Prazosin First Line for PTSD
Vol 2 # 5
Traitement des etats de stress post-traumatique par un antagoniste alpha-1-adrenergique, la prazosine: une revue des etudes d’evaluation.
Simon P, Rousseau P.
Can J Psychiatry, 62 issue: 3, 186-198 March 2017
This review assessed the clinical efficacy and safety of the α-1-adrenergic antagonist prazosin as primary pharmacologic treatment for post-traumatic stress disorder (PTSD).
A systematic review was performed using keywords (i.e., prazosin, α-1-adrenergic antagonist, α-1-blocker, post-traumatic stress disorder) in the databases PubMed/Medline (1966–May 2016), Embase (1966–May 2016), ScienceDirect (1823–May 2016), OvidSP (1946–May 2016) and Nature (1845–May 2016). To be considered for inclusion, studies had to test the efficacy of prazosin either alone or added to ongoing treatment in adults with PTSD, use validated tools to assess and monitor the disorders, allow comparisons on the basis of univariate analyses (i.e., p-values of t-tests and effect sizes) and list the identified adverse reactions.
12 studies were included: 5 randomized controlled trials, 4 open-label prospective trials and 3 retrospective file reviews. The evaluation concerned 276 patients exposed to civilian trauma (19%) or war trauma (81%). Prazosin significantly decreases trauma nightmares, avoidance, hypervigilance and improves patient status in all studies. No significant difference of blood pressure was observed at the end of trials.
Beyond the methodological and clinical biases of these studies, the present review not only confirms the effectiveness and good tolerability of prazosin, but also suggests its possible use as primary pharmacologic treatment for PTSD. Uncertainties remain, however, regarding the prescription modalities and dosages.
How many different symptom combinations fulfil the diagnostic criteria for major depressive disorder? Results from the CRESCEND study.
Park SC, Kim JM, Jun TY et al.
Nord J Psychiatry. 2017 Apr;71(3):217-222. doi: 10.1080/08039488.2016.1265584.
The polythetic nature of major depressive disorder (MDD) in DSM- IV
and DSM-5 inevitably leads to diagnostic heterogeneity.
This study aimed to identify the number of depressive symptom combinations
actually fulfilling the DSM-IV diagnostic criteria that can be found in Korean
MDD patients and the relative frequencies of each combination.
Using the data from the Clinical Research Center for Depression
(CRESCEND) study in South Korea, we enrolled 853 MDD patients diagnosed using
DSM-IV and scored as 8 or more on the Hamilton Depression Rating Scale (HAMD).
Descriptive statistical analyses were performed to reveal the degree of
diagnostic heterogeneity of the MDD.
This study identified 119 different depressive symptom combinations. The
most common combination consisted of all nine depressive symptom profiles, and
nine different combinations were each present in more than 3% of the patients.
The findings support the criticism that the diagnosis of MDD is not
based on a single mental process, but on a set of ‘family resemblances’.