Nightmares (cont.)
Psychopharmacological treatment for nightmares
Researchers also have conducted studies of medications for the treatment of nightmares. However, it should be noted that the research findings in support of these treatments are more tentative than findings from studies of Imagery Rehearsal Therapy. Part of the reason for this is simply that fewer studies have been conducted with medications at this point in time. Also, the studies that have been conducted with medications have generally been small and have not included a comparison control group (that did not receive medication). This makes it difficult to know for sure whether the medication is responsible for reducing nightmares, or whether the patient's belief or confidence that the medication will work was responsible for the positive changes (a.k.a., a placebo effect).
Some medications that have been studied for treatment of PTSD-related nightmares and may be effective in reducing nightmares include topiramate (Topamax), prazosin (Minipress), nefazodone (Serzone), trazodone (Desyrel), and gabapentin (Neurontin, Gabarone). Because medications typically have side effects, many patients choose to try a behavioral treatment first. If that does not help improve their symptoms, they may choose to try medication.
What happens if nightmares are left untreated?
Nightmares can be a chronic mental health problem for some individuals, but it is not yet clear why they plague some people and not others. One thing that is clear is that nightmares are common in the early phases after a traumatic experience. However, research suggests that most people who have PTSD symptoms (including nightmares) just after a trauma will recover without treatment. This typically occurs by about the third month after a trauma. However, if PTSD symptoms (including nightmares) have not decreased substantially by about the third month, these symptoms can become chronic. If you have been suffering from nightmares for more than three months, you are encouraged to contact a mental health professional and discuss with him or her the behavioral treatments described above.
References:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
Bliwise, D.L. (1996). Historical change in the report of daytime fatigue. Sleep, 19, 462-464.
Klink, M., & Quan, S.F. (1987). Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest, 91, 540-546.
Kilpatrick, D.G., Resnick, H.S., Freedy, J.R., Pelcovitz, D., Resick, P.A., Roth, S., et al. (1998). Posttraumatic stress disorder field trial: Evaluation of the PTSD construct -- criteria A through E. In T.A. Widiger, A.J. Frances, H.A. Pincus, R. Ross, M.B. First, W. Davis, & M. Kline (Eds.), DSM-IV Sourcebook, v. 4. º(4th ed., pp. 803-844) Washington DC: American Psychiatric Press.
Krakow, B., Schrader, R., Tandberg, D., Hollifield, M., Koss, M.P., Yau, C.L., et al. (2002). Nightmare frequency in sexual assault survivors with PTSD.
Journal of Anxiety Disorders, 16, 175-190.
Krakow, B., Hollifield, M., Johnston, L., Koss, M.P., Schrader, R., Warner, T.D., et al. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial.
Journal of the American Medical Association, 286, 537-545.
Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T.D., Chavez-Kennedy, D., et al. (2001). An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD.
American Journal of Psychiatry, 158, 2043-2047.
Forbes, D., Phelps, A., & McHugh, T. (2001). Treatment of combat-related nightmares using imagery rehearsal: A pilot study.
Journal of Traumatic Stress, 14, 433-442.
Berlant, J., & van Kammen, D.P. (2002). Open-label Topiramate as primary or adjunctive therapy in chronic civilian posttraumatic stress disorder: A preliminary report.
Journal of Clinical Psychiatry, 63,15-20.
Taylor, F., & Raskind, M.A. (2002). The " 1 -adrenergic antagonist Prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. Journal of Clinical Psychopharmacology, 22, 82-85.
Gillin, J.C., Smith-Vaniz, A., Schnierow, B., Rapaport, M.H., Kesloe, J.R., Raimo, E., et al. (2001). An open-label, 12-week clinical and sleep EEG study of Nefazodone in chronic combat-related posttraumatic stress disorder.
Journal of Clinical Psychiatry, 62, 789-796.
Warner, M.D., Dorn, M.R., & Peabody, C.A. (2001). Survey on the usefulness of Trazodone in patients with PTSD with insomnia or nightmares. Pharmacopsychiatry, 34, 128-131. Hamner, M.B., Brodrick, P.S., & Labbate, L.A. (2001). Gabapentin in PTSD: A retrospective, clinical series of adjunctive therapy. Annals of Clinical Psychiatry, 13, 141-146.
Rothbaum, B., Foa, E., Riggs, D., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims.
Journal of Traumatic Stress, 5, 455-475.
Source: United States Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder
Last Editorial Review: 2/9/2005
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