Based on the tree-ring width chronology of Sabina przewalskii Kom., a 450-year Palmer Drought Severity Index (PDSI) series was reconstructed in the middle Qilian Mountains, northeast Tibetan Plateau. During the calibration period of 1957–2004, the predictor variable accounts for 47% of the variance in the modeled PDSI data. There were three sustained severe multiyear droughts during the periods of 1705–1723, 1814–1833, and 1925–1941 before the instrumental period of 1957–2004, while no drought event lasting longer than 10 years occurred during the instrumental period. Although the modeled PDSI during the 1957–2004 period adequately assessed the intensity of the multiyear droughts for the last 450 years, the potential for prolonged droughts was underestimated. In the multidecadal scale, the drought of 1640–1730 had the greatest magnitude and the longest duration, the drought of 1808–1846 had the highest intensity, and the drought of 1917–1973 was moderate. Both the multiyear and decadal scale droughts in the middle Qilian Mountains corresponded to the droughts in the northeast Tibetan Plateau, demonstrating that drought occurrences in the northeast Tibetan Plateau are synchronous in decadal to multidecadal scales. The drought variations in the middle Qilian Mountains have significant periodicities of 2.05–2.31, 54.44, 98, and 122.5 years at a 99% confidence level.