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Cited by 174Posttraumatic Stress Disorder ResearchMemory Processes and InfluencesTraumatic Brain Injury Research

Effect of Acute Posttrauma Propranolol on PTSD Outcome and Physiological Responses During Script‐Driven Imagery

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Hoge, Elizabeth A., Worthington, John J., Nagurney, John T., Chang, Yuchiao, Kay, Elaine B., Feterowski, Christine M., Katzman, Anna R., Goetz, Jared M. +6 more·2012·CNS Neuroscience & Therapeutics
DOI 10.1111/j.1755-5949.2010.00227.xPMC PMC6493400
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Abstract

SUMMARY: Introduction: Animal and human research suggests that the development of posttraumatic stress disorder (PTSD) may involve the overconsolidation of memories of a traumatic experience. Previous studies have attempted to use pharmaceutical agents, especially the β‐adrenergic blocker propranolol, to reduce this overconsolidation. Aims: In this randomized, placebo‐controlled study of the efficacy of propranolol in reducing the development of PTSD, we optimized dosages and conducted both psychophysiological and clinical assessments 1 and 3 months after the traumatic event. Forty‐one emergency department patients who had experienced a qualifying acute psychological trauma were randomized to receive up to 240 mg/day of propranolol or placebo for 19 days. At 4 and 12 weeks post‐trauma, PTSD symptoms were assessed. One week later, participants engaged in script‐driven imagery of their traumatic event while psychophysiological responses were measured. Results: Physiological reactivity during script‐driven traumatic imagery, severity of PTSD symptoms, and the rate of the PTSD diagnostic outcome were not significantly different between the two groups. However, post hoc subgroup analyses showed that in participants with high drug adherence, at the 5‐week posttrauma assessment, physiological reactivity was significantly lower during script‐driven imagery in the propranolol than in the placebo subjects. Conclusions: The physiological results provide some limited support for a model of PTSD in which a traumatic conditioned response is reduced by posttrauma propranolol. However, the clinical results from this study do not support the preventive use of propranolol in the acute aftermath of a traumatic event.

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  • Another 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”

    From Resolution of flashbacks of PTSD with propranolol: A case report (2016) · cites this paper as [19]

    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)

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  • Beta blockers (e.g., propranolol) inhibit the action of norepinephrine and epinephrine at β1- and β2-adrenergic receptors and have shown promise in both animal models and humans when administered during the acute phase of trauma, but results have been mixed.

    “Beta blockers (e.g., propranolol), a class of compounds that are antagonists of β1- and β2-adrenergic receptors, inhibit the action of norepinephrine and epinephrine at these sites and have shown promise in both animal models and humans when administered during the acute phase of trauma, however, results have been mixed (Cahill et al., 1994; Vaiva et al., 2003; Hoge et al., 2012; Bailey et al., 2”

    From Maladaptive autonomic regulation in PTSD accelerates physiological aging (2015) · cites this paper as Hoge et al., 2012

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  • Prolonged administration of the beta-receptor blocking agent propranolol early after trauma did not result in fewer PTSD symptoms.

    “Pharmacologically, prolonged administration of the beta-receptor blocking agent propranolol early after trauma did not result in fewer PTSD symptoms [13,14].”

    From Efficacy of oxytocin administration early after psychotrauma in preventing the development of PTSD: study protocol of a randomized controlled trial (2014) · cites this paper as [13]

  • Administration of propranolol in the hours after trauma exposure does not prevent overall PTSD.

    “although it does not prevent overall PTSD 69,70 .”

    From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [70]

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Authors
Hoge, E. A., Worthington, J. J., Nagurney, J. T., Chang, Y., Kay, E. B., Feterowski, C. M., Katzman, A. R., Goetz, J. M., Rosasco, M. L., Lasko, N. B., Zusman, R. M., Pollack, M. H., Orr, S. P., & Pitman, R. K.
Affiliations
  • Massachusetts General Hospital (US)
  • Harvard University (US)
Corresponding author
Hoge, Elizabeth A.
ORCID
Venue
CNS Neuroscience & Therapeutics
Publisher
Wiley
Published
2011-01-10
Volume
18
Issue
1
Pages
21-27
ISSN
  • 1755-5930 (ISSN-L)
  • 1755-5949
DOI
10.1111/j.1755-5949.2010.00227.x
PMC
PMC6493400
OpenAlex
W1542396424
Cited by
174
References
19
Citations by year
2026: 4 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 13 · 2021: 8 · 2020: 10 · 2019: 12 · 2018: 6 · 2017: 7 · 2016: 15 · 2015: 20 · 2014: 20 · 2013: 27 · 2012: 11
FWCI
20.66
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • CNS Neuroscience & Therapeutics (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (R01MH068603, MH068603)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Memory Processes and Influences
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
propranolol, post-traumatic stress disorder, memory reconsolidation, beta-adrenergic blockade, script-driven imagery, physiological reactivity, medication adherence, injury prevention, emergency department patients
MeSH terms
Adolescent, Adrenergic beta-Antagonists, Adult, Aged, Drive, Electromyography, Female, Follow-Up Studies, Galvanic Skin Response, Heart Rate, Humans, Imagination, Male, Middle Aged, Propranolol, Psychiatric Status Rating Scales, Psychometrics, Retrospective Studies, Severity of Illness Index, Stress Disorders, Post-Traumatic, Medication Adherence, Young Adult

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