Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
CNS Drugs. 2022 Jul;36(7):721-737. doi: 10.1007/s40263-022-00929-x. Epub 2022 Jun 10.
Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for suicide. Nightmare cessation can lead to improved quality of life, fewer hospital admissions, lower healthcare costs, and reduced all-cause mortality. Effective treatment of nightmares is critical and often leads to improvement of other PTSD symptomatology. However, approved pharmacological agents for the treatment of PTSD have modest effects on sleep and nightmares, and may cause adverse effects. No pharmacological agent has been approved specifically for the treatment of PTNs, but multiple agents have been studied. This current narrative review aimed to critically appraise proven as well as novel pharmacological agents used in the treatment of PTNs. Evidence of varying quality exists for the use of prazosin, doxazosin, clonidine, tricyclic antidepressants, trazodone, mirtazapine, atypical antipsychotics (especially risperidone, olanzapine and quetiapine), gabapentin, topiramate, and cyproheptadine. Evidence does not support the use of venlafaxine, β-blockers, benzodiazepines, or sedative hypnotics. Novel agents such as ramelteon, cannabinoids, ketamine, psychedelic agents, and trihexyphenidyl have shown promising results. Large randomized controlled trials (RCTs) are needed to evaluate the use of these novel agents. Future research directions are identified to optimize the treatment of nightmares in patients with PTSD.
创伤后应激障碍（PTSD）可能是一种慢性且使人丧失能力的疾病。创伤后梦魇（PTN）是 PTSD 的核心组成部分，在该患者群体中非常普遍。PTSD 中的梦魇与显著的痛苦、功能障碍、不良健康结果和生活质量下降有关。PTSD 中的梦魇也是自杀的独立风险因素。梦魇的消除可以提高生活质量，减少住院次数，降低医疗保健成本，并降低全因死亡率。有效治疗梦魇至关重要，通常会改善其他 PTSD 症状。然而，用于治疗 PTSD 的批准药物对睡眠和梦魇的影响有限，并且可能会引起不良反应。没有专门批准用于治疗 PTN 的药物，但已经研究了多种药物。本综述旨在批判性评估用于治疗 PTN 的已证实和新型药理学药物。对于使用普萘洛尔、多沙唑嗪、可乐定、三环抗抑郁药、曲唑酮、米氮平、非典型抗精神病药（特别是利培酮、奥氮平、喹硫平）、加巴喷丁、托吡酯和赛庚啶，存在不同质量的证据。没有证据支持使用文拉法辛、β-受体阻滞剂、苯二氮䓬类药物或镇静催眠药。新型药物如雷美替胺、大麻素、氯胺酮、迷幻药和三己酚丁胺已显示出有希望的结果。需要进行大型随机对照试验（RCT）来评估这些新型药物的使用。确定了未来的研究方向，以优化 PTSD 患者的梦魇治疗。
