From the Guidelines
Cyproheptadine is not recommended as a first-line treatment for PTSD-related nightmares due to limited and conflicting evidence of its effectiveness, as highlighted in a 2018 position paper by the American Academy of Sleep Medicine 1. The evidence for cyproheptadine in treating PTSD-related nightmares is based on a few small studies with conflicting results, including a case series of four veterans with combat-related PTSD, a case series of 16 patients with PTSD and distressing dreams, and a retrospective review of psychiatric records of patients who received cyproheptadine as treatment for nightmares 1. Key points to consider when evaluating the use of cyproheptadine for PTSD-related nightmares include:
- The limited number of studies and the small sample sizes of these studies
- The conflicting results, with some studies showing improvement in nightmares and others showing no significant change
- The potential side effects of cyproheptadine, including fatigue, restlessness, and worsening nightmares
- The importance of considering alternative treatments, such as prazosin or image rehearsal therapy (IRT), which have more robust evidence supporting their effectiveness in reducing nightmare frequency and intensity 1. In contrast to cyproheptadine, prazosin has been shown to be effective in reducing nightmare frequency and intensity in several studies, including a 15-week randomized controlled trial of prazosin for combat trauma PTSD with nightmares 1. Therefore, based on the available evidence, prazosin or IRT may be a more effective treatment option for PTSD-related nightmares, and cyproheptadine should only be considered if these first-line treatments are not effective or tolerated 1.
From the Research
Effectiveness of Cyproheptadine for PTSD Nightmares
- Cyproheptadine has been studied as a potential treatment for post-traumatic stress disorder (PTSD) nightmares, with some evidence suggesting its efficacy 2, 3.
- A retrospective review of nine patients with PTSD found that cyproheptadine treatment resulted in complete remission or a decrease in the intensity and frequency of nightmares 3.
- However, the current evidence base for cyproheptadine is limited, and larger randomized controlled trials are needed to fully evaluate its effectiveness 2.
- Other treatments, such as prazosin, doxazosin, and imagery rehearsal therapy, have also shown promise in reducing PTSD-related nightmares 2, 4, 5, 6.
Comparison with Other Treatments
- Prazosin, an alpha-1 adrenergic antagonist, has been commonly used off-label for the treatment of PTSD-related nightmares and has shown efficacy in reducing their frequency and severity 4, 6.
- Doxazosin, another alpha-1 antagonist, has also been investigated as a potential treatment for PTSD-related nightmares, with some case studies suggesting its effectiveness 5.
- The choice of treatment for PTSD nightmares may depend on individual patient factors, such as medical history and treatment preferences, and should be guided by a comprehensive treatment plan 2.