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Expert Q&A

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Have you heard of a heart drug that also helps PTSD?

Asked by Dan, San Luis Obispo, California

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I have heard secondhand information about a drug that was originally developed as a heart medication. However, according to my friend, the medication was recently the subject of a peer-reviewed study that showed it to be effective as a beta blocker and useful for treatment of traumatic memories (PTSD, etc). If you have any information about the drug and the study, I would very much appreciate it, as I would like to read about it.

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Dan,

From your question, I am pretty sure you are referring to a small body of research showing that a type of blood pressure medication called a beta blocker may help prevent the development of post-traumatic stress disorder.

Here is the setup of these studies: Take people who have just had something very bad happen to them, like a motor vehicle accident or a rape, and within a few hours or a day or two at most, flip a coin and put half these people on a beta blocker and half on an inactive substance that looks the same (i.e. placebo).

Some studies that have done this find that people who got the beta blocker were less likely over time to go on to develop post-traumatic stress disorder (PTSD). A good example of this literature can be found in the November 1, 2003, issue of the journal Biological Psychiatry, under the title "Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma."

The first thing to say about this is that the data are mixed: Some studies find an effect of giving beta blockers such as propranolol, and other studies do not find this. So it is not an open-and-shut case that these medications work. They are certainly no miracle cure, and they don't seem to be of value once a person has gone on to develop significant PTSD symptoms.

The second thing to say is that the possibility that a beta blocker may work right after a trauma is of great theoretical interest. Why?

Beta blockers work by reducing activity in the sympathetic nervous system, which is one of the two major branches of the body's stress (or fight-and-flight) system. This makes sense. When you get stressed, one of the first things that happens is that blood pressure rises. So the idea behind beta blockers for preventing PTSD is that if you can prevent the body's stress system from reacting strongly to a trauma, you might be able to reduce the brain's fear and horror response. Without such a response, there is nothing to develop PTSD about.

The classic example of this phenomenon comes from a European study that looked at risk factors for developing PTSD in people trapped in a terrible nightclub fire in which many people died. As in all studies, people who were vulnerable as a result of already being depressed, or having been traumatized in the past, were more likely to develop PTSD after the disaster. But the novel finding was that the drunker people were, the less likely they were to develop PTSD.

This follows the same logic as beta blocker use: Alcohol blocks stress pathways in the brain (which is why it relaxes people), so people who were drunk were in a condition in which the terrible event couldn't register fully in the brain in a way that would lead to PTSD. In short, trauma is as trauma feels. If your body and brain don't register something as a terrible threat, it doesn't cause stress-related problems later.

Please note, however, that I am most definitely not advising alcohol as a way of managing trauma. Drinking on a regular basis to help cope with one's demons only gives those demons a stronger voice. And medications called benzodiazepines that work on the same brain systems as alcohol can actually make PTSD worse when taken on a regular basis.

So what is the take-home message? Although beta blockers may hold some promise, the most important thing to do for someone who has experienced a trauma is to get that person professional help as soon as possible so that he or she can get maximal (and personally tailored) help.

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