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Mark Dombeck, Ph.D.Mark Dombeck, Ph.D.
Essays and Blogs Concerning Mental and Emotional Health

Treating PTSD with Beta-Blockers

Mark Dombeck, Ph.D. Updated: Apr 18th 2006

People reading this weblog probably already know about Postraumatic Stress Disorder, a fairly severe anxiety and arousal problem that occurs in the wake of trauma when the trauma experience is so overloading and overpowering as to become "undigestable". PTSD patients do their best to avoid those memories, but still fall victim to debilitating nightmares and other unwanted trauma-memory intrusions, and concurrent intense body fear arousal. Time usually heals wounds, but PTSD wounds do not heal with time. Trauma memories may remain fresh and unfaceable 20 and 40 years after the fact.

PTSD is treated with a variety of techniques, including anti-anxiety and other psychiatric medications, and various forms of psychotherapy including behaviorally informed graduated exposure and eye movement desensitization and reprocessing therapy (EMDR). The theory has been that trauma memories need to become tolerated so that they can be revisited and 'reprocessed' so that it can finally become clear to the patient that the memories are firmly in the past. Drugs and the therapeutic environment help to contain and blunt the patient's fear arousal, and exposure and EMDR techniques help to reprocess the memories. These therapies are useful for many patients, but they are not curative and there is clear room for improvement.

Psychologist Alain Brunet of McGill University in Montreal (Canada) is looking for ways to make those improvements happen, through the use of an old-fashioned 'beta-blocker' drug called Propranolol (see articles here and here). Primarily intended as heart medicine, beta blocker drugs like Propranolol have long been used "off label" to treat anxiety patients because they block or lessen "peripheral autonomic activation" (e.g., symptoms of anxiety occurring in the periphery of the body such as might be noticeable in the limbs e.g., clammy skin, sweating, shaking, etc.). A socially phobic patient who normally would freak out during a speech can take Propranolol and not notice their palms getting sweaty, etc. Because they are not distracted by arousal symptoms that do not occur (or occur with less force), they are better able to remain focused on their speaking task and to execute it without incident.

This last paragraph has been reworded based on feedback from Jed Struckus, Ph.D. who noted a prior error. Dr. Struckus writes, "Beta blockers , suppress sympathetic (not parasympathetic) activity, and actually lessen the production of the physical symptoms themselves (such a sweaty palms), not simply the awareness of these symptoms". Thank you for the clarification, Jed.

Propranolol may have another useful effect as well - in that it may suppress the long term storage of emotional memories. A Psychiatrist at Harvard, Dr. Roger Pitman, has shown that trauma patients treated with Propranolol immediately after traumas (accidents, rapes) show somewhat fewer PTSD-like symptoms than patients who did not receive Propranolol. The explanation for this is that Propranolol interferes with the formation of the strong emotional memories that might otherwise crystallize into true trauma memories.

Brunet has taken this secondary line of reasoning and applied it to PTSD. He encourages his patients to talk about their traumas after he has dosed them with Propranolol. The idea is that the Propranolol will prevent re-storage of trauma memories, resulting in a less intense trauma memory after the treatment. Apparently, his early findings with this technique are encouraging, some patients have been helped, and more trials of the approach are underway. We can only hope that test results continue to be encouraging. This Propranolol treatment would surely be a wonderful, cheap and relatively easy way to help long-term sufferers of PTSD if it pans out.

The articles I've read about the Brunet and Pitman research suggest these researchers are thinking that the mechanism for the Propranolol effect lays in its ability to block the storage or re-storage of trauma memories. However, another explanation is also possible. It might be enough that the drug simply blunts the PNS arousal and activation that would normally occur when trauma memories are discussed. The result would be that the patient would have an experience of talking about trauma without feeling as overwhelmed and this would translate into new learning which would potentially intermingle with prior trauma learning and lessen the overall intensity of the trauma memory.

Ultimately, it don't much matter how it works, if it works. I'm glad to see progress being made so that people will maybe suffer less.

Mark Dombeck, Ph.D.

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Presently, he is an Oakland Psychologist (Lic#PSY25695) in private practice offering evidence-based acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) and addressing a range of life problems. Contact Dr. Dombeck by calling 510-900-5123, send Dr. Dombeck email or visit Dr. Dombeck's practice website for more information.

    Reader Comments
    Discuss this issue below or in our forums.

    Propanolol treatment - Willy - Dec 7th 2012

    I saw the McGill psychologist speak about this PTSD research. The propanolol was not given continuously and not given without another key factor.

    Patients were given the medication, then asked to write or describe their trauma in detail, so they 're-lived' the incident with a therapist, while under the effects of the medication.

    Many of those who received this treatment, although they still remembered the event in detail, had less fear/emotional reaction to it later, while on no medication.  The effects appeared to be long lasting (at least months).  

    The reasons for this effect are unknown, however, propanolol is very well tolerated in low dose by most people, but it probably should be used in conjunction with a therapy session like was done in the studies.  Repeat treatments over time may be needed but long-term studies are pending.

    Propranalol provided much relief - BJH - Aug 18th 2010

    Live in grandson received much relief from propranalol and EMDR.  After years of severe PTSD symptoms following severe abuse, he is laughing, singing and more organized.

    ptsd - chris - Apr 30th 2010

    I've been battling the after effects of something that happened almost five years ago and believe I have PTSD.  I need some help with this, as there are numerous triggers to the event.  I've been trying to go and "act as if" I'm ok when deep down inside I am not sure If I can continue going like this.  I'm apprehensive with trying medications, as some of the side effects concern me as well.  I'd like to get back to living again, as it has taken not only a tremendous toll on me, but my family as well.  I used to be more outgoing and have found that it is getting harder to get out of the outside, drive, etc.

     

    Any insight would be helpful.

    fearful - vicson - Mar 2nd 2010

    Sometimes,truly this research would be helpful;with this findings I have a simple question that bothers the research.Presently at this time is this research and kind of somewhat medical findings really used and practiced widely today?because I assume if this findings is trusted and widely used by many today only means that this helps and also accepted by many and that this findings is allowed legally. And this research is my choice of making a term paper this may also encounter a problem with those who study moral theories with every human individual.

    meds and anxiety ptsd - - Sep 6th 2009

    if you have ever experienced or watched someone with ptsd anxiety the condition its self makes the person numb,depersonalise,detatched from reality,feel like they are looking through a fog and are not realy here.no feeling for loved ones,going crazy, etc the list goes on .depending on other drugs ie a mixture as some people are on for this condition propranolol does not have the sedative efect as of chlorpromazine etc which are antipsychotic meds sometimes used to try to help with this condition,which can then confuse, is it the meds or the anxiety that is causing the tired drowsy not here feelings,because they can both cause the same .in my case the propranolol does not.hope this helps,my thoughts are with anyone with this condition or trying to help someone get through it.find a helpline,that could be useful when you feel scared and alone.

    This medication is a Godsend - - Apr 24th 2009

    For as long as I can remember, I have had an unusually high fight/flight response. The simple act of switching lanes on the freeway would cause a surge of adrenaline to course through me. It would take a long time to subside. Moving through my daily life, I was constantly tense.  And for over twenty years, I suffered through at least four migraines per month, most lasting three days. It wasn't until a year ago that I began looking at medication for these problems. I just figured that everyone has problems and I'm no different. I worked through blinding headaches and tolerated anxiety so bad it felt like I had ice in my veins.  I finally sought medical attention for my migraines when a friend reported good results with Maxalt. That drug did remove my migraines once they started. It took at least half a day to recognize the migraine, take the medication, slow down and let it work, then feel extremely sleepy for a few hours. But it worked. Since the migraine medication worked, my doctor suggested trying an anti-depressant as a preventative medicine. For three months, I took Celexa. Celexa made me so tense I had to take it in combination with Ativan! Every day I was taking an anti-depressant and a tranquilizer. My doctor thought I was taking too much Ativan (.5 mg per day). But without it, I was so tense I could scarcely walk. Finally, I had enough and tapered off the both drugs. The migraines came back in full force.I found a different doctor who suggested beta blockers. I feel like a whole, real, normal person. No longer plagued by unreasonable fear to ordinary situations, I move freely, sweetly throughout my day. I have been a longtime meditator and have practiced yoga. I get lots of exercise and eat a diet of whole foods. But I could not control the surges of adrenaline that were constantly being unleased in my bloodstream. I don't know if it is hereditary or a consequence of being raised in a highly unstable environment and today I don't really care because I have relief. My memories and my emotional responses are the same as ever...rich and meaningful and rewarding. I am a person who leads others and who participates in many wonderful activities! If anything, the beta blockers help me be more present in each moment because I'm not experiencing a rush of fear of being late or a sudden paranoia that I will forget what I'm supposed to say.  This spiritual, natural-food yogini is grateful that someone invented this cure. I have not had any side-effects other than lighter than normal sleep. 

    I thank the Good Lord for this medicine - debbie - Apr 5th 2009

    Inderal helped me feel normal again and it stopped the severe anxiety i felt 24/7. I had no life and could not work or even drive on the highway. after using inderal i could gradually drive again , go to stores ,sit on parking lots( flat open spaces) work, enjoy people and life again. I thank the Good Lord for this medicine and for my Dr.the only draw back is ,i have gained a lot of weight.

    This is a very dangerous and useless drug - - Mar 1st 2009

    I suffered a severe adverse reaction to a medication for depression and anxiety, and then ongoing problems when the offending drug had to be removed c/t.  Because of the severity of the reaction, and the brutal treatment I experienced from doctors, I now have a form of PTSD.  I also happen to take Propranolol, which was prescribed to treat one of the symptoms of the drug reaction--akathisia (severe anxiety and feelings of terror coupled with the inability to sit still.)

    This drug is not helpful in the least for PTSD.  I was given the drug right after I had the reaction, and it has not erased my knowledge of the trauma.  Instead I find the "reversible amnesia", a "side" effect they are now trying to capitalize on, seems to select out recall of positive memories.

    And it is considered a "high alert" medication.  It can cause heart failure, even if you have a healthy heart or bronchospasms, which can be fatal.  It also frequently causes depression, something a PTSD suffered surely can do without.

    correction needed - Mia - Feb 22nd 2009

    "It might be enough that the drug simply blunts the PNS arousal and activation that would normally occur when trauma memories are discussed. "

    It is the SNS activation that is blunted! Poor research.

    And yes, betablockers blunt arousal, thus emotions and endoding, thus memory. People 'skim' through their life, not even aware of it. They might even think that they are well-adjusted...

    You have to know yourself well enough to recognize that there is a change in how you experience things/emotions. Some people can be hit over the head, and would not notice. 

    POLICE AND PTSD - bill rollinson - Feb 18th 2009

    I WAS A POLICE OFFICER FOR 20 YEARS BEFORE I HIT THE WALL.

    I HAVE BEEN SUFFERING FOR 18 YEARS WITH PTSD AND AFTER NUMEROUS MEDICATIONS, ECT AND OTHER MIRACLES OF MODERN MEDICINE WHICH WERE SUPPOSED TO CURE MY AILMENT.

    GUESS WHAT I STILL SUFFER FROM PTSD. AND NOBODY WANTS TO KNOW WHAT IS ALL ABOUT, LEAST OF ALL, THOSE WHOM I ONCE WORKED WITH. THANKYOU FOR YOUR INFORMATIVE SITE

    propanalol - Daniel - Dec 14th 2008

    I have taken beta blockers since last year for anxiety and a sense of being detatched from my own body following a 3/4 month period of isolation.

    The beta blockers at first worked amazingly at removing the sense of detatchment and after taking them for 2 days my anxiety seemed to be 100% gone. after withdrawing for 2-3 days the detatchment will return. I really want to be off it but it seems to help and given that i am now working and have more pressure time wise i dont wanna risk comin off them as i can sense / feel anxiety now even as im still taking the blockers but they have never blunted my emotions or affected my memory. Hope this helps and i hope more people make use of it because unlike many other drugs its quite simple in its formula as far as i know.

    beta blockers - chrissie - Nov 7th 2008

    Obviously there is a place for beta blockers, and a huge need. In the right responsible hands this drug helps so many people. I was diagnosed with Graves disease over 12 months ago, when I was 1st diagnosed my heart rate was nearly 200 beats a minute, I was sure I was dying of a heart attack,I was drastically losing weight even though I was eating more food! I envisioned leaving my 2 daughters alone without me in their life. I felt I couldn't breathe as my thyroid and my stress levels were uncontrollable. It takes some months for the thyroid meds to kick in and do their job,SO, I was put on beta blockers, they made me take control again and feel I had the strenghth to fight Graves, in the early days the beta blockers were lifesaving,as I got better I needed them less and less, until finally I stopped taking them without any side effects or withdrawals.

    Large and Grandios statements from someone who's never been there... - - Aug 12th 2008

    You read or heard one doctor's statements and possible concerns, and now you are an expert on other people concerns and medical needs- If you care about other people and appreciate an open mind. Please open yours a little. And maybe your heart too. Did you read what some of the the commentators said about their own experience. These are not drugged, numb zombies, but people who need(ed) help in gaining back some control over their feelings and their lives. It's not meant to be so hard or such a nightmare. If you've even been close to someone with these problems or suffered some yourself- I think you'd be saying something very different. I think I'll go take an asprin now- or will I be denying myself the truth of my pain.

    propranolol paranoia - - Aug 9th 2008

    Anyone who has tried propranolol might realize that the first comment from May 2006 is an expression of that author's habituated fear of his/her unknown (because the actual effects of propranolol on a person suffering from an ongoing anxiety problem are clearly, and unfortuntely for that author, outside of his/her experience).

    If you suffer from ongoing anxiety problems, find a decent doctor (in this case, someone polite and kind, that knows how to listen) and make an appointment. First, ask them to give you a full medical assessment. Then explain that you have an ongoing anxiety problem and that you want to try propranolol (it is very likely the doc will already know about the theraputic use of propranolol with anxiety problems). If you are reasonably healthy and don't have a history of asthma (which the doctor should ask you about, amoung other things, and you should tell them truth about your history), there is a very good chance that they will prescribe some for you, probably a low dose tablet (10mg) and a suggestion to 'take one table each morning and evening, as required'. That suggestion does not mean you must take it every morning and evening, or at all. If you can endure your anxiety about visiting the doc long enough to actually go, and actually go to a pharmacist and buy the tablets, then all you have to do is endure your anxiety about taking one.

    Any suggestion that low-dose propranolol is capable of rendering you forever incapable of feeling or remembering positive emotions is just paranoid nonsense.

    To the May 1, 2006 post - - Apr 22nd 2008

    You must not be someone who has PTSD because you wouldn't be saying what you are saying if you did.

     PTSD can rob you of your life and it's not something that easily controlled or treated.  If there is a treatment option out there to improve my ability to get healthier w/ PTSD, hand it over!  I'll take the risk and it's not you who should be judging those who decide to take it!

    Go stick you head back in the sand and remain naive about a disorder you don't understand!

    Propranonal - Christine - Oct 25th 2007

    I have been taking the drug propranonal because I have a hyper thyroid. Until I could have some additional testing done this drug was to be used so I would feel less symptons of my thyroid.  I was unaware that the drug did things to your memories or emotions.  I was watching the show Private practice when they said on there that this drug was used to help Katrina survivors.  My mouth dropped to the floor. All of a sudden I had a reason why I was feeling so numb.  Why for the last few months I was going through life in a daze.  Not to mention my major decreasing sex drive.  I was very angry then at my doctor, at no time was this discussed with me that these things could happen.  They told me that this was a drug to protect my heart and that I was on a small dose.  When I finally got my tests back for my throid they put me on a thyroid drug.  I asked to be taken off the propranonal.  I was told to remain on it even though in the begining this was only to be a temporary med.  I want off!!!  This drug has given me decreased emotions, sex drive and sleeplessness and nightmares.  I'd rather take my chances off the drug and how come the doctors aren't informing their patients?

    Probably doesn't "de-personize" people - Jen - Dec 7th 2006
    Regarding the much earlier comment on the concern that using beta-blockers would rid ppeople of their "personhood"... Doctors have been using beta-blockers for YEARS to treat hypertension and as a protective medicine following heart attack. Hundreds of thousands of people have already taken effective doses of these drugs for extended periods of time (usually at higher doses when given for cardiovascular than for psychiatric purposes). These people have gone through the ups and downs of life and I assume some of them had traumatic experiences while on propranolol. I have yet to hear of anyone complaining about being "depersonized" by having the emotional valence of their memories dampened by propranolol. An interesting analogy to PTSD might be an autoimmune illness. Yes, we all need fully functioning immune systems. Some people's immune systems "go too far" and cause serious disruption to their daily lives and can even be life threatening. These people should take some kind of immunosuppressant if needed. Same with PTSD. Yes, we all have (adaptive) stress responses. But when those adaptive responses overshoot and make someone's life a livng hell, then those responses aren't adaptive anymore.

    Please help me! - - Nov 30th 2006
    I have been suffering for nearly 20 years and this treatment could really help me. I don't want to type out a long history of my problems, but I could really use some basic help from anyone who is taking this medication for PTSD or to help block traumatic memories. What is your daily dose and how many times do you take it a day? How long has your doctor told you that you can take it? I mean, if it helps you, and then going off suddenly makes you fall back to where you were, have you been told that this treatment can go on as long as you need it-possibly for the rest of your life? Were you told that taking a beta-blocker, in any way, for something it wasn't originally intended to treat could potentially have any long term side effects or cause problems with your heart? I have great hope that this might help me, when I've tried everything else and cannot seem to lead close to normal life. I have decent insurance, but I tend to get the kind of doctors who have 5 minutes, don't look up at me, and then leave the room handing me whatever meds they think I need or that I request. It would greatly help me if I could go to my doctor and know exactly what to ask for, dose wise, and to be able to engage her in a conversation with information that I've asked about above from those of you who are doing this right now. PLEASE help me and let me know how the treatment works, so that I too might soon be on the road to a recovery that I never expected would come. Thank you.

    What a load of rubbish - - Nov 28th 2006
    I took it and it helped alleviate my symptoms whilst allowing me to explore the causes of my anxiety with a counsellor. During this period, I got married to my husband. Having got engaged on my 22nd birthday, married on my 25th and just celebrated my 5th wedding anniversary on my 30th birthday, I can still honestly say that my wedding was the most wonderful day and night of my life. In no way are my either my good or painful memories diminished. I still remember how I was bullied at work, how I coped through a major op at 22, how I thought I had cancer at that age as well as losing the plot and developing a bizarre phobia. The drug simply gave me time to cope, and train my body not to respond to all stimuli with abandon. At the end of the day, if it works for you, take it.

    reaction to other comment - - Nov 27th 2006
    The other comment irritated me to the point that I had to respond. Why should we think the people given the propranalol are being robbed of their personhood? They're not becoming emotionless zombies who can't react to suffering. It's just that their own suffering is somewhat alleviated. As Roger Pitman said in the recent 60 minutes special, we wouldn't think of withholding morphine from a guy in intense pain after an accident. Mental illness should not be different. I don't like this reasoning that we can't alleviate intense suffering because it's dehumanizing to suffer less. If that's so, why not let little kids with terminal illnesses die agonizing deaths? Wouldn't it be dehumanizing to lessen their pain?

    propranalol - - May 1st 2006
    After reading your article I was greatly dismayed to note that you would class the memory suppression induced by beta blockers as beneficial. These drugs do not only 'supress' memory, they remove the emotional attatchment of memories both long and short term. They are also not selective about which memories will be be stripped of thier emotive content and can desensitise futher emotive responses, i.e. to graphic or disturbing imagery. Do you value the memory of your wife on your wedding day? The pivotal experiences through which you establish meaning in your life? Would you, for all your triumphs over adversity, through difficulties which have hindered you in some ways yet enriched your life in others think it worth it for them to be rendered obselete in a matter of hours? Is it a good thing to veiw images of injured and dying people and feel nothing? "If you disrupt those memories, remove continuity, what you have is an erosion of personhood." This was said by Dr. William B. Hurlbut, a consulting professor in biology at Stanford University and a member of the President's Council on Bioethics, I am deeply comforted that someone has the broad mindedness to consider the humanistic and ethical side of issues pertaining to the use of these drugs in an unbiased manner. I find the research alluded to in your article disturbing due to the casual nature in which it is expressed. An overdose or a mis-diagnoses due to oversensitivity to a beta-blocker such as propranolol can shatter somebodies life, or more to the point shatter somebody, leaving them with serious mental health difficulties and a complete inability to cope with the altered state in which they may find themselves.

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