile. Good luck and keep reading.

Wow, these stories are heart-breaking, but its so great to hear hope in all these posts. My daughter was gang-raped at 12 and, five years later her life is in ruins. We are just starting on Prazosin after a lot of resistance from her psych and counsellor (who feel her nightmares are useful to process her experience). Personally, I think we are "over" the processing and need for her to get a good night's sleep and be able to pick up the pieces. I am very, very, scarily hopeful that Prazosin is the answer. She has started low - is now on 1mg at night and has not seen any benefits yet. What sort of dose seems to be optimal? (She is small build 5'3").

I've been on it for 2 years, it really helps. It might be what you need?

Hi my 15 yr old daughter was diagnosed with ptsd she has opted to try this prozasin drug as well I hope this drug helps her as much as it has helped all of you. Im so hoping it helps her nightmares and her sleep problems caused by her sexual assault

Anony1, the nightmares are not useful in processing trauma. They exacerbate the daytime symptoms and rob us of our regenerative down time. I'm concerned that your therapist and doctor don't have a good understanding of trauma therapy. I would ask them if they are certified in CPT, EP and evidence-based therapies. If not, get another therapist and psychiatrist who specialize in PTSD. A doctor that understands PTSD would know the benefits of Prazosin and have it in their arsenal.

Evidence-based therapies do not have nightmare components, the best treatments for PTSD are exposure based and deal with memories and processing them. Taking Prazosin will help alleviate the power of many of her symptoms. I have been taking Prazosin for five years and recently I went without it for a couple of months. I guess I needed the reminder of the way I feel after not sleeping all night. My symptoms increased in severity. Prazosin does not delete the nightmares or memories, it extinguishes them from short term memory thus decreasing the reactions.

I am 5'9" and weigh 260 and take 5mg at night. Your daughter may need a larger dose depending on several factors. If her blood pressure is high then need a larger dose than 5mg to get the beneficial side effects from the drug. Another factor is the severity of the nightmares. My doctor won't prescribe more than 5mg for PTSD. From this thread I've learned that some doctors prescribe a much higher dose.

It's important to slowly raise the dose 1mg at a time to gauge her reaction. I hope that she is at a comfortable dosage and receiving the beneficial side effects.

Laurie, I pray that both you and Anony1's daughters find peace and happiness in their lives soon. The best therapies for Complex PTSD is exposure based therapies. Cognitive Processing Therapy is the front-line treatment at the Veteran's Administration. It is a proved therapy for sexual assault victims also.

Hey Scott im glad I found you,i have been taking prozain for a year now at 1mg doing nothing for me, I need to go up, but I do have low blood pressure, so tonight im going to take 2, one day I took 15mg just to see if it would work, I wont do that again, I have read all the post about this drug, so I will see again if it works..Kim harden

Scott, I'm in the same boat your are in. I have PTSD stemming from a brutal MST. My VA doctor prescribed Prazosin for the nightmares. And I have the same side effects you have. So my friend you are not alone. The VA has been a Godsend. I went for many years not knowing I was eligible for VA care. They have me in HUD VASH housing for homeless vets due to I haven't been able to hold down a job, and unfortunately I was self medicating with several substances including alcohol. It's been a brutally vicious cycle of stress, anger, anxiety, nightmares, disappointment in myself and drugs and alcohol, and inability to have any kind of normal relationships, even with my own family. I'm all alone with no friends and nothing constructive to do. But I soldier on as best I can and just try my best to stay calm and remember it's not my fault. I'm also on citalopram 40 mg for depresion, Trazodone 100 mg as a sleep aid, Tramadol 50 mg for joint pain, and Nortriptyline 10 mg for headaches.Also Ranitidine and Promethazine for nausea and indigestion. I wish I could turn back time to before I was assaulted but since that's impossible the meds along with treatment are my only options. I went through a month long intensive in-patient VA PTSD treatment program, which did help a little.

Welcome home to you both.

Kim, please consult with your doctor about taking a higher dosage. I was started off at 1mg and my doc raised the dosage until I began see relief from the nightmares. Always followup with your doctor if the medicine you area taking does not work. I hope that you find relief and blessings to you.

Anony, so glad you found out you were eligible for VA care. The bureaucracy can be a pain in the ass at times to deal with, but I still consider it a blessing. I'm alone too with hardly no friends, I do have one awesome friend though. I spend 99% of my time at home and most of the day on the internet talking to veterans and caregivers.

I spent 22 months in a veterans homeless shelter along with receiving counseling, treatment and help applying for veterans benefits. After I left the shelter I started writing this blog. Six years later I've found purpose and meaning from connecting with veterans and caregivers who think and feel as I do. From writing and blogging, social media, networking and pursuits in higher education I discovered a vehicle to deliver suggestions and resources on living with severe PTSD.

I hope you are following the comments. I volunteer for The Veteran's PTSD Project, we collect stories of posttraumatic growth and would like to help you craft your story. We have free online writing workshops to explore your writing about military trauma. Our workshops look for the best to be published in one of our journals.

We are a part of organization Military Experience and the Arts (MEA) and the Journal of Military Experience (JME). We are a group of veterans and family members whom are professional writers, artists and college professors. We promote veteran art and writing.

Are you service-connected for PTSD and receiving compensation?

hello there,
im 23 years old, and finally took myself to the doctor because i suffer from horrible anxiety, Im just hoping the doctor prescribed me the right medication, ive had a few bad dreams, but nothing as serious as ive heard from other people, but 75 percent of my mornings i wake up, im shaking as if im panicing from nothing.i was diagnosed with PTSD when i was about 13, and never recieved anymore treatment after that.. i guess what im trying to get at is, is this the right medication for me? im definitely a procrastinator, and usually pretty doubtful, and pretty paranoid about taking medication, i have a very important job, and i would hate for the medication to effect it, ive only been prescribed 1mg 30 minutes before bed, but i do have a 3 year old, if he wakes up in the middle of the night, will i have trouble waking up with him??

i just started this medication today, havent taken it yet.
I dont have the horrible nightmares others explain, but only once in a while, the main issue i suffer with is waking up in a panic state, i get very shaky and its hard for me to focus, then throughout the day i have my normal up and down anxiety.
i was diagnosed with PTSD when i was 13, its not severe, its very mild. and never got further treatment.
is this still the right medication for me?
I have a 3 year old son, if he wakes up at night, am i going to have trouble waking up with him?
also, i have heard a lot of people talking about "fainting" on it,.. does that occur right after you take the medication? or even throughout the day?

thanks for all the info, i really appreciate it :)

You will find out if it's the right medication for you by taking it under the strict care of your psychiatrist. Prazosin doesn't make you do to sleep or keep you asleep, so you will be able to wake up without grogginess. They can help with night terrors.

I am a female 58 suffering from PTSD from a traumatic event a year ago. My trauma is nothing like a vets but I have most the sysmptoms of one.I have flashbacks, all day anxiety, night terrors, depression, hyper-vigilent.Feel like I am coming out of my skin. Have tried most SSRI's that made me horribly ill. Psych doc just kept prescribing benzo's. Xanaz & Lorazepam (for sleep). I am off the xanax and the lorazepam is not helping the night terrors. I wake up every 2-3 hours in a panic. I am looking for what others have tried.The xanax works but at what cost? Have been in therapy for 8 months doing EMDR.Helps sometimes other times not so much. Need some sleep without becoming dependent or addicted. thank you for the prazosin suggestion. Just feeling a bit hopeless. I pray everyday for everyone who suffers.

Female58, my doctor prescribed Lexapro for PTSD and it works better than any that I have tried so far. I am in the VA system, so he had to get it approved for PTSD. Which means that it is being used 'off label,' it has yet to be approved by the FDA for that use but it's been found beneficial. It has less negative side effects and helps me get past the apathy I so profoundly feel without it.

I'd say the reason the Lorazepam is not working now is because you are off of the Xanax. The Xanax is powerful benzodiazepine and Lorazepam not so much. They should only be used under strict psychiatrists care for a short term in conjunction with therapy. After teaching the client coping skills and when the client has reached a stable period they should be discontinued.

I tried EMDR and it did not work for me. The best therapy I've discovered is Cognitive Processing Therapy. It helps to reframe the trauma and gain a new perspective from examining the false beliefs that spring up in relation to our trauma, meaning and identity. It gives the person a set of tools to apply in their life and releases the trauma through writing and processing it.

If your therapist does not do CPT then you may need to find another one. If you do, look for one that specializes in trauma.

Hey Folks,
Just another Marine [9yrs, 72-1981] with PTSD and a 'minor' case of TBI, along with chronic pain and depression. Been on disability, social security - not VA/military as that claim is still pending. I have tasted my gun barrel as has alot of you vets out there have, I'm sure.....My question is does anyone have any experience taking this med along with narcotics? I am presently taking about 540mg [total daily] of morphine ER, with 270mgs of oxycontin available [30mg tabs, max 9/day] for breakthrough pain. Also up to 3 x 10mg Valium as needed for muscle spasms. I would love to try this med to rid the nightmares of PTSD-but am leery as military docs had me on Melleril + Thorazine as in 1981 I spent 4 months in Camp Kuwae NRMC in Okinawa, seeking psych help...they just said they didn't know what else to do with us.
How has it worked with you folks that also have to deal with pain? Any response welcome, as I don't know for sure if the next time I can pull that muzzle back out...you all know what I meen. If it wasn't for my wife, I would have cashed in long ago, but hate the cowardly thought of doing that to her. Comments?
Regards, FREDO

How is your daughter doing? Is she still on the med?
My daughter will be starting it tomorrow.

The VA put me on Prazosin two weeks ago for PTSD related nighmares. The nightmares seem to have subsided however, I now get multiple erections (both day and night) lasting from 45 minutes to an hour at a time.

Does anyone know if this condition is temporary? Will this problem subside once my body adjusts to Prozasin? I don't have another VA appointment for another month so any advise is appreciated.

I've been prescribed Prazosin for PTSD for my nightmares. I live alone and have had pretty severe effects after taking it a few days. The way I was left feeling for hours in the morning left me riddled with panic attacks. I'm also experiencing some symptoms that are consistent with having had a minor stroke or aneurysm. I went to the doctor while experiencing these symptoms and had my blood pressure taken and he said it was perfectly fine. Now that's fine and dandy except I fear whole-heartedly a medical catastrophe from taking this medication while residing alone after what's already happened. I've nearly fallen face first into my toilet while awakening, sitting down doesn't alleviate the light-headedness, I get a distinct numbness in the face and extremities, not to mention difficulty breathing, and being awoken and forced out of bed because I can't breath throughout the night, which then brings on the waves of dizzyness, nausea, and blackouts. Loss of memory, feeling like I don't know what happened after I took the medicine is very reminiscent of a blackout from drinking. Does anyone know the potential risks of taking this medication while still experiencing the long-term symptoms of alcohol abuse and withdrawal. Not all of these things are listed under the potential side-effects, but the only variable between experiencing these feelings and feeling 'normal' is taking this medication. It is a frightening thing to experience, worse than the night terrors and daytime interruptions and episodes. I hear this is a God-send for others, I do hope that someone might have better advice than the doc who's just telling me to keep taking it anyway.
Feel free to email me any response to ensure I see it
Headykrew@live.com

Hi Scott,
I have been finding it very interesting to read everyone's posts. My situation is a little different and I hope that it is helpful to someone out there so I have decided to share it. I have had extreme Narcolepsy since I can remember as a small child. I was only diagnosed with it around 7 years ago at the age of 48. I was managing the daytime symptoms since diagnosis with a stimulant (adderall, the provigil normally prescribed didn't work as well at keeping me awake). Most people only think of Narcolepsy as falling asleep during the day but the night-time symptoms were the worst part of it for me. I would experience hypnagogic hallucinations and sleep paralysis sometimes as many as 6 times a night. I was afraid of falling asleep which only made my days much harder. The only solution the doctors offered was to take zyrem (the date rape drug) before I went to sleep and then set an alarm for two hours later to take it again. The idea of not being aware at all or being able to wake up in an emergency terrified me. My night symptoms were getting worse though and I went to the doctor, almost willing to be talked into the zyrem but was still scared. The doctor came in and said that there was a drug used for PTSD that he hadn't used before but since my hallucination dreams were so severe, he'd be willing to give it a try. The night after taking my first 1mg dose of Prazosin was shocking! I hadn't really experienced a full night of deep sleep ever before. I have now taken it for 11 nights and there has been some variance in my nights. Some nights are solid and some are interrupted briefly (no hallucinations) but I fall back to sleep. The major initial side effect of this was that my heart rate went up and I was so anxious during the day. I finally realized that it was the adderall, I didn't need it and it was raising my heartrate and making me jittery and anxious. I have been weaning off of it and staying awake and calm during the day! I researched Prazosin for Narcolepsy and everything I have seen states that it is counter-indicated. Perhaps not everyone has the hallucination/paralysis as severely as I did and that is why it worked for me. My daughter inherited the exact same type of Narcolepsy from me and we are trying to get the Prazosin prescribed for her too (she is an adult of 23). This is life changing for me and hopefully for my daughter too. If anyone out there is having similar problems, maybe they could ask their doctor about giving it a try. Take Care, Sher

Hi Scott,

I found the comments on your blog to be very interesting. My experience is somewhat difference and hopefully it will be helpful to someone out there.
I was diagnosed with Narcolepsy 7 years ago at age 48. I have had it since I was a toddler, just didn't know what it was. The worst part for me was the night-time hallucinations and sleep paralysis. The daytime sleep episodes were pretty well taken care of with stimulants. The only solution offered for the terrible night traumas was zyrem, the date rape drug. It terrified me to take something that would leave me so vulnerable so I resisted taking it. My night troubles were getting worse so I went back to the doctor, almost ready to be talked into the zyrem. He surprised me by saying that since I didn't want zyrem and the hallucinations were so severe, I could try Prazosin which is usually used for the hallucinations/dreams of those affected with PTSD. After taking my first 1mg dose, I slept solidly through the night. My very first time that I can remember because the experience was shocking! After a few days, I noticed extreme anxiety and increased heart rate. It turns out, I didn't need the adderall that I was taking to keep me awake during the day since I was getting such deep, solid sleep at night. I have been slowly weaning off of the adderall and am down to only 15% of what I was taking before after only 11 days of being on Prazosin. I have a headache which the pharmacist thinks is most likely from the withdrawal from the adderall and she suggested just tylenol until my body adjusts. This is life changing for me. I am hoping that my 23 yr. old daughter will be able to get it prescribed for her too since her Narcolepsy is identical to mine.
When I researched Prazosin for Narcolepsy online, it mostly came up as "counter-indicated". It is really working great for me so far but that might just be because of the severity of the night symptoms in my case and if you are not plagued by hallucinations and paralysis, it wouldn't help you, I'm not sure. If any one out there knows someone or has a similar experience with Narcolepsy with hallucinations and paralysis, my suggestion would be to talk to their doctors about Prazosin.

Sher,

I got chills reading your words, thank you for sharing your experience with Prazosin, it was a life changing event for me too. Too know the freedom of falling asleep and not have horrific nightmares. I've been taking it so long now that I sometimes forget that it was an issue. What a blessing for you to discover this drug for your condition and to be able to pass on that knowledge to your daughter.

Hi Scott,

We haven't made it through the Doctor red tape yet but I'll let you know how my daughter does if they ever prescribe it for her.
Dealing with doctors has been a nightmare on it's own when it comes to presenting them with problems that aren't easily/quickly solved. It's like they have a bubble over their heads that either says, "next" or "Kaching $$$". I rarely experience any kind of human concern that goes beyond the 5 minutes allotted for my appointment.

I spent the first 50 years of my life with a long list of ailments that most doctors either said, "I wouldn't worry about it" or, "have you seen a psychiatrist?". It's the doctors that made me think I was crazy when I had real physical problems.

Ha, wish I could update them all with the reality of my diagnose's that they all missed.

Well, guess I really vented now, it just gets so frustrating. I am so happy that I seem to have been given a solution to one of my major problems. I pray that it lasts and that no obstacles come up to prevent my taking Prazosin and finally getting to sleep well.

Take care,
Sher

Hi Scott,

I'd like your feedback. I noticed that my Dr. ordered Prazosin and that my copay was $30. Do you know if there is a generic? Is it as effective?

Thanks,
Sher

Hi Scott,

I'd like your feedback. I noticed that my Dr. ordered Prazosin and that my copay was $30. Do you know if there is a generic? Is it as effective?

Thanks,
Sher

Sher, there are doctors out there that understand your condition and have the compassion to help you. Seek them out, demand them in your care. You have a mechanism in the system of care you are in to get another doctor, advocate for yourself. The best advice you can get about generic prices and availability is from your pharmacist.

Hi Scott,
I just found your blog and am in tears...I have had PTSD for 20 years. I am a 57 year old woman who covered the drug war in Colombia in the early 1990s (Medellin cartel, bombings, massacres, torture, you name it.) I have never been the same...I have had nightmares, but the worst for me has been the "daymares"--the crazy way my mind spins out the most horrific scenarios of torture whenever I have a second of free time. As a result, I have spent the last 20 years drinking too much, eating too much, overworking, overexercising, overcommitting. It worked for a long time, but I'm too old and too injured now to be able to keep it up. That means I am completely dependent upon my meds for help. You seem so knowledgeable about the drugs out there, I wonder if I could ask your opinion. I have been on cymbalta, clonodine, seroquel, lamotrigine, and adderall for about six years. It has kept the daymares manageable, which is amazing because I would be suicidal otherwise. But, I am so FAT from the seroquel and I can't believe that these are my choices--daymares that will kill me or hugely overweight, unhealthy, and depressed. I recently tried to go off the seroquel, which I did over the course of 5 weeks. It was brutal. My doctor wanted to switch me to geodon, but after three days on it, I was in the ER with a thunderclap headache and blood pressure over 200. It was so scary. I went right back on the old regime of the seroquel, but recently had a consult with some bigwig doctor. He is recommending prazosin, which I want to try. But he also tells me that the reason seroquel is typically prescribed is for sleep. If that is the case, then there would be other options. But I don't really think that is true--I think the seroquel does something magic to my brain and I worry that just switching to a sleep aid is not going to address that. So I am scared to try it. Also, I have read about a homeopathic treatment called stramonium. Do you know anything about that? I would love to think that I could stop the daymares without being fat. I don't know if that is possible. I have never known anyone else with PTSD and have never felt comfortable sharing the horrors of my life with people who have no idea of the hell that this is....so it is very meaningful to hear about other people who understand this. My hats off to all the vets--and the stories about the young girls being sexually abused, God, I am so sorry that other people have to go through this. I would love any advise and I do so appreciate your help and your blog.

God Bless you Scott!! and all those suffering with PTSD!!

I too suffer from this and other issues... I have an amazing chronic pain specialist who knows about Prazosin and I now take 5mgs/day... unbelieveable how it has changed my daily life! Been on it for 2 yrs now.

To Anonymous from Oct 13, 2013:
I know exactly what you mean. I was prescribed Prazosin for nightmares as well. I was told it was originally prescribed for high blood pressure but supposedly didn't work for that. I don't have high blood pressure but it sure as hell gets too low when I take this stuff. I woke up in the middle of the night a few nights ago with sciatica pain. I definitely wasn't getting up quickly (as you know if you get sciatic pain) but it was still too quickly for this medication. The second I got out of bed to get my sciatica medication I almost fell on my face. If the place had been on fire, I'd probably be dead. The scary part is I don't think that is a stretch. It was a pretty scary night. I also live alone and thought about calling 911. I blacked out so I couldn't tell you how I got back to bed. That isn't the first black out since starting the med but I also started Seroquel at the same time and I don't know which one to blame yet. I have no history of alcohol abuse and have never had an alcohol blackout but still had these issues. I did not experience the other things you listed: nausea, difficulty breathing, or symptoms of a minor stroke.

Hope this helps. Personally, I'm done with both the blackouts and the low blood pressure. How will I ever get a sense of control over my life if my evenings will always be so uncertain. I can't remember what happened and if something bad happens, I can't get away from it without passing out!

Hello Katie, check your dose. I was started out with 1mg dose and worked up to 5mg. After a couple of months the bad fainting went away. But i took a couple of hard spills from faiting first. When i was on that med for a year or two i had to be careful of getting up quickly and fast head movement would trigger vertigo.

Talk to your doctor about your dosage and tell them about the fainting. It did get better over time and for me the protection and sleep was important so i decided to stay on the med. But this is a med that should only be administered by doctor that knows PTSD and how this med works with it. God bless

Scott,

First and foremost, thank you for your service to our country!! Many sacrifices are made...God bless you and all those who serve or have served.

I have non-combat PTSD (faced death, was in ICU for 2 months + other trauma). Once I was diagnosed, I was prescribed klonopin/clonazapam. I did not know any better but as you and others have mentioned, it is very addictive. I'm now down to .5 mg/night and would like to taper completely off. I'm thinking that prazosin would help control my anxiety to where getting off of the clonazapam would be easier. I also have other symptoms, the worst of which is insomnia. Nothing really helps much (remeron, the clonazapam - on both now, ambien, etc.). I was also recently prescribed an SSRI during the day but it worsens my insomnia (can't come down at night). I've tried 3 different types of SSRI. My psych doesn't seem to know a whole lot and I'm attempting to find one that does and that actually cares about my situation. My question to you is this - I do not have nightmares so does the prazosin help with insomnia alone or does it only reduce or eliminate the nightmares which then make for a more restful night? I've read a lot about the nightmares but am not sure how sleep is affected otherwise. I hope this makes sense.

Thanks for all you do!!

From the first night I took this I have not had one nightmare and is definitely worth a try. My doctor who runs a private practice for civilians is the head of a large VA Hospital PTSD Clinic. I am currently at 3 mgs per night working towards a goal of 6 mgs. Just a thought, all doctors and patients are different.

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Please share your comments, stories and information. Thank you. ~ Scott Lee

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