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Pharmacological treatment of post-traumatic stress disorder

  • Jonathan I. Bisson
Abstract

Post-traumatic stress disorder (PTSD) causes significant distress and is often associated with markedly reduced functioning. Recent reviews have consistently recommended trauma-focused psychological therapies as a first-line treatment for PTSD. Pharmacological treatments have also been recommended but not as consistently. This article reviews the available trials of the pharmacological treatment of PTSD and discusses their implications.

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References
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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Pharmacological treatment of post-traumatic stress disorder

  • Jonathan I. Bisson
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eLetters

Propanolol treatment of traumatic memories

Robin P D Menzies, psychiatrist
02 December 2008

Bisson (2007) discusses the use of propanolol in the prevention of post-traumatic stress disorder, reported in a study by Pitman et al (2002). They found encouraging results with patients who experienced very recent trauma. More recently Brunet et al (2008) reported similar findings in patients with long-term traumatic memories (mean duration of about 10 years). These studies, as well as one by Vaiva et al (2003), recorded physiological measures e.g. heart rate, and did not report on any clinical benefits e.g. reduced distress or changes in the integrity of the traumatic memories.

In their study, Nader et al (2000) rekindled the reconsolidation hypothesis of memory. In brief, it proposes that when long-term memories are reactivated

through retrieval, they remain labile for several hours before conversion to long-term memory. During this period they are susceptible to amnestic agents, like propanolol. It is thought that propanolol blocks the adrenaline-induced state of high arousal, which is believed to be important in giving

traumatic memories their unique quality, including the potency and immediacy they possess (Pitman, 1989).

In order to explore any clinical benefits in terms of reducing distress and changes in memory integrity, I have treated six patients with a single dose of propanolol, sometimes in conjunction with a single dose of long-acting propanolol. They were asked to retrieve their traumatic memories by talking about them. Bringing these memories into immediate memory was accompanied by varying degrees of visible distress, anxiety and dissociation. They were given propanolol within three hours of retrieval.

One patient with a 38 year-old memory, who had been on regular atenolol for 14 years, reported no change in the intensity, frequency, integrity or

distress associated with the traumatic memory. All the other five patients, with memories ranging in age from four months to 31 years, reported improvement. This included “fragmentation” of the memory and difficulty accessing it, minimal or absent distress when thinking about it and a feeling of emotional detachment, as if it were like a normal non-traumatic memory or had happened to someone else. Post-treatment, several of the patients requested propanolol treatment for other traumatic memories. Benefits have

been maintained for up to 4 months, with no relapse to date. None of the patients reported any negative effects from retrieving the memory, even the patient who did not respond, and side effects from propanolol (sedation, dry mouth) were mild and transient.

These clinical cases suggest that propanolol treatment may prove to be effective, cheap, simple and safe in the treatment of traumatic memories, which are characteristic of post-traumatic stress disorder. However, randomized controlled trials are needed to confirm any efficacy of this treatment.

Bisson (2007) Pharmacological treatments of post-traumatic stress disorder. Advances in Psychiatric Treatment, 13, 119–126.

Brunet, A., Orr, S. P., Tremblay, J., et al (2008) Effects of post-retrieval propanolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder. Journal of Psychiatric Research, 42, 503-506.

Nader, K., Schafe, G., & Le Doux, J. (2000) Fear memories requireprotein synthesis in the amygdala for reconsolidation after retrieval. Nature, 406, 722-726

Pitman, R. (1989) Post-traumatic stress disorder, hormones and memory. Biological Psychiatry, 26, 221223.

Pitman, R., Sanders, K., Zusman, R., et al (2002) Pilot study of secondary prevention of posttraumatic stress disorder with propanolol. Biological Psychiatry, 51, 189-192)

Vaiva, G., Ducrocq, F., Jezequel, K., et al (2003) Immediate treatment with propanolol decrease posttraumatic stress disorder two months after trauma.

Biological Psychiatry, 54, 947-949.

Declaration of interest: None

Robin P D Menzies FRCPsych, FRCP(C)

Clinical Assistant Professor,

Dept of Psychiatry, University of Saskatchewan.

Address:

Knox Manse,

505 4th Avenue North,

Saskatoon,

Saskatchewan, S7K 2M5,

Canada.

Phone: (306) 668.0505

Fax: (306) 668.0507
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Conflict of interest: None Declared

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