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The Seattle Times
SEATTLE - Millions of combat veterans have lived through these nightmares every night, often for decades, as one symptom of post-traumatic stress disorder (PTSD).
Now though, a group of PTSD patients at the Veterans Administration hospital in Seattle say they are getting a nightly reprieve with help from Dr. Murray Raskind, a VA psychiatrist. Since 1998, Raskind has been experimenting with prazosin, an old blood-pressure medication that, in tests, has reduced and often stopped the nightmares.
If the drug delivers on its promise, prazosin could transform the lives of hundreds of thousands of veterans, including a new generation of soldiers returning from Iraq.
"I would lie in bed and say, 'I can't handle it anymore.' It's time to end it. But since I started this, life is so nice," said Vietnam veteran Larry Scott, 56.
"It changed everything. It was like being born again," said Don Hall, who lives in Seattle and was the first PTSD patient to take prazosin, in 1998. He now takes it nightly before bed.
Raskind, vice chairman of psychiatry at the University of Washington School of Medicine, believes his 1-year-old VA study will show that prazosin cuts down on an adrenalinelike compound that floods the brain at night - much as when the men were soldiers in Asian jungles or the Kuwaiti desert.
He said the drug has restored more normal sleep to 80 percent to 90 percent of his patients. He estimates about 1,000 PTSD patients in the Puget Sound region are using prazosin.
(Doctors at Madigan Army Medical Center south of Tacoma are now experimenting with prazosin but declined to comment on its success because they've been using it only for about three months.)
Chronic post-traumatic stress disorder affects 5.2 million Americans - including 30 percent of all combat veterans - who've endured a traumatic event or series of events, like combat, rape or a natural disaster, according to the National Mental Health Association. Scientists think these events can change the brain's hardwiring, leading to nightmares and other symptoms.
"We look at life through a different eye," said Carl Hightower, a veteran of the first Gulf War and one of Raskind's PTSD patients.
Veterans say subtle changes in their environments - a helicopter overhead, diesel fumes - can take them back to the scenes of combat. Rage rests close at hand. Relationships are elusive. They are easily startled and struggle to feel the emotions, like happiness and grief, that come easily to everyone else.
And, they often re-live their worst experiences while asleep, night after sweat-drenched night.
In November 1965, Lee Jones, now 61 and a Seattle resident, fought in the Ia Drang Valley in Vietnam. The battle there is described by Harold Moore in his book, "We Were Soldiers Once and Young":
"Now the dying had begun in earnest, in wholesale lots, here in this eerie forested valley beneath the 2,401-foot-high crest of the Chu Pong massif, which wandered 10 miles back into Cambodia. The din of battle was unbelievable. Rifles and machine guns and mortars and grenades rattled, banged and boomed."
These violent and chaotic images, sounds and smells imprinted themselves on Jones' mind. "It was just a bunch of buddies getting bodies on the helicopters and trying to get them home," he said recently at the VA hospital in Seattle.
Jones now leads a group of 250 black veterans - many in the prazosin trial - who meet to tell stories few others understand.
One of the regulars is Hall, who served in the infantry in Vietnam and earned a Purple Heart when he took shrapnel to his face.
He remembers arriving at the "replacement center" in Saigon, where new soldiers took the place of departing troops, including the dead and wounded.
"You go out on a chopper that just unloaded bodies from where you're going to. It was like a factory. It opened your eyes."
After an incident that for him is literally unspeakable, Hall spent his last four months in combat carrying an unloaded weapon.
"They think they can take you out of society and put you in a war and see all these terrible things and put you back in society, and it just doesn't work," he said.
Once Hall came home, sleep became a traumatic, rather than a restorative experience. He would wake up in terror, sometimes ripping up the bedding or breaking the television.
After years of drinking and using drugs, an on-the-job injury that ended his career as an iron worker, two collapsed marriages and regular nightmares, Hall said he was ready to kill himself, to "check out," as many veterans say.
Doctors have treated PTSD with psychotherapy, anti-depressant and anti-anxiety medications and sleeping pills - all with limited success. No treatment successfully dealt with the nightmares.
Then Raskind asked Hall to try prazosin.
Within a week, he was sleeping through the night.
Raskind then asked Jones and some of the other veterans to try prazosin. Men once prone to walk the perimeters of their homes at night with loaded weapons suddenly were sleeping well, Raskind and veterans said.
Following the work of other neurobiologists, Raskind became convinced the nightmares come from an increase in a hormone called norepinephrine, a compound with effects similar to adrenaline.
"In the jungle, you had to be at the top of your game, especially at night," he said, explaining the hormonal change. "What was adaptive in a firefight in Vietnam - adrenalinelike compounds - doesn't shut off when they come home, especially at night."
Raskind sought a drug therapy that reduces norepinephrine output. He turned to prazosin, which since the 1970s has been prescribed as a blood-pressure medication. It costs less than a penny per pill.
(Once a drug is approved for any condition, physicians are free to use it on other disorders - a common practice called "off-label" use.)
Doctors at VA hospitals in Biloxi, Miss., Oklahoma City, Chicago and Spokane are now prescribing the drug. Some cautiously share Raskind's optimism.
"For some patients, it's made a tremendous difference in nightmares," said Dr. Gregory Winter, chief of behavioral health service at the VA hospital in Spokane. He has prescribed prazosin to about 150 patients and has seen it work in about half.
"I think it was something we stumbled into, but in retrospect it makes some sense," he said. Doctors and patients say a good night's rest has had multiple residual effects, like eased anxieties, better personal relations and quieter urges for drugs and alcohol.
There should be no illusions, however, that prazosin is a cure for PTSD, which stalks its chronic sufferers much as their enemy assassins once did. Even successful prazosin treatment leaves patients exposed to the daylight hours.
"You spend a lot of time trying to forget. But your unconscious won't let you," Jones said.
(c) 2003, The Seattle Times. Distributed by Knight Ridder/Tribune News Service.