The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering
Background The α 1 -adrenoreceptor antagonist prazosin has in many but not all studies been found to be effective for PTSD associated nightmares, hyperarousal symptoms, and total symptom severity. The particular efficacy of prazosin for nightmares and hyperarousal symptoms suggests there may be a su...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-02-01
|
| Series: | Chronic Stress |
| Online Access: | https://doi.org/10.1177/2470547020979780 |
| _version_ | 1818663639833378816 |
|---|---|
| author | Rebecca C. Hendrickson Steven P. Millard Kathleen F. Pagulayan Elaine R. Peskind Murray A. Raskind |
| author_facet | Rebecca C. Hendrickson Steven P. Millard Kathleen F. Pagulayan Elaine R. Peskind Murray A. Raskind |
| author_sort | Rebecca C. Hendrickson |
| collection | DOAJ |
| description | Background The α 1 -adrenoreceptor antagonist prazosin has in many but not all studies been found to be effective for PTSD associated nightmares, hyperarousal symptoms, and total symptom severity. The particular efficacy of prazosin for nightmares and hyperarousal symptoms suggests there may be a subset of PTSD symptoms that are more tightly associated with an α 1 -adrenoreceptor mediated noradrenergic mechanism, but cross traditional diagnostic symptom clusters. However, the efficacy of prazosin for individual symptoms other than nightmares and sleep disruption has not previously been examined. Methods In a post hoc reanalysis of a previously published, randomized controlled trial of twice daily prazosin for PTSD, we examined the relative effect of prazosin on individual items of the CAPS for DSM-IV, and tested whether prazosin responsiveness predicted the partial correlation of the changes in symptom intensity at the level of individual subjects. Results were not adjusted for multiple comparisons. Results Prazosin showed the largest effect for distressing dreams, anhedonia, difficulty falling or staying asleep, difficulty concentrating, and hypervigilance. These items were also (a) of higher baseline severity in the underlying population, and (b) more related in how they fluctuated at the level of individual subjects. Covariance analysis did not support a clear cutoff between highly prazosin responsive items and those showing a smaller, not statistically significant response. Conclusions In this data set, twice daily prazosin substantially reduced not only nightmares and sleep disruption, but the majority of hyperarousal symptoms, with some evidence of efficacy for avoidance symptoms. The relationship of baseline symptom distribution to which symptoms showed significant response to prazosin reinforces the possibility that differences in a clinical trial’s participant populations may significantly influence trial outcome. The pattern of symptom endorsement at the level of individual subjects was consistent with prazosin-responsive items sharing a common pathophysiologic mechanism. |
| first_indexed | 2024-12-17T05:20:03Z |
| format | Article |
| id | doaj.art-bed632bc58b946549ff50730299edc11 |
| institution | Directory Open Access Journal |
| issn | 2470-5470 |
| language | English |
| last_indexed | 2024-12-17T05:20:03Z |
| publishDate | 2021-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Chronic Stress |
| spelling | doaj.art-bed632bc58b946549ff50730299edc112022-12-21T22:02:00ZengSAGE PublishingChronic Stress2470-54702021-02-01510.1177/2470547020979780The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related ClusteringRebecca C. HendricksonSteven P. MillardKathleen F. PagulayanElaine R. PeskindMurray A. RaskindBackground The α 1 -adrenoreceptor antagonist prazosin has in many but not all studies been found to be effective for PTSD associated nightmares, hyperarousal symptoms, and total symptom severity. The particular efficacy of prazosin for nightmares and hyperarousal symptoms suggests there may be a subset of PTSD symptoms that are more tightly associated with an α 1 -adrenoreceptor mediated noradrenergic mechanism, but cross traditional diagnostic symptom clusters. However, the efficacy of prazosin for individual symptoms other than nightmares and sleep disruption has not previously been examined. Methods In a post hoc reanalysis of a previously published, randomized controlled trial of twice daily prazosin for PTSD, we examined the relative effect of prazosin on individual items of the CAPS for DSM-IV, and tested whether prazosin responsiveness predicted the partial correlation of the changes in symptom intensity at the level of individual subjects. Results were not adjusted for multiple comparisons. Results Prazosin showed the largest effect for distressing dreams, anhedonia, difficulty falling or staying asleep, difficulty concentrating, and hypervigilance. These items were also (a) of higher baseline severity in the underlying population, and (b) more related in how they fluctuated at the level of individual subjects. Covariance analysis did not support a clear cutoff between highly prazosin responsive items and those showing a smaller, not statistically significant response. Conclusions In this data set, twice daily prazosin substantially reduced not only nightmares and sleep disruption, but the majority of hyperarousal symptoms, with some evidence of efficacy for avoidance symptoms. The relationship of baseline symptom distribution to which symptoms showed significant response to prazosin reinforces the possibility that differences in a clinical trial’s participant populations may significantly influence trial outcome. The pattern of symptom endorsement at the level of individual subjects was consistent with prazosin-responsive items sharing a common pathophysiologic mechanism.https://doi.org/10.1177/2470547020979780 |
| spellingShingle | Rebecca C. Hendrickson Steven P. Millard Kathleen F. Pagulayan Elaine R. Peskind Murray A. Raskind The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering Chronic Stress |
| title | The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering |
| title_full | The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering |
| title_fullStr | The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering |
| title_full_unstemmed | The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering |
| title_short | The Relative Effects of Prazosin on Individual PTSD Symptoms: Evidence for Pathophysiologically-Related Clustering |
| title_sort | relative effects of prazosin on individual ptsd symptoms evidence for pathophysiologically related clustering |
| url | https://doi.org/10.1177/2470547020979780 |
| work_keys_str_mv | AT rebeccachendrickson therelativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT stevenpmillard therelativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT kathleenfpagulayan therelativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT elainerpeskind therelativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT murrayaraskind therelativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT rebeccachendrickson relativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT stevenpmillard relativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT kathleenfpagulayan relativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT elainerpeskind relativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering AT murrayaraskind relativeeffectsofprazosinonindividualptsdsymptomsevidenceforpathophysiologicallyrelatedclustering |