Comments on the 2017 VA/DoD Practice Guideline for the Management of PTSD

By: David Osser, MD; Flavio Guzman, MD

In June 2017, the U.S. Department of Veterans Affairs and the Department of Defense published a new edition of the Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder.

After we published a video lecture (Faculty: David Osser, MD , Harvard Medical School) on the rationale for the use of prazosin for PTSD, some readers wrote us to let us know that prescribing prazosin may be actually conflicting with this recent guideline.

In short, what the guideline says about prazosin is that for nightmares associated with PTSD, “there is insufficient evidence to recommend for or against the use of prazosin as monotherapy or augmentation therapy”.

We talked with Dr. Osser to hear his opinion on the guideline.

More specifically, he discusses these topics:

  • Why some PTSD patients are reluctant to psychotherapy
  • Why he still recommends prazosin for PTSD, even after one unpublished negative study
  • A potential relationship between hypertension and response to prazosin
  • What to do if your patient is already taking an antihypertensive medication

Download Audio Comments Here

VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress

Download Pocket Guide Here

The presentation we are referring to in the audio comment is displayed below, it describes the rationale and dosing strategies for the use of prazosin. The video is an excerpt from the lecture “Psychopharmacology of PTSD Algorithm”. The full presentation is available for Premium Members of our CME program.

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