Prazosin Use During Prolonged Exposure Therapy with Veterans: An Examination of Treatment Effectiveness

Abstract

Prazosin is being used to treat sleep symptoms for individuals with posttraumatic stress disorder (PTSD). Prescription of prazosin for veterans with PTSD has increased every year in the Veteran’s Healthcare Administration (VHA) since 2000; however, a recent trial found prazosin was no more effective than placebo. Little is known about the effectiveness of prazosin in combination with first-line psychosocial treatments for PTSD (e.g., prolonged exposure; PE). This effectiveness study investigated the relationship between prazosin and PTSD symptom change in a VHA PTSD clinic among 120 veterans [86% male, 49% Black, 47% White, mean age = 45.5 years (SD = 12.02)]. Hierarchical linear modeling examined PTSD symptom change between veterans who were and were not prescribed prazosin during PE. Nearly half of the veterans (52%) had an active prazosin prescription at the start of PE, and there were no between group differences between groups with respect to baseline PTSD or nightmare symptoms. Veterans who were not prescribed prazosin experienced greater PTSD symptom reduction after completing PE compared to veterans who were prescribed prazosin. Results support the need for continued examination of the efficacy and effectiveness of prazosin on PTSD symptoms when prescribed alone and/or in combination with evidence-based psychotherapy.