Pre-reactivation propranolol therapy effective for PTSD

Alain Brunet

Trauma memory reactivation performed while using propranolol appears to effectively treat PTSD symptoms, according to new study findings.

“Given the limitations of existing PTSD treatments, new approaches are needed. One novel strategy is pharmacological impairment of memory reconsolidation,” Alain Brunet, PhD, clinical psychologist and associate professor of psychiatry at McGill University, and colleagues wrote in The American Journal of Psychiatry. “A recent meta-analysis revealed that a single session of memory reactivation plus propranolol in healthy humans reduced the strength of negatively valanced emotional memories.”

In a 6-week, placebo-controlled, randomized trial, researchers examined the efficacy of using trauma memory reactivation with propranolol as a reconsolidation blocker to reduce PTSD symptoms in 60 adults.

“Our study ... is a demonstration of how we might treat mental disorders in the future. The treatment combines a medication with a therapeutic procedure,” Brunet told Healio Psychiatry. “The medication clearly aims to repair the brain rather than mask the symptoms of the mental disorder.”

Participants received either propranolol or placebo weekly for 6 weeks, 90 minutes before a short memory reactivation session. The investigators used the Clinician-Administered PTSD Scale (CAPS) and the patient-rated PTSD Checklist–Specific (PCL-S) to assess PTSD symptom scores. Patients who attended at least three treatment sessions were included in the intention-to-treat sample. The study also included a posttreatment assessment and 6-month follow-up.

Patients with PTSD who actively recalled their trauma under the influence of propranolol once a week for up to 6 weeks showed a substantial reduction in symptoms compared with placebo. Although the propranolol and placebo groups had similar pretreatment CAPS scores, and both experienced reductions in the posttreatment assessment, the propranolol led to significantly greater improvements in symptoms.

“Because it is easy to learn, and it works fast, I believe that reconsolidation blockade will be used in the future as the first-line treatment for PTSD,” Brunet said. “In addition, reconsolidation blockade will be used with other mental disorders that have at their core an upsetting life event, such as adjustment disorders, certain phobias, etc.”

The intention-to-treat pre- to posttreatment effect sizes (Cohen’s d) were 1.76 for propranolol vs. 1.25 for placebo, and the CAPS improvements were 38% vs. 24%. When measuring PCL-S scores, the researchers observed significantly greater reductions in the propranolol group compared with the placebo group at the posttreatment assessment. The intention-to-treat pre- to posttreatment effect sizes were 2.74 for propranolol vs. 0.55 for placebo, and PCL-S improvements were 56% vs. 15%. In the propranolol group, the PCL-S time-by-group interactions showed an average decrease of 2.43 points each week. At 6-month follow-up, the average CAPS scores were 52 for the propranolol group compared with 69.2 for the placebo group, and the average PCL-S scores were 38.4 compared with 69.

“The effect sizes obtained for pre-reactivation propranolol in our study compare well to those obtained with the best evidence-based treatment for PTSD, namely, cognitive-behavioral therapy, as well as those obtained with the most recommended pharmacological treatment for PTSD, namely, SSRIs,” Brunet and colleagues wrote. “Should these results be replicated in further studies, propranolol blockade of reconsolidation may become a new therapy for some patients with PTSD.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.