Old pill helps relieve nightmares of war

TACOMA, Wash. — The war followed Gillian Boice home from Iraq and into her dreams.

The thrashing would begin minutes after the Army officer fell asleep. She sometimes screamed out battle orders. She often woke the next morning already exhausted.

Relief came in the form of a decades-old blood pressure drug. Puget Sound-area military health specialists have turned it into a leading treatment for nightmares, after experimenting with it as a long shot.

"Prazosin has changed so, so much in my life," said Boice, a retired military police lieutenant colonel living in Olympia. "I couldn't sleep before, and it's given me my nights back."

Thousands of veterans who fought in conflicts ranging from Vietnam to Iraq and Afghanistan are taking prazosin for trauma-related nightmares. Its nighttime use started at the Seattle VA hospital and has spread across the country.

Today, the prazosin initiative is one of Madigan Army Medical Center's most visible campaigns on Fort Lewis. Signs in company headquarters buildings and banners attached to fences outside — many with the slogan "Got Nightmares?" — can be found all over post.

Hospital officials have delivered briefings to most units at Fort Lewis. They say acknowledging having problems with nightmares can be less stigmatizing for soldiers than talking about post-traumatic stress disorder.

Service members now deployed in combat zones are taking prazosin, also sold by the trade names Minipress, Vasoflex and Hypovase.

It's a cheap fix for a problem that has spiked in veterans since the start of the wars in Iraq and Afghanistan. Because it was introduced in 1973 and can be produced generically, it costs pennies per dose.

Other treatments required sedatives, which could become addictive and often sidelined service members from future deployments. But this drug doesn't appear to have any major side effects, officials said.

Three trials of the drug's effect on nightmares have been positive, and the Puget Sound VA and Madigan Army Medical Center are in the midst of larger studies that aim to establish the use of prazosin as standard practice to fight nightmares.

Dr. Murray Raskind, the director of the VA's Northwest Mental Illness Research, Education and Clinical Center, first experimented with using the drug to treat nightmare-stricken Vietnam veterans.

A hypersensitivity to adrenaline triggered many of their nightmares. Prazosin helps dull those spikes in the hormone, which the body naturally creates to speed the heart rate and raise awareness of one's surroundings.

The drug can also be used during the day to cut down on flashbacks, a product of the same adrenaline hypersensitivity.

About 75 percent to 80 percent of patients who try prazosin stop having nightmares — but continue to dream — within days of starting treatment, said Raskind and Maj. Jess Calohan, the assistant chief of psychiatry at Madigan. Calohan is overseeing the hospital's nightmare initiative.

Calohan said Army regulations prohibit him from disclosing the length or scope of the study, but he added that close to 1,000 patients had been prescribed the medicine at Madigan in the past few years. (Not all of the patients were necessarily part of the study.)

The VA has also launched a three-year study that includes 300 veterans at 13 hospitals.

"Prazosin is getting pretty widely known on the West Coast," Raskind said. "But we're hoping this study raises its profile nationwide."

The drug is especially effective in the military because it doesn't disqualify troops from deploying overseas. And it doesn't blunt the brain's reaction to adrenaline, but rather the hypersensitivity to it — important when a firefight requires soldiers to have an extra sense of vigilance.

Calohan, a 35-year-old Puyallup resident, recently returned from a deployment to several bases in northern Iraq, where he prescribed the medicine to about 50 soldiers.

"There were soldiers with PTSD for two, three or four years who just couldn't function because of the lack of sleep," he said. "With this, we could treat them effectively at a time when restorative sleep is probably the most important."

Boice, a West Point graduate who last served with Fort Lewis' 42nd Military Police Brigade before retirement, deployed to Iraq during the Gulf War, to Kosovo, to Iraq during the 2003 invasion and to Guantanamo Bay, Cuba. She was awarded a Bronze Star with "V'' device for valor for her actions as a platoon leader with the 3rd Armored Division during the first Iraq war.

Her nightmares stemmed from her deployment to Iraq during the invasion six years ago. She helped train Baghdad police officers and was in the country as the insurgency gathered momentum.

"I'd fall asleep on the couch while watching movies (at home), and my kids would see me having one of my dreams," she said. "I'd constantly be moving around, calling out orders, stuff like that."

Boice had back surgery two years ago, and the sleep thrashing during her recuperation period worried her nurses. They offered to prescribe Ambien, but she declined, worrying she might become dependent.

She saw one of the nightmare initiative signs at Madigan and called.

"Taking it was just amazing," she said. "The nightmares went away in a few days. I had forgotten what a good night of sleep was like."

One of the first patients to use prazosin for nightmares is still using it more than a decade later. Don Hall fought as an infantryman in the Vietnam War. His Army unit was involved in several bloody battles, including one "where we went out battalion-sized and came back company-sized."

"That was the most frightening thing of my life," he said.

When they returned to their base from that battle, Hall was cleaning his rifle when it accidentally fired, hitting his best friend in the back and killing him.

"That's something I live with every hour of every day," said Hall, now 65 and living in Oklahoma City. "And at night, when I go to sleep, I used to dream about it a couple times a week. Sometimes every night. And that was 40 years ago. But not anymore."

Hall met Raskind through a support group for black Vietnam vets at the Seattle VA. Raskind, whose background is in geriatric psychology, had tinkered with the idea of using blood pressure medication to fight nightmares. He prescribed prazosin for the first time in 1998.

"He had high blood pressure anyway," Raskind said. "But honestly, I figured it was a long shot."

At that point, Hall had been drinking nightly and smoking marijuana in hopes of quieting the nightmares and stealing an hour or two of sleep. But three weeks after he started the medicine, the nightmares began to fade away.

He said he hasn't had a drink since the nightmares ceased. And the mental freedom allowed him to visit Washington, D.C., several years ago to visit the Vietnam Veterans Memorial, where he saw his friend's name etched in the black granite.

Raskind accompanied Hall on the trip.

"Without him and without the prazosin, I would have killed myself by now," Hall said. "I know I would have."

A few months ago, Hall stopped taking the medication to see what effect it would have. The nightmares returned four days later.

"This has really kept me alive," he said. "It's simple: If it weren't for this, I would be dead."

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