Background: Trazodone is commonly used in the treatment of insonmia and nightmares in patients
with PTSD. There is little evidence in the literature for this practice. Method: Seventy-four patients from the Palo Alto Veterans Affairs Health Care System in California
who were admitted to a specialized 8 week inpatient treatment program for PTSD were
surveyed regarding their use of trazodone in the treatment of insomnia or nightmares.
Patients were asked to complete a questionnaire regarding trazodone's effectiveness,
side effects, and optimal doses. Results: Of 74 patients surveyed, 60 patients were able to maintain an effective dose of trazodone.
The other 14 patients were unable to tolerate the medication. Seventy-two percent
of the 60 patients assessed found trazodone helpful in decreasing nightmares, from
an average of 3.3 to 1.3 nights per week (p < .005). Ninety-two percent found it helped
with sleep onset, and 78 % reported improvement with sleep maintenance. There was
a significant correlation between the effectiveness in decreasing nightmares and improving
sleep (r = .57, p < .005). The effective dose range of trazodone for 70 % of patients
was 50 to 200 mg nightly. Of the 74 patients surveyed, 9 (12 %) reported priapism.
Conclusion: Trazodone appears effective for the treatment of insomnia and nightmares associated
with chronic PTSD. However, controlled trials are needed before any definite conclusions
can be drawn. The higher than expected occurrence of priapism warrants clinicians
asking directly about this side effect.
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