Prazosin is an alpha-one noradrenergic antagonist that reduces sleep disturbances and nightmares associated with PTSD with a medium effect size.
What medications can reduce nightmares in people with PTSD? Read More »
Benzodiazepines are associated with falls, fractures, impaired cognitive functioning, and dementia; the American Geriatric Society strongly recommends avoiding their use in the elderly.
How do you counsel an older patient about the risks of benzodiazepines? Read More »
There are multiple drugs available and FDA-approved for insomnia; choose one based on the patient’s concerns around falling and/or staying asleep and the medication’s onset of action, duration, and risk profile.
How do you treat insomnia with medications if CBTi doesn’t help? Read More »
All society guidelines recommend CBTi as the first-line treatment for insomnia given its efficacy and durability.
When the sheep are gone, how do you treat insomnia? Read More »
Mirtazapine (Remeron) is at least as effective as the SSRIs for depression, and is also commonly used off-label for anxiety, PTSD, and insomnia. Mirtazapine doses of 3.75-7.5mg are helpful for sleep maintenance. Higher doses (30-45mg) are necessary for the antidepressant and anti-anxiety effects.
What change could reduce anxiety in a patient with partial benefit from an SNRI? Read More »
