Resolution of flashbacks of PTSD with propranolol: A case report
Open accessAbstract
An individual suffering from post-traumatic stress disorder (PTSD) can continue to re-experience the traumatic incident, which can involve a sense of extreme fear. In this article, the authors describe the case of a 36-year-old gentleman in whom the use of propranolol for the management of these persistent PTSD symptoms proved beneficial and led to the resolution of his flashback symptoms following difficulty in initial management with multiple other first-line treatment modalities. Propranolol is currently not licensed for use in PTSD. © 2016 John Wiley & Sons, Ltd.
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Claims the paper makes
3 of 11 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Premisecitation§ Discussion
Brunet et al. found that physiological response to trauma reactivation remained low even four months after treatment.
“Brunet et al. found that the physiological response to trauma reactivation was low even at four months after the treatment.15”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [15] 15. Brunet A, Thomas É, Saumier D, et al. Trauma reactivation plus propranolol is as- sociated with durably low physiological re- sponding during subsequent script-driven traumatic imagery. Can J Psychiatry 2014; 59(4):228-32. source
- Findingown data§ Case presentation
The patient's anxiety score dropped from 9 out of 10 before propranolol to 2-3 out of 10 after propranolol.
“He reported that during the day, his anxiety symptoms had substantially reduced, with a score of 9/10 (pre-propranolol) compared with 2-3/10 (post-propranolol).”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The 1-10 subjective anxiety scale is a valid measure of anxiety.
- Findingown data§ Case presentation
The patient had recurrent flashbacks triggered by the sound of car doors closing.
“He was suffering from regular flashbacks of someone chasing him, which were triggered by the sound of the slamming of car doors”
Quote in the paperNot a substantial claim - Findingown data§ Case presentation
The patient reported a major improvement in his quality of life.
“He reported a great improvement in the quality of his life”
Quote in the paperNot a substantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Premisecitation§ Discussion
Evidence is inconclusive on whether propranolol differs clinically importantly from placebo in reducing PTSD diagnosis at one month (k=1; n=41; RR=1.14, 95% CI 0.55 to 2.35).
“The evidence is inconclusive and so it is not possible to determine if there is a clinically important difference between propranolol and placebo on reducing the likelihood of having a PTSD diagnosis at 1 month (k=1; n=41; RR=1.14, 95% CI 0.55 to 2.35).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] 18. Pitman RK1, Sanders KM, Zusman RM et al. Pilot study of secondary prevention of posttraumatic stress disorder with proprano- lol. Biol Psychiatry 2002;51(2):189-92. source
- Interpretationreasoning§ Case presentation
The patient's clinical presentation strongly suggested PTSD.
“All these features were strongly indicative of PTSD.”
Quote in the paperSubstantial claim - Premisecitation§ Discussion
Limited evidence suggests placebo may be better than propranolol in reducing PTSD diagnosis at three months (k=1; n=41; RR=1.28, 95% CI 0.69 to 2.38).
“There is limited evidence suggesting a difference favouring placebo over propranolol on reducing the likelihood of having a PTSD diagnosis at 3 months' follow-up (k=1; n=41; RR=1.28, 95% CI 0.69 to 2.38).18”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] 18. Pitman RK1, Sanders KM, Zusman RM et al. Pilot study of secondary prevention of posttraumatic stress disorder with proprano- lol. Biol Psychiatry 2002;51(2):189-92. source
- Classified as probably not a substantial claim. 6
- May combine two claims. 16
- The quote only partly states this claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ DiscussionAnother study suggested propranolol reduces intrusive thoughts and psychological stress in newly diagnosed cancer patients.
“Another study suggested that propranolol can reduce the intrusive thoughts in newly diagnosed cancer patients and subsequently reduce psychological stress.16”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] 16. Lindgren ME, Fagundes CP, Alfano CM, et al. Beta-blockers may reduce intrusive thoughts in newly diagnosed cancer patients. Psychooncology 2013;22(8):1889-94. source
The Discussion reports that beta-blocker users had 32% fewer intrusive thoughts than non-users among newly diagnosed breast and colorectal cancer patients, and the Conclusions report less cancer-related psychological distress. But the study examined beta-blockers as a group, not propranolol specifically, and its observational association does not establish that fewer intrusive thoughts subsequently caused less stress. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ DiscussionAnother study suggests propranolol given within hours of trauma reduces physiological responses during later mental imagery of the event.
“Another study suggests that propranolol given within hours of a psychologically traumatic event reduces physiological responses during subsequent mental imagery of the event.19”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [19] 19. Hoge EA, Worthington JJ, Nagurney JT, et al. Effect of acute post trauma propranolol on PTSD outcome and physiological respons- es during script-driven imagery. CNS Neurosci Ther 2012;18(1):21-7. source
The Discussion (page not provided) reports significantly lower physiological responses during later traumatic imagery only in a small, post hoc subgroup with high medication adherence. It also says the full propranolol group did not show a significant reduction versus placebo, so the claim omits an important qualification. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown data§ Case presentationThe patient was a 36-year-old white, single, unemployed man with PTSD and a family history of depression.
“we present the case of Mr A, a 36-year-old white, single, unemployed man suffering from PTSD, with a strong family history of depression.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingreasoning§ Case presentationThe patient's PTSD symptoms had shown little improvement with several prior treatments, including trauma-focused CBT, EMDR, psychodynamic therapy, paroxetine, and risperidone.
“Mr A had been treated with paroxetine and risperidone for the previous 4 years.His depressive symptoms were improving but there was little benefit to the paranoia, flashbacks and nightmares.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown data§ Case presentationThe patient reported no improvement in his paranoia with propranolol.
“He did not report any benefit to his paranoia symptoms.”
Quote in the paperNot a substantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
May combine two claims.
Findingown data§ Case presentationAt follow-up, the patient reported continued benefit and a significant reduction in PTSD symptoms even 10 months after starting propranolol.
“on follow-up was reporting a benefit and a significant reduction in his PTSD symptoms, even after 10 months of commencing propranolol.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
May combine two claims.
Findingown data§ Case presentationIn February 2014, the patient was admitted with recurring flashbacks and nightmares that caused insomnia and anxiety and made him feel suicidal.
“In February 2014, he was once again admitted to the inpatient unit with complaints of recurring flashbacks and nightmares leading to insomnia and anxiety, all of which were making him feel suicidal.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ Case presentationThe patient continued to have nightmares, but his emotional reaction to them was much less intense, he coped better, and he could go back to sleep.
“He stated that although he still experienced nightmares his emotional response to them was significantly lowered: he could cope with them more effectively and was able to go back to sleep, which had not been the case earlier.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
May combine two claims.
Findingown data§ DiscussionIn this case, propranolol produced a clear and lasting benefit at five months, with flashbacks stopping completely and emotional response to nightmares greatly reduced.
“The benefit following the use of propranalol in our case was very clear and sustained even after 5 months: the flashbacks stopped completely and the emotional response to the nightmares was significantly reduced.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingreasoning§ Case presentationAfter propranolol, the patient's alcohol intake fell substantially; after discharge he drank about four cans of lager daily, usually starting late in the evening.
“As his anxiety symptoms reduced and as he felt more relaxed, his alcohol consumption reduced significantly.Following his discharge from the supportive and protective environment of the inpatient unit, Mr A currently drinks about four cans of lager every day and he generally starts his first drink late in the evening.”
Quote in the paperNot a substantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
- Rests on an assumption: The patient's reports of alcohol consumption are accurate.
May combine two claims.
Findingown data§ Case presentationWithin four days of starting propranolol, the patient reported that his flashbacks had completely stopped, he felt relaxed, and his nightmares occurred much less often.
“Within 4 days following the commencement of propranolol Mr A reported a complete resolution of flashbacks along with a relaxed state of mind and a significant reduction in the frequency of his nightmares.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
May combine two claims.
Findingown data§ Case presentationAfter propranolol, the patient was able to participate in EMDR and got a job.
“He was able to engage with EMDR and even managed to get a job.”
Quote in the paperNot a substantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
May combine two claims.
Premisecitation§ DiscussionA Cochrane review found moderate-quality evidence for hydrocortisone in preventing PTSD in adults, and no evidence supporting propranolol, escitalopram, temazepam, or gabapentin for preventing PTSD onset.
“A Cochrane review of pharmacological interventions for preventing PTSD concluded that there is moderate quality evidence for the efficacy of hydrocortisone for the prevention of PTSD development in adults.20 They found no evidence to support the efficacy of propranolol, escitalopram, temazepam and gabapentin in preventing PTSD onset.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] 20. Amos T, Stein DJ, Ipser JC. Cochrane Database Syst Rev 2014;7: CD006239. Phar- macological interventions for preventing post-traumatic stress disorder (PTSD). doi: 1002/14651858.CD006239.pub2. source
May combine two claims.
Interpretationown data§ DiscussionPropranolol treatment led to lower alcohol consumption and better quality of life for the patient.
“It has led to a reduction in alcohol consumption along with an improvement in the quality of the life of the patient.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
- Rests on an assumption: The patient's reports of alcohol consumption are accurate.
May combine two claims.
Premisecitation§ DiscussionPropranolol disrupts consolidation of traumatic memories and can lower physiological response during script-driven imagery of the trauma.
“Propranolol interferes with consolidation of traum a t i c m e m o r i e s a n d t h e physiological response can be lowered while participants engage in script-driven mental imagery of the traumatic event.14”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] 14. A psychophysiologic study of weakening traumatic combat memories with post-reactiva- tion propranolol. (Last updated April 27, 2010) clinicaltrials.gov/ct2/show/NCT00709735?ter- m=propranolol+ptsd&rank=8 (accessed Decem- ber 2015).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ DiscussionBeta-blockers block adrenaline and noradrenaline at beta-1 and beta-2 receptors, which is the proposed mechanism of propranolol.
“Beta-blockers inhibit the binding of these neurotransmitters at the receptors (beta-1 and beta-2 for adrenaline, beta-1 for noradrenaline) -the proposed clinical mechanism of action of propranolol.12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] 12. PTSD. survive.org.uk/PTSD.html (accessed December 2015).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Premisecitation§ DiscussionAdrenaline is believed to help memory consolidation and contribute to re-experiencing symptoms in PTSD.
“Adrenaline is thought to aid memory consolidation, playing a role in the re-experiencing of symptoms of PTSD.11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] 11. Auxéméry Y. Posttraumatic stress disorder (PTSD) as a consequence of the interaction between an individual genetic susceptibility, a traumatogenic event and a social context. L'Encéphale 2012;38(5):373-80
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationown data§ Dr Chandavarkar is a ST5 trainee in General AdultIn this case, propranolol helped persistent PTSD symptoms and resolved flashbacks after other first-line treatments had been difficult.
“In this article, the authors describe the case of a 36-year-old gentleman in whom the use of propranolol for the management of these persistent PTSD symptoms proved beneficial and led to the resolution of his flashback symptoms following difficulty in initial management with multiple other first-line treatment modalities.”
Quote in the paperSubstantial claim- Rests on an assumption: The patient's self-reported symptom changes accurately reflect his clinical state.
- Rests on an assumption: The observed improvements were attributable to propranolol rather than other concurrent factors.
- The authors state this as an assumption: There are case reports from the USA on the use of propranolol in PTSD.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPropranolol is not approved for treating PTSD.
“The use of propranolol to mask the physical symptoms of anxiety is well established but it is not licensed for use in PTSD.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [9] 9. Therapeutic indications Bedranol* (Propranolol Hydrochloride) SR. Availa- ble at https://www.medicines.org.uk/emc/ medicine/21729. Accessed 12 March 2016.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
Interpretationreasoning§ DiscussionPropranolol may reduce memory formation and separate the memory from its emotional response.
“Propranolol may both dampen memory formation and dissociate the memory from the emotional response.”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ DiscussionPeople with PTSD usually have higher noradrenaline and adrenaline levels, which cause stress.
“Patients with PTSD typically have higher levels of noradrenaline and adrenaline, which induce stress.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] 11. Auxéméry Y. Posttraumatic stress disorder (PTSD) as a consequence of the interaction between an individual genetic susceptibility, a traumatogenic event and a social context. L'Encéphale 2012;38(5):373-80
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
The patient's self-reported symptom changes accurately reflect his clinical state.
“Mr A reported a complete resolution of flashbacks”
The paper relies on this without support.
The observed improvements were attributable to propranolol rather than other concurrent factors.
“Within 4 days following the commencement of propranolol Mr A reported a complete resolution of flashbacks”
The authors state this as an assumption.
There are case reports from the USA on the use of propranolol in PTSD.
“we noted a few case reports from the USA of the use of propranolol in PTSD.”
The authors state this as an assumption.
There are not many studies in the UK on PTSD and propranolol; studies are mainly from the USA and Canada.
“There are not many studies done in the UK that specifically address PTSD and the use of propranolol; the studies or case reports are mainly from the USA and Canada.”
The paper relies on this without support.
The 1-10 subjective anxiety scale is a valid measure of anxiety.
“He scored his anxiety on a scale of subjective 1 to 10”
The paper relies on this without support.
The patient's reports of alcohol consumption are accurate.
“his alcohol consumption reduced significantly”
Cites
Diagnostic and Statistical Manual of Mental Disorders
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Posttraumatic Stress Disorder in the National Comorbidity Survey
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Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults
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Full and partial posttraumatic stress disorder: findings from a community survey
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Pilot study of secondary prevention of posttraumatic stress disorder with propranolol
Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., Cahill, L., & Orr, S. P. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(01)01279-3 · Cited by 964 · see citing works
Revised Prevalence Estimates of Mental Disorders in the United States
Narrow, W. E., Rae, D. S., Robins, L. N., & Regier, D. A. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.2.115 · Cited by 807 · see citing works
CREAMER, M., Burgess, P. M., & McFARLANE, A. C. (2001) · Psychological Medicine · doi:10.1017/s0033291701004287 · Cited by 757 · see citing works
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Classification in psychiatry: ICD–10 <i>versus</i> DSM–IV
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Beta‐blockers may reduce intrusive thoughts in newly diagnosed cancer patients
Lindgren, M. E., Fagundes, C. P., Alfano, C. M., Povoski, S. P., Agnese, D. M., Arnold, M. W., Farrar, W. B., Yee, L. D., Carson, W. E., Schmidt, C. R., et al. (2013) · Psycho-Oncology · doi:10.1002/pon.3233 · Cited by 35 · see citing works
Prazosin for the Treatment of PTSD
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A Psychophysiologic Study of Weakening Traumatic Combat Memories With Post-Reactivation Propranolol
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Flagged first, then by citations
Research works printed but not linked: 3
- [10]10. Trautmann S, Schönfeld S, Behrendt S, et al. Association between lifetime PTSD symp- toms and current substance use disorder using a five factor model of PTSD. J Anxiety Disord 2014;29:93-100.
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Cited by
Sorted by citations
Szeleszczuk, Ł., & Frączkowski, D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms231710099 · Cited by 46 · see citing works
- Authors
- Chandavarkar, R., Sangha, S., & Khalil, S.
- Venue
- Progress in Neurology and Psychiatry
- Publisher
- Wiley
- Published
- 2016-03
- Volume
- 20
- Issue
- 2
- Pages
- 10-13
- ISSN
- 1367-7543 (ISSN-L)
- 1931-227X
- OpenAlex
- W2339499408
- Cited by
- 1
- References
- 12
- Citations by year
- 2022: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Progress in Neurology and Psychiatry (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Developmental Neuroscience › Anesthesia and Neurotoxicity Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- post-traumatic stress disorder, propranolol, flashbacks, re-experiencing symptoms, beta-blocker therapy, off-label drug use, treatment-resistant PTSD
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