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President Obama: End the Nightmares, Give Prazosin Back to Our PTSD Veterans!

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In 1879, General Wililliam Tecumsah Sherman told the eager young graduates of the Michigan Military Academy, " I've been through two wars and I know. I've seen cities and homes in ashes. I've seen thousands of men lying on the ground, their dead faces looking up at the skies. I tell you, war is Hell!"

History has taught us that the horrors of war that Sherman described don't stop at the battle's end. The men who remained trembling and shattered after the Civil War were said to suffer "soldier's heart". The men broken by World War I were described as "shell-shocked." The veterans of World War II suffered "battle fatigue." It was the Vietnam War that gave birth to the term, Post Traumatic Stress Disorder or PTSD. However, it is only the words, and the names and faces of the soldiers, that have changed through the years. The damage to the mind our veterans currently suffer is no different from what their comrades from before had suffered. We are now involved in wars in Iraq and Afghanistan, and thousands of veterans, both men and women, are returning home with PTSD. Estimates suggest that nearly 25 percent of these combat veterans suffer this condition. Treatment for PTSD is essential. The Veterans Administration owes this to our veterans.

I am a psychiatrist at the VA Hospital in Roseburg, Oregon. Every day, I treat combat veterans from the Vietnam, Gulf and Afghanistan wars who suffer PTSD. The symptoms of PTSD include: a constant wariness, referred to as hypervigilence; intense fear and anxiety when memories of the traumatic events are triggered; reluctance to be around people and crowded places for fear of having memories triggered; and recurring, intrusive recollections of the trauma.

One of the most common and troubling symptoms of PTSD is the upwelling of memories of the traumas of combat in nightmares. Sleep no longer "knits the reveled sleeve of care." Sleep is no longer a blessing. It becomes a horror. Many veterans have told me their dreams are so vivid and terrifying that they dread going to sleep. Many sit up in an arm chair, fighting sleep as long as possible until they drift off in spite of their intentions to remain awake. Others, night after night, drink themselves into a dreamless stupor. The lack of sleep not only causes great suffering, but also exacerbates Major Depression, Bipolar Disorder and anxiety disorders. It disrupts the ability to function at work, and increases the stress of an already difficult adjustment to civilian life. It separates men from their wives at night. These men often sleep in another room out of fear they might hurt their wives in the midst of the blind terror and rage of the nightmares. Although PTSD has many distressing and even disabling components, what I hear most often from the sufferers themselves is their wish that they could just get some sleep without the nightmares.

A simple and very effective treatment for nightmares was discovered by Dr. Murray Raskind, Dr. Elaine Peskind and their team of psychiatrists at the VA Mental Health Research Center in Seattle, Washington. Most veterans with PTSD call it a "God send." Adrenaline triggers the so-called "fight or flight" response in our bodies that occurs when we are in danger. The old blood pressure medication, prazosin, reduces blood pressure by blocking the effect of adrenaline-like substances on arteries in the body that cause blood pressure to increase during stress and fear. This same mechanism of action by prazosin also appears to block adrenaline-like signals in the brain that turn common dreams into nightmares. Many veterans with PTSD enjoy remarkable relief from nightmares after starting quite modest doses of prazosin. The effects are almost immediate, and relatively small doses of this safe, non-addictive medication continue to provide combat veterans freedom from the horror of nightmares night after night for years. Of all the treatments I can offer veterans with PTSD, prazosin is among the most effective, beneficial and appreciated. Unfortunately, there is a problem.

For the last few months, there has been a shortage of prazosin in the VA system. On several occasions, I have ordered prazosin for my patients with PTSD only to be told to "try something else," because there was none to dispense. This shortage of prazosin is national. We doctors in the VA system were informed that the problem would likely resolve by the end of April, but now, in May, the problem continues. This is unacceptable, and I am compelled to say something about it. Prazosin is an old medication. It has been produced for many years using well known, standard methods. There is absolutely no reason why there should be a shortage of this medication.

Therefore, I am appealing to President Obama, General Shinseki and the Department of Veterans Affairs. Please! Give our soldiers freedom from the horrors of war for eight hours a night. Give them back a night of restful sleep to which they can look forward each difficult day. Spare them their nightmares! To run out of this simple and safe medication is a disgrace. Make certain that VA's supply of prazosin is adequate, and that we never run out of this precious medication again!

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