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Pilot study of secondary prevention of posttraumatic stress disorder with propranolol
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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“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]
In the citing paper
“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]
In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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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Metadata
- 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.
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2002-01
- Volume
- 51
- Issue
- 2
- Pages
- 189-192
- ISSN
- 0006-3223 (ISSN-L)
- 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
- 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 › Clinical Neurology › 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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