Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares

Background: Trazodone is commonly used in the treatment of insonmia and nig htmares in patients with PTSD. There is little evidence in the literature f or this practice. Method: Seventy-four patients from the Palo Alto Veterans Affairs Health Care System in California who were admitted to a specialize d 8 week inpatient treatment program for PTSD were surveyed regarding their use of trazodone in the treatment of insomnia or nightmares. Patients were asked to complete a questionnaire regarding trazodone's effectiveness, sid e effects, and optimal doses. Results: Of 74 patients surveyed, 60 patients were able to maintain an effective dose of trazodone. The other 14 patient s were unable to tolerate the medication. Seventy-two percent of the 60 pat ients assessed found trazodone helpful in decreasing nightmares, from an av erage of 3.3 to 1.3 nights per week (p < .005). Ninety-two percent found it helped with sleep onset, and 78% reported improvement with sleep maintenan ce. There was a significant correlation between the effectiveness in decrea sing nightmares and improving sleep (r=.57, p < .005). The effective dose r ange of trazodone for 70% of patients was 50 to 200 mg nightly. Of the 74 p atients surveyed, 9 (12%) reported priapism. Conclusion: Trazodone appears effective for the treatment of insomnia and nightmares associated with chro nic PTSD. However, controlled trials are needed before any definite conclus ions can be drawn. The higher than expected occurrence of priapism warrants clinicians asking directly about this side effect.