Prazosin for PTSD Patients with Nightmares and Suicidal ideation.

PTSD and nightmares have had a long association, there is also believed to be a link between the occurrence of PTSD related nightmares and suicidal ideation. If a change in the intensity and frequency of  PTSD related nightmares is linked to reduction of suicide due to PTSD then it makes sense to work towards reducing PTSD nightmares.

McCall and colleagues (2018) completed a pilot study of 20 PTSD sufferers with nightmares and suicidal ideation. After taking Prazosin at night-time there were no significant changes in daytime measures of suicidal ideation and daytime-only PTSD symptoms.

In contrast, night-time measures of  PTSD related nightmares and insomnia showed significantly less improvement in the prazosin group. This means that the placebo group had better improvement in nightmares and insomnia! In other words placebo was better than prazosin!

Worth considering if you have clients taking prazosin who have difficulties with suicidal ideation, nightmares and insomnia. Front line treatments for PTSD such as Cognitive Processing Therapy are shown to reduce nightmares. Although as Gutner et al. (2013)  point out even these treatments did not cause complete remission of PTSD related sleep symptoms.


McCall WV, Pillai A, Case D, McCloud L, Nolla T, Branch F, Youssef NA, Moraczewski J, Tauhidul L, Pandya CD, Rosenquist PB. A Pilot, Randomized Clinical Trial of Bedtime Doses of Prazosin Versus Placebo in Suicidal Posttraumatic Stress Disorder Patients With Nightmares. J Clin Psychopharmacol. 2018 Dec;38(6):618-621. doi: 10.1097/JCP.0000000000000968. PubMed PMID: 30335633.

Gutner, C. A., Casement, M. D., Stavitsky Gilbert, K., & Resick, P. A. (2013). Change in sleep symptoms across Cognitive Processing Therapy and Prolonged Exposure: a longitudinal perspective. Behaviour research and therapy51(12), 817–822. doi:10.1016/j.brat.2013.09.008