- The Washington Times - Thursday, February 8, 2018

A popular blood-pressure medication prescribed to patients with post-traumatic stress disorder failed to treat PTSD symptoms in military veterans, a new study reports.

But the study’s lead researcher cautions against abandoning the blood-pressure therapy, which has shown to have enormous success in treating traumatized people.

The study, published Wednesday in the New England Journal of Medicine, concludes there was no difference between the drug Prazosin and a placebo in treating veterans with PTSD.

“I was, to be frank, pretty down in the dumps because it was such a shock,” Dr. Murray Raskind, the study’s lead author and director of the Department of Psychiatry and Behavioral Sciences at the University of Washington.

In an interview with The Washington Times, he said he first started prescribing Prazosin to combat veterans with PTSD in the 1990s, when he started working at the VA Puget Sound Health Care System’s African-American veterans stress disorders program.

His patients complained of a number of symptoms, including intense, recurrent nightmares that would jolt them awake and leave them sweaty, anxious and unable to go back to sleep. During the day, they maintained a state of hypervigilance.

Their personal and professional relationships suffered, and they were chronically sleep-deprived, irritable and prone to unpredictable outbursts. Many self-medicated with heavy alcohol use.

“They described it as this adrenaline storm,” Dr. Raskind said. “It seemed to me that trying to tone down that storm might be helpful.”

Pravosin is a blood pressure regulator that blocks alpha receptors in the brain from being signaled to release adrenaline or norepinephrine to the body. In stressful circumstances, these receptors are activated to increase blood pressure and personal awareness of the surrounding environment.

“So you can imagine when you’re in a combat situation, in tip-top arousal and sensitive in what’s novel or different in the environment, it can keep you and your comrades alive,” Dr. Raskind said.

The problem was that upon returning home, veterans found that these feelings didn’t subside.

Dr. Raskind first got the idea to use Prazosin for PTSD when he started working with Vietnam-era veterans in VA Puget Sound program. The drug was successful: His patients reported sleeping normally without recurrent nightmares, and that they stopped drinking to self-medicate, he said. Six subsequent clinical trials further supported Prazosin’s usefulness in alleviating symptoms caused by an overabundance of adrenaline.

But in the latest study, which involved more than 300 patients at 12 VA hospitals over six months, participants in the both the experimental Prazosin group and the placebo trial reported little change in their symptoms. The one meaningful difference: The experimental group had a greater decrease in standing blood pressure.

“The question we have to ask is, what was different in the characteristics of the sample in this large study versus the earlier ones?” Dr. Raskind said.

On paper, the subjects met the diagnostic criteria to qualify for the study. They were having nightmares, trouble sleeping and difficulty functioning during the day. But they also were more stable than the patients Dr. Raskind typically treats. He said that was intentional because he didn’t want to ask medical providers he didn’t know to use their most vulnerable patients in a clinical trial in which they might receive a placebo for their symptoms.

He also surmised that some patients might be better suited biologically to respond to Prazosin.

In an earlier study that had mixed results, Prazosin was found to work on the patientw who had a higher standing blood pressure. These results are encouraging the move toward more precision medicine, Dr. Raskind said.

“We have a very serious problem with post-traumatic stress disorder, we have multiple subtypes, we’re learning that it’s not just one overall PTSD you have to personalize your treatments,” he said.

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