Effect of cyproheptadine on combat related posttraumatic stress disorder nightmares

Recent studies have shown the role of serotonergic system in posttraumatic stress disorder (PTSD). Terazodone and nefazodone (5HT2 receptor antagonists) ameliorated PTSD nightmares but the reports are mixed. This study prompted an open trial of cyproheptadine for Iran versus Iraq combat PTSD patient nightmares. 25 patients studied in an eight-week, before-after trial of cyproheptadine. The participants were male and chronic PTSD patients with combat related nightmare. The exclusion criteria included current substance abuse or dependence, psychotic disorders and any medical condition that contraindicated the use of cyproheptadine. Five patients were excluded from the study because of side effects including dizziness and somnolence. Twenty patients completed the study. Average of nightmare severity decreased from 6.85 to 5.05, which was statistically significant (P<0.01) The data suggest that cyproheptadine, as a 5HT2 antagonist, may be effective in treament of PTSD nightmare.