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Cited by 964Posttraumatic Stress Disorder ResearchPsychoanalysis and Psychopathology ResearchTraumatic Brain Injury Research

Pilot study of secondary prevention of posttraumatic stress disorder with propranolol

Pitman, Roger K., Sanders, Kathy M., Zusman, Randall M., Healy, Anna R., Cheema, Farah, Lasko, Natasha B., Cahill, Larry, Orr, Scott P.·2002·Biological Psychiatry
DOI 10.1016/s0006-3223(01)01279-3
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Abstract

Background Preclinical considerations suggest that treatment with a beta-adrenergic blocker following an acute psychologically traumatic event may reduce subsequent posttraumatic stress disorder (PTSD) symptoms. This pilot study addressed this hypothesis. Methods Patients were randomized to begin, within 6 hours of the event, a 10-day course of double-blind propranolol (n = 18) versus placebo (n = 23) 40 mg four times daily. Results The mean (SD) 1-month Clinician-Administered PTSD Scale (CAPS) score of 11 propranolol completers was 27.6 (15.7), with one outlier 5.2 SDs above the others' mean, and of 20 placebo completers, 35.5 (21.5), t = 1.1, df = 29, p =.15. Two propranolol patients' scores fell above, and nine below, the placebo group's median, p =.03 (sign test). Zero of eight propranolol, but six of 14 placebo, patients were physiologic responders during script-driven imagery of the traumatic event when tested 3 months afterward, p =.04 (all p values one-tailed). Conclusions These pilot results suggest that acute, posttrauma propranolol may have a preventive effect on subsequent PTSD.

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  • 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).”

    From Resolution of flashbacks of PTSD with propranolol: A case report (2016) · cites this paper as [18]

  • 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”

    From Resolution of flashbacks of PTSD with propranolol: A case report (2016) · cites this paper as [18]

  • Beneficial effects of combining propranolol with trauma reactivation have been reported in a recent small randomised controlled trial and three earlier pilot studies; however, negative outcomes have also been reported.

    “Beneficial effects of combining propranolol with trauma reactivation have been reported in a recent small randomised controlled trial (Brunet et al., 2018) as well as in three earlier pilot studies (Brunet et al., 2008;Pitman et al., 2002;Vaiva et al., 2003); however, negative outcomes have also been reported (Hoge et al., 2012;Wood et al., 2015).”

    From Novel pharmacological targets in drug development for the treatment of anxiety and anxiety-related disorders (2019) · cites this paper as Pitman et al., 2002

  • Administration of propranolol (a beta-adrenergic antagonist) in the hours after trauma exposure limits subsequent reactivity to reminders.

    “administration of propranolol (a beta-adrenergic antagonist) in the hours after trauma exposure limits subsequent reactivity to reminders 68”

    From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [68]

  • The initial trial of propranolol found that it resulted in reduced subsequent reactivity to trauma reminders, even though it did not reduce the severity of PTSD.

    “As noted above, the initial trial of propranolol found that it resulted in reduced subsequent reactivity to trauma reminders, even though it did not reduce the severity of PTSD 68 .”

    From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [68]

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Authors
Pitman, R. K., Sanders, K. M., Zusman, R. M., Healy, A. R., Cheema, F., Lasko, N. B., Cahill, L., & Orr, S. P.
Affiliations
  • Harvard University (US)
  • University of California, Irvine (US)
Corresponding author
Pitman, Roger K.
ORCID
Venue
Biological Psychiatry
Publisher
Elsevier BV
Published
2002-01
Volume
51
Issue
2
Pages
189-192
ISSN
0006-3223 (ISSN-L)
DOI
10.1016/s0006-3223(01)01279-3
OpenAlex
W2026396276
Cited by
964
References
11
Citations by year
2026: 6 · 2025: 8 · 2024: 11 · 2023: 16 · 2022: 21 · 2021: 32 · 2020: 22 · 2019: 41 · 2018: 65 · 2017: 26 · 2016: 30 · 2015: 51 · 2014: 51 · 2013: 49 · 2012: 53
FWCI
54.91
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Biological Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01mh058671-02)
  • National Institute of Mental Health (MH58671)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
post-traumatic stress disorder, propranolol, beta-blockers, secondary prevention, early intervention, script-driven imagery, physiological reactivity, Clinician-Administered PTSD Scale
MeSH terms
Accidents, Traffic, Adult, Arousal, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Emergency Service, Hospital, Female, Humans, Male, Pilot Projects, Propranolol, Stress Disorders, Post-Traumatic

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