Prazosin as an Antimanic Agent in Severe Mania or Mixed States

Prazosin as an Antimanic Agent in Severe Mania or Mixed Episodes: a Double-blind, Placebo-controlled Study

Mania has been considered to be, in part, a hyperadrenergic state. One focus of treatment of mania involves directly targeting this hyperexcitable state by reducing arousal with antiadrenergic agents. This can be achieved by decreasing norepinephrine release by stimulating presynaptic inhibitory receptors. Prazosin, FDA approved for the treatment of high blood pressure works in part by blocking postsynaptic alpha-adrenergic receptors. Prazosin has been found to be clinically useful for the treatment of Post Traumatic Stress Disorder. It is reasonable, therefore, to anticipate that prazosin might be helpful in the treatment of mania.

Inclusion Criteria:

• Age 18-60
• Primary diagnosis of bipolar disorder with severe mania or mixed episode
• YMRS score of > 20
• Documented medical evaluation without acute or serious medical illness
• Negative pregnancy test
• Healthy functioning liver

Exclusion Criteria:

• Lack of capacity to provide informed consent
• Involuntary commitment
• Low blood pressure
• History of adverse reaction or allergy to prazosin or other quinazolines
• Informed consent not given or retracted during study
• History of narcolepsy
• Unstable or acute medical illness