Beta blockers and PTSD: A real cure?

[JPINFV]

The latest thread on PTSD brought back something I remember learning about in one of my upper-level bio courses (full disclosure: Dr. CaHill and Dr. McGaugh are both professors at my undergrad and the course I heard about this in was taught by CaHill. If trials ultimately pan out, could beta blockers be potentially prescribed as a prophylactic in the same sense as EpiPens and MDIs (start taking it following an event)?

Scientists Work on 'Trauma Pill'

(January 14, 2006) -- Suppose you could erase bad memories from your mind. Suppose, as in a recent movie, your brain could be wiped clean of sad and traumatic thoughts.

That is science fiction. But real-world scientists are working on the next best thing. They have been testing a pill that, when given after a traumatic event like rape, may make the resulting memories less painful and intense.

Will it work? It is too soon to say. Still, it is not far-fetched to think that this drug someday might be passed out along with blankets and food at emergency shelters after disasters like the tsunami or Hurricane Katrina.

Psychiatrist Hilary Klein could have offered it to the man she treated at a St. Louis shelter over the Labor Day weekend. He had fled New Orleans and was so distraught over not knowing where his sisters were that others had to tell Klein his story.

"This man could not even give his name, he was in such distress. All he could do was cry," she said.

Such people often develop post-traumatic stress disorder, or PTSD, a problem first recognized in Vietnam War veterans. Only 14 percent to 24 percent of trauma victims experience long-term PTSD, but sufferers have flashbacks and physical symptoms that make them feel as if they are reliving the trauma years after it occurred.

Scientists think it happens because the brain goes haywire during and right after a strongly emotional event, pouring out stress hormones that help store these memories in a different way than normal ones are preserved.

Taking a drug to tamp down these chemicals might blunt memory formation and prevent PTSD, they theorize.

Some doctors have an even more ambitious goal: trying to cure PTSD. They are deliberately triggering very old bad memories and then giving the pill to deep-six them.

The first study to test this approach on 19 longtime PTSD sufferers has provided early encouraging results, Canadian and Harvard University researchers report.

"We figure we need to test about 10 more people until we've got solid evidence." said Alain Brunet, a psychologist at McGill University in Montreal who is leading the study.

It can't come too soon.

The need for better treatment grows daily as American troops return from Iraq and Afghanistan with wounded minds as well as bodies. One government survey found almost 1 in 6 showing symptoms of mental stress, including many with post-traumatic stress disorder. Disability payments related to the illness cost the government more than $4 billion a year.

The need is even greater in countries ravaged by many years of violence.

"I don't think there's yet in our country a sense of urgency about post-traumatic stress disorder" but there should be, said James McGaugh, director of the Center for the Neurobiology of Learning and Memory at the University of California at Irvine.

He and a colleague, Larry Cahill, did experiments that changed how scientists view memory formation and suggested new ways to modify it.

Memories, painful or sweet, don't form instantly after an event but congeal over time. Like slowly hardening cement, there is a window of opportunity when they are shapable.

During stress, the body pours out adrenaline and other "fight or flight" hormones that help write memories into the "hard drive" of the brain, McGaugh and Cahill showed.

Propranolol can blunt this. It is in a class of drugs called beta blockers and is the one most able to cross the blood-brain barrier and get to where stress hormones are wreaking havoc. It already is widely used to treat high blood pressure and is being tested for stage fright.

Dr. Roger Pitman, a Harvard University psychiatrist, did a pilot study to see whether it could prevent symptoms of PTSD. He gave 10 days of either the drug or dummy pills to accident and rape victims who came to the Massachusetts General Hospital emergency room.

In follow-up visits three months later, the patients listened to tapes describing their traumatic events as researchers measured their heart rates, palm sweating and forehead muscle tension.

The eight who had taken propranolol had fewer stress symptoms than the 14 who received dummy pills, but the differences in the frequency of symptoms were so small they might have occurred by chance - a problem with such tiny experiments.

Still, "this was the first study to show that PTSD could be prevented," McGaugh said, and enough to convince the federal government to fund a larger one that Pitman is doing now.

Meanwhile, another study on assault and accident victims in France confirmed that propranolol might prevent PTSD symptoms.

One of those researchers, Brunet, now has teamed with Pitman on the boldest experiment yet - trying to cure longtime PTSD sufferers.

"We are trying to reopen the window of opportunity to modulate the traumatic memory," Pitman said.

The experiments are being done in Montreal and involve people traumatized as long as 20 or 30 years ago by child abuse, sexual assault or a serious accident.

"It's amazing how a traumatic memory can remain very much alive. It doesn't behave like a regular memory. The memory doesn't decay," Brunet said.

To try to make it decay, researchers ask people to describe the trauma as vividly as they can, bringing on physical symptoms like racing hearts, then give them propranolol to blunt "restorage" of the memory. As much as three months later, the single dose appears to be preventing PTSD symptoms, Brunet said.

Joseph LeDoux, a neuroscience professor at New York University, is enrolling 20 to 30 people in a similar experiment and believes in the approach.

"Each time you retrieve a memory it must be restored," he said. "When you activate a memory in the presence of a drug that prevents the restorage of the memory, the next day the memory is not as accessible."

Not all share his enthusiasm, as McGaugh found when he was asked to brief the President's Council on Bioethics a few years ago.

"They didn't say anything at the time but later they went ballistic on it," he said.

Chairman Leon Kass contended that painful memories serve a purpose and are part of the human experience.

McGaugh says that's preposterous when it comes to trauma like war. If a soldier is physically injured, "you do everything you can to make him whole," but if he says he is upset "they say, 'suck it up - that's the normal thing,'" he complained.

Propranolol couldn't be given to soldiers in battle because it would curb survival instincts.

"They need to be able to run and to fight," Pitman said. "But if you could take them behind the lines for a couple of days, then you could give it to them after a traumatic event," or before they're sent home, he said.

Some critics suggest that rape victims would be less able to testify against attackers if their memories were blunted, or at least that defense attorneys would argue that.

"Medical concerns trump legal concerns. I wouldn't withhold an effective treatment from somebody because of the possibility they may have to go to court a year later and their testimony be challenged. We wouldn't do that in any other area of medicine," Pitman said. "The important thing to know about this drug is it doesn't put a hole in their memory. It doesn't create amnesia."

Practical matters may limit propranolol's usefulness. It must be given within a day or two of trauma to prevent PTSD.

How long any benefits from the drug will last is another issue. McGaugh said some animal research suggests that memory eventually recovers after being squelched for a while by the drug.

Overtreatment also is a concern. Because more than three-quarters of trauma victims don't have long-term problems, most don't need medication.

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But LeDoux sees little risk in propranolol.

"It's a pretty harmless drug," he said. "If you could give them one or two pills that could prevent PTSD, that would be a pretty good thing."

Klein, the Saint Louis University psychiatrist, said it would be great to have something besides sleep aids, antidepressants and counseling to offer traumatized people, but she remains skeptical about how much long-term good propranolol can do.

"If there were a pill to reduce the intensity of symptoms, that would be a relief," she said. "But that's a far step from being able to prevent the development of PTSD." Only more study will tell whether that is truly possible.

Source: AP

http://www.healthyplace.com/Communities/An...2006/ptsd_1.asp

[AnthonyM83]

Woah, that's a long article...

I've alluded to it in other posts, though. There are indicators of potential PTSD merely hours after the event (such as pulse rate) and steps that can be taken to prevent it the day of the event, such as medication.

[Scaramedic]

They are also using the Alpha Blocker Prazosin (Minipress) for long term PTSD treatment.

[Kaisu]

This is soooo typical of our society today.. got an ache? take a pill! sore toe? take a pill. Child birth? demand an epidural. Where did we get the idea that life is supposed to be easy or that pain is bad?

If something horrible happens (or is done) to you, it is SUPPOSED to give you a problem... and sometimes for years or even a lifetime. This is part of what makes you you. While I am not a fan of suffering needlessly, something that messes with our memories and our honest responses to them goes to the very core of our identity.

Human beings are hardwired to try and avoid pain and unpleasantness as a way to survive. No one in their right mind says "oh I think I will experience some personal growth today" but someof us are forced to grow to deal with pain. Coping with PTSD has allowed me to delve deep into myself and the people around me. It has made me strong and wise and given me the ability to empathise and really help those I come in contact with. It has been a terrible and wonderful gift and today, I am grateful, if not for the pain, for everything that has come out of it.

If a pill had been available to wipe out the pain and the struggle would I have taken it? Damn straight - and asked for another. I am grateful now that it wasn't.

[AnthonyM83]

Yeah, I guess the idea here is that the PTSD can be so scarring it takes away years of your life and that might overshadow the fact you're just masking it. So, you can relive the memory, but not have all the accompanying emotions flood back, since it's being imprinted in a manner that's too strong for your circuits to handle, anyway. Lose a little of the human experience versus lose a lot of your life.

The latest thread on PTSD brought back something

Yes, JP...that's the point . . . PTSD will do that . . . ;-)

[JPINFV]

This is soooo typical of our society today.. got an ache? take a pill! sore toe? take a pill. Child birth? demand an epidural. Where did we get the idea that life is supposed to be easy or that pain is bad?

If something horrible happens (or is done) to you, it is SUPPOSED to give you a problem... and sometimes for years or even a lifetime. This is part of what makes you you. While I am not a fan of suffering needlessly, something that messes with our memories and our honest responses to them goes to the very core of our identity.

Human beings are hardwired to try and avoid pain and unpleasantness as a way to survive. No one in their right mind says "oh I think I will experience some personal growth today" but someof us are forced to grow to deal with pain. Coping with PTSD has allowed me to delve deep into myself and the people around me. It has made me strong and wise and given me the ability to empathise and really help those I come in contact with. It has been a terrible and wonderful gift and today, I am grateful, if not for the pain, for everything that has come out of it.

If a pill had been available to wipe out the pain and the struggle would I have taken it? Damn straight - and asked for another. I am grateful now that it wasn't.

It's not that PTSD patients forget about the event, it's just that they don't get the overwhelming memories coming back. Heck, why treat half the stuff medicine does if medication is bad? HTN? Sorry, lose some weight and get some exercise. Pain medication because you broke your arm? Well, just don't do something stupid next time, but no pain meds for you. Bipolar? Buck up Nancy and learn to control your self.

Hmm, I couldn't imagine telling someone in either of those situations that a pill is the easy way out, but for some reason people think psychological issues are different and would rather perpetrate things like CISD.

[mrmeaner]

This is soooo typical of our society today.. got an ache? take a pill! sore toe? take a pill. Child birth? demand an epidural. Where did we get the idea that life is supposed to be easy or that pain is bad?

If something horrible happens (or is done) to you, it is SUPPOSED to give you a problem... and sometimes for years or even a lifetime. This is part of what makes you you. While I am not a fan of suffering needlessly, something that messes with our memories and our honest responses to them goes to the very core of our identity.

Human beings are hardwired to try and avoid pain and unpleasantness as a way to survive. No one in their right mind says "oh I think I will experience some personal growth today" but someof us are forced to grow to deal with pain. Coping with PTSD has allowed me to delve deep into myself and the people around me. It has made me strong and wise and given me the ability to empathise and really help those I come in contact with. It has been a terrible and wonderful gift and today, I am grateful, if not for the pain, for everything that has come out of it.

If a pill had been available to wipe out the pain and the struggle would I have taken it? Damn straight - and asked for another. I am grateful now that it wasn't.

This post got me thinking about another aspect. There opinions out that PTSD is being used as a blanket diagnosis like ADD. If they can identify a treatment for PTSD, would this not help identify the existence of PTSD itself?

[Virginia NPP]

My 2 Cents.

Propranolol will slow your heart rate down regardless of the cause. It blocks the effects of epinephrine. It has been used for stage fright and by public speakers for many years.

What happens is if you are anxious, your heart rate goes up and then you become even more anxious in response. It becomes a vicious cycle. The propanolol seems to break the cycle by slowing the heart rate.

This research is so very early, it really can't tell us much at this point. It needs to contiue, and hopefully will because of all the soldiers returning from wars who are suffering.

I personally agree PTSD is over diagnosed for the same reason I mentioned in an earlier post. Clinicians make the diagnosis based on there own ideas, and do not use the specific criteria in DSM.

PTSD is a very real problem, over-diagnosing it just makes it less reliable, and leads to questioning of its' validity. This is what seems to be happening with Bipolar disorder also.

PTSD is really a syndrome, so medication is prescribed for the particular symptoms that a client has. There is no medication for PTSD per se.