Propranolol as an Adjunctive Treatment of PTSD

The beta-adrenergic–receptor blocker propranolol reduces somatic symptoms of anxiety such as tachycardia and sweating and, when paired with in vivo exposure, can reduce phobic responses to spiders. In open trials, propranolol combined with trauma activation has reduced symptoms of post-traumatic stress disorder (PTSD). Investigators in Canada have now examined this use in a 6-week, double-blind, randomized, controlled trial involving 60 participants with ≥6 months of symptomatic PTSD (58% female; 70% white; mean age, 39).

The most common traumas were sexual trauma, physical assaults, motor-vehicle accidents, and combat trauma. Exclusions included contraindicating medications or diseases (e.g., arrhythmia, asthma), substance use, psychosis, traumatic brain injury, and suicidality. Participants received propranolol (0.67 mg/kg conventional short-acting plus 1.00 mg/kg long-acting formulations) or placebo 1 hour before trauma reactivation. This task involved writing a first-person account of the most upsetting moments of the trauma, including bodily sensations, and reading the account to a therapist. At each subsequent weekly visit, participants received the medication 90 minutes before rereading and, if necessary, editing these accounts (typically, 10–20 minutes).

Only 15 patients from each group completed the full protocol (10% of propranolol dropouts experienced adverse effects). Propranolol was associated with superior posttreatment improvements in both intent-to-treat and per-protocol completer groups (intent-to-treat analysis: 38 vs. 24% with placebo), with very large effect sizes. Gains were largely retained at 26 weeks.