All right so you’ve completed the initial evaluation you’ve considered whether they have sleep disturbance that could be from the ptsd you’ve considered a trial of praising so what if sleep smoothness through the night is improved but they still have trouble initiating sleep this is node 2b of the algorithm they still have trouble falling asleep even though they’re
Doing better with their nightmares and disturbed awakenings our first choice hypnotic for helping them fall asleep is tracidone i’m sure you’re familiar with trazodone it’s a sedating antidepressant it’s shown some effectiveness for sleep disturbances in ptsd but really only in open label studies it has been described though as an ideal hypnotic agent by steven
Stahl in an article he wrote a few years ago because of its triple sleep promoting actions on the 5 ht2a alpha 1 and h1 receptors it also has a short half-life no weight gain low risk of dependence no problems with sexual side effects so it’s got a lot of things that make it a relatively ideal choice for many patients it has a reasonable role we think to add to
Your praises and or instead of it if there really are no problems with nightmares but just difficulty falling asleep now if prasasin was not effective you could consider trying it for the total picture for the falling asleep and the difficulties uh maintaining sleep because of the nightmares before moving on to the ssris but i have to say the evidence for it is
Pretty minimal it’s pretty much clinical experience that is all we have as a solo treatment for the major symptoms of ptsd now as far as what evidence we do have with trazadone there is that one open label study what i do offer though is two studies of using trazodone versus placebo for ssri induced insomnia ssris as noted often cause insomnia as a side effect maybe
15 or 20 percent of patients and in two randomized controlled trials tracidone was an excellent treatment for that it also has been compared with zolpidem for primary insomnia it was in a large trial which also had a placebo control and it proved comparable in efficacy for primary insomnia so there’s a variety of lines of evidence that trisodone is a reasonable
Insomnia treatment that you might apply in this situation the side effects of trazodone include excess sedation dizziness orthostatic problems occur from time to time and syncope occasionally so you do have to be cautious for warn about and watch for that now perhaps the most often mentioned side effect though in males is priapism and that is a concern it’s an
Infrequent concern serious priapism only occurs in one in two or three thousand patients but you do need to warn people about it and in theory the risk of priapism may be increased if you combine trazodone with prasasin which has a very rare sometimes not even mentioned in typical patient information sheets that praises and has been associated with priapism so
Some have thought that you shouldn’t combine prazasin with trazadone because of a possible increased risk of priapism so far there hasn’t been any reported cases of priapism in this commonly used combination nevertheless extra caution with warning about priapism is certainly necessary in combining them and we do that routinely trazodone is usually started at 50
At bedtime with instructions to reduce to 25 if it’s too sedating sometimes people have done well with just 12.5 milligrams of transition
Transcribed from video
trazodone for sleep initiation By NEUROSCIENCE NPA-GP
