Clinical Topics   /   Sleep

Alpha Blockers Tested as Potential Treatment for PTSD Symptoms

By US Medicine

By Stephen Spotswood

Col. Kris Peterson, Chief of the Psychiatry Department at Madigan, Tammy Williams, Licensed Clinical Social Worker, and Dr. Murray Raskind of the Puget Sound VA, want to help soldiers deal with combative nightmares. Photo by Melissa Renahan

HOUSTON — As researchers delve deeper into the pathophysiology of PTSD, the complex interplay among the disease’s symptoms becomes more transparent, opening the possibility of new treatments.

One area of treatment that remains very limited, however, is medication.

Currently, the only two drugs approved by the FDA for PTSD are sertraline (Zoloft) and paroxetine (Paxil), both SSRI-type antidepressants. While physicians have been known to prescribe other types of medications, including tranquilizers, beta-blockers, anticonvulsants and atypical antipsychotics, all of those are off-label.

Researchers conducting a study at the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston are hoping to add at least one more drug — the antihypertension drug doxazosin — to the frustratingly short list of approved medications.

“The current medication treatments for PTSD are essentially limited to antidepressants,” said Thomas Newton, MD, a MEDVAMC physician and associate professor at Baylor College of Medicine. “And the biggest trouble with those is that they don’t work for everybody. They have side effects for those willing to take them, and they’re not profoundly effective. Things like sleep can still be very affected.”

Some of the potential side effects can mimic problems already faced by PTSD sufferers, including agitation and restlessness, irritability, insomnia, headache and loss of appetite. SSRIs also can take weeks to become effective.

Doxazosin would have few of those problems, if found to be effective.

Newton honed in on the drug after seeing the success of Seattle VA researchers in using another alpha blocker, prazosin, to treat PTSD-related nightmares. Prazosin is an alpha-adrenergic blocker designed to treat high blood pressure and anxiety. It makes users less sensitive to the effects of adrenaline — something that can be produced in excess in PTSD patients.

Murray Raskind, MD, a psychiatrist, and his colleagues with the VA Puget Sound Health Care System have been prescribing prazosin to Vietnam-era PTSD sufferers for years, having found that the drug significantly reduced the intense nightmares associated with the disorder.

Raskind also conducted three positive controlled trials using prazosin to treat PTSD-related sleep disorders in Vietnam-era veterans and in active duty soldiers at Joint Base Lewis-McChord. This was the first joint VA-Army study on behavioral disorders in active duty servicemembers.

VA has been conducting a nationwide study on prazosin and PTSD nightmares that was scheduled to wrap up this year, though results have yet to be released.

Seeing Raskind’s success, Newton began looking at alpha-blockers as potential treatment for a larger range of PTSD symptoms. He chose doxazosin, which is in the same class of drug but only needs to be taken once a day, instead of two or three times, as with prazosin.

Newton is recruiting patients into a double-blind study that will compare doxazosin to placebo. Over the course of many weeks, the dose will be gradually increased. The veterans will undergo exposure therapy using an Iraq/Afghanistan virtual reality computer simulation to help determine optimal dosage and to prove effectiveness.

Newton and his fellow researchers are hoping the treatment not only reduces current PTSD symptoms but prevents the onset of new symptoms.

While not all drugs work for everyone, this class of medication is less unpredictable than SSRIs and works much more quickly.

“This is a completely different mechanism of action, and it works for many indications right away,” Newton said. “We don’t know if it will work on PTSD right away but, based on [what we know of the drug], it should.”

This could be key when treating veterans with PTSD who are suffering from exhausting, sometimes debilitating, symptoms. They will be more likely to stick with the treatment program if they can see immediate results.

An additional benefit of doxazosin is its side effects. While it might have been designed to decrease blood pressure, it also reduces anxiety, enhances sleep and blocks nightmares.

If doxazosin is proven to be effective, that opens the door to a number of other drugs in the same class, Newton said.

“There’s a bunch of other medications that do similar things. And all should be investigated as potential treatment options.”

Another advantage is that doxazosin could be combined with other approved medications with relative ease.

“This is a completely orthogonal approach,” Newton said. “It could be applied with current treatment; it could be used as a sole treatment; or it could be used to augment ongoing treatment. It could have a big impact on how people [with PTSD] are cared for if it works.”

Veterans seeking to enroll or physicians looking to learn more about the project can call 1-877-228-5777.


Related Articles

Shulkin Ousted, White House Physician Nominated for VA Secretary

WASHINGTON — After several weeks of speculation regarding his future in the Trump Administration, VA Secretary David Shulkin, MD’s tenure came to an abrupt end on March 28.

Congress Seeks More Oversight of VA EHR Program

WASHINGTON — Legislation under consideration by Congress would increase oversight of VA’s adoption and implementation of its forthcoming electronic health record (EHR) system. The VA announced last year that it would adopt the same Cerner... View Article


U.S. Medicine Recommends


More From department of defense dod

Department of Defense (DoD)

GAO: ‘Gaps’ in MHS Physician Specialties Could Affect Wartime Readiness

Vascular Events Lead to Stroke About a Fourth of the Time. INDIANAPOLIS — While many healthcare systems measure the quality of their stroke care, looking at performance early in the vascular disease process can help... View Article

Department of Veterans Affairs (VA)

VA Vows to Meet Deadline for Revamp of Veteran Claims Appeal Process

Vascular Events Lead to Stroke About a Fourth of the Time. INDIANAPOLIS — While many healthcare systems measure the quality of their stroke care, looking at performance early in the vascular disease process can help... View Article

Department of Defense (DoD)

DoD, VA Still Struggle with Diagnosing, Treating Mild Traumatic Brain Injuries

Diagnosing and treating mild traumatic brain injury continues to pose challenges for clinicians, TBI experts told lawmakers.

Department of Defense (DoD)

VA Promises to Resolve Late Payment Issues with Community Healthcare Providers

Vascular Events Lead to Stroke About a Fourth of the Time. INDIANAPOLIS — While many healthcare systems measure the quality of their stroke care, looking at performance early in the vascular disease process can help... View Article

Department of Defense (DoD)

Change in VA/DoD Guidelines for Low Back Pain Surprising Even for Authors

If VA clinicians are surprised by the significant changes in the updated recommendations recently issued by the VA and DoD for the diagnosis and management of low back pain, they are not alone. The evidence review even shocked many members of the work group that wrote the new clinical practice guidelines.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up