For PTSD, which medication is commonly used to treat nightmares?

• A. Benzodiazepines for nightmares.
• B. Prazosin for nightmares.
• C. SSRIs are only for nightmares.
• D. Antipsychotics for nightmares.

Answer: (B)

Nightmares in PTSD are driven by heightened sympathetic activity during sleep, and a targeted approach at night can significantly reduce their frequency and intensity. Prazosin is an alpha-1 adrenergic blocker that lowers this nocturnal adrenergic surge, helping to diminish distressing dreams and improve overall sleep quality. Because it works specifically at night, it’s commonly used for PTSD-related nightmares and can lead to clearer daytime functioning.

Starting with a low dose at bedtime and gradually increasing helps minimize side effects like dizziness or orthostatic hypotension. Other options aren’t as well suited for nightmares: benzodiazepines can cause dependence, sedation, and may worsen PTSD symptoms or sleep architecture; SSRIs address broader PTSD symptoms but aren’t notably effective for nightmares; antipsychotics are not first-line for nightmares and carry metabolic and movement-related risks.