Trauma reactivation under the influence of propranolol: An examination of clinical predictors

Université de Montréal, Montréal, QC, Canada.
European Journal of Psychotraumatology (Impact Factor: 2.4). 02/2012; 3. DOI: 10.3402/ejpt.v3i0.15470
Source: PubMed

ABSTRACT

In two recent studies conducted by our group, a treatment combining propranolol with a brief reactivation session subsequently reduced posttraumatic stress disorder (PTSD) symptom severity and diagnosis, as well as reducing psychophysiological responses during trauma-related script-driven imagery. One likely explanation for those results is that memory reconsolidation was blocked by propranolol.
We explored the influence of various predictors on treatment outcome (i.e., PTSD severity), and whether the treated individuals improved in other important domains of functioning associated with PTSD.
Thirty-three patients with longstanding PTSD participated in a 6-week open-label trial consisting of actively recalling one's trauma under the influence of propranolol, once a week.
Treated patients reported a better quality of life, less comorbid depressive symptoms, less negative emotions in their daily life and during trauma recollections. Women were also found to improve more than men. Type of trauma (childhood vs. adulthood), time elapsed since trauma, borderline personality traits, depressive symptoms severity, Axis I comorbidity, and age did not influence treatment outcome.
These results must await publication of a randomized-controlled trial to further delineate effectiveness with this novel treatment approach.

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Available from: Alain Brunet, Feb 19, 2015
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    • "Fear memories were then tested at a later 230 time point, in a drug free state. Propranolol treatment attenuated physiological fear measures 231 (Brunet et al., 2008Brunet et al., , 2011Brunet et al., , 2014Kindt et al., 2009;Soeter & Kindt, 2011, 2012), and both men 232 and women with chronic PTSD reported a better quality of life (Poundja et al., 2012). Collectively, these data appear to strongly suggest that propranolol effectively blocks the 234 reconsolidation of fear memories in both healthy volunteers and individuals with PTSD. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) has been described as the only neuropsychiatric disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted individuals. PTSD is characterized by heightened noradrenergic signaling, as well as a resistance to extinction learning. Research aimed at promoting more effective treatment of PTSD has focused on memory erasure (disrupting reconsolidation) and/or enhancing extinction retention through pharmacological manipulations. Propranolol, a β-adrenoceptor antagonist, has received considerable attention for its therapeutic potential in PTSD, although its impact on patients is not always effective. In this review, we briefly examine the consequences of β-noradrenergic manipulations on both reconsolidation and extinction learning in rodents and in humans. We suggest that propranolol is effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly preventing or dampening the later development of PTSD. In individuals who have already suffered from PTSD for a significant period of time, propranolol may be less effective at disrupting reconsolidation of strong fear memories. Also, when PTSD has already developed, chronic treatment with propranolol may be more effective than acute intervention, given that individuals with PTSD tend to experience long-term, elevated noradrenergic hyperarousal.
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    • "However, memory reconsolidation blockade has shown promise in animal models of drug dependence (e.g., Przybyslawski et al. 1999), indicating that more work may be needed to translate the animal model of drug dependence to a therapeutic intervention that can be tested the clinic. It may be premature to rule out an inhibitory role for propranolol in reconsolidation blockade of smoking-related memories until trials are done in recently abstinent smokers, with a range of doses (e.g., Poundja et al. 2012) and with repeated propranolol administration in order to detect whether a greater, longer lasting effect of reconsolidation blockade on smoking-related memories can be obtained. "
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    ABSTRACT: Smoking cue exposure reactivates salient smoking-related memories, triggering craving to smoke, a phenomenon associated with maintenance of smoking behavior and relapse after periods of abstinence. Acute β-adrenergic blockade with propranolol reduces physiologic reactivity during subsequent recollection of traumatic events by inhibiting reconsolidation of reactivated memories in a process called memory reconsolidation blockade. The objective of this study is to determine whether a single dose of propranolol prior to retrieval of smoking-related memories reduces subsequent physiologic reactivity to personally salient smoking imagery scripts in current smokers. Fifty-four overnight-abstinent, adult smokers received a single-dose propranolol or placebo prior to reactivation of smoking-related memories in a randomized, double-blind, placebo-controlled trial and resumed smoking afterward. One week later, skin conductance (SC), heart rate (HR), left corrugator electromyogram (EMG), self-reported emotional state, and craving were assessed following script-driven imagery with neutral and personalized smoking-related scripts. Smoking scripts were associated with increased physiologic activation (SC, HR, EMG), craving, and negative emotional state compared with neutral scripts. Propranolol did not moderate the effect of script type on any outcome. Personalized smoking script-driven imagery robustly increased physiologic activation, negative emotional state, and craving, and a single dose of propranolol prior to memory reactivation did not moderate this effect.
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    • "Second, reconsolidation disruption by noradrenergic receptor antagonism is memory specific and does not eliminate associated or nonreactivated memories (Bernardi et al, 2006; Kindt et al, 2009; Otis et al, 2013; Przybyslawski et al, 1999; Soeter and Kindt, 2011). Third, noradrenergic receptor blockade during reconsolidation has been shown to improve quality of life in patients with PTSD (Brunet et al, 2011; Poundja et al, 2012). Finally, noradrenergic receptor blockade during reconsolidation is capable of reducing cue-induced drug cravings (Saladin et al, 2013), suggesting that such therapy could limit relapse susceptibility. "
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    ABSTRACT: Emotional and traumatic experiences lead to the development of particularly strong memories that can drive neuropsychiatric disorders, such as posttraumatic stress disorder (PTSD) and drug addiction. Disruption of these memories would therefore serve as a powerful treatment option, and targeting the pathologic emotional, but not declarative, component of a memory would be ideal for clinical intervention. Research reveals that after retrieval of a consolidated memory, the memory can be destabilized, and must then be reconsolidated through synaptic plasticity to allow subsequent retrieval. Disruption of reconsolidation-related plasticity would therefore impair specific, reactivated memories. Noradrenergic signaling strengthens synaptic plasticity and is essential for encoding the emotional components of memory. Consistent with this, investigations have now revealed that noradrenergic signaling is a critical mechanism for reconsolidation of emotional memories in rodent and human models. Here, we discuss these investigations and promising clinical trials indicating that disruption of noradrenergic signaling during reconsolidation may abolish the pathologic emotional, but not declarative, component of memories allowing alleviation of neuropsychiatric disorders including PTSD and drug addiction.
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