RESEARCH USING PROPRANOLOL TO TREAT PTSD [POST TRAUMATIC STRESS DISORDER] AND MY EXPERIENCE WITH PROPRANOLOL.
I mistakenly thought that there were some research studies supporting prescribing propranolol for treating PTSD. In reviewing the research literature that I was able to find, there was not much support for this use of propranolol. I reviewed an article entitled: Propranolol for Post-Traumatic Stress Disorder: A Review of Clinical Effectiveness by Calvin Young and Robyn Butcher in Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Mar 18. This was a comprehensive review of studies that were considered to have reliable results. Initially they reviewed the literature confirming why it was felt that propranolol was an excellent candidate to reduce PTSD symptoms based on how it works in the brain by blocking the beta receptors that then would down regulate epinephrine and norepinephrine responses during trauma or as activated by recalling traumatic experiences. There were a number of studies showing that propranolol 40 mg tablets given after traumatic events but prior to traumatic memory activation, was able to decrease the severity of PTSD symptoms. However, no studies were identified that showed propranolol reducing the severity of PTSD symptoms after traumatic events were recalled with the doses in the range of 60-80 mg of tablet form of propranolol and 60-100 mg of the long acting er form or propanolol. There was one study that used 240 mg for 3 months and also did not find any benefit from propranolol.
I believe that the lack of benefit from the propranolol may have been because the doses of propranolol were not managed individually in order to obtain an optimal [effective] dose for each person the results were not positive. 240 mg can be an effective dose and yet again the dose was not titrated until there was a benefit to determine the optimal dose. My experience is not that propranolol extended release or tablet form is always successful in significantly lowering PTSD symptoms, but it was frequently very helpful.
Also , my patients did not experience side effects except for a small number who initially had symptoms of lightheadedness or fatigue or nausea. These symptoms were related to the propranolol lowering blood pressure by blocking the beta receptors in the body. I discovered that if the propranolol was stopped for 10 days and restarted the blood pressure related symptoms did not recur. It was as if the brain had learned that the propranolol was needed to have an effect in the brain and not in the body. After my patients were able to take propranolol with no blood pressure lowering symptoms they did not experience any other side effects. In addition, this means that none of my patients experienced any toxicity from the propranolol. Toxicity is usually experiened at higher doses starting at around 2 grams/ kilogram. The highest doses I prescribed were 1-1.2 grams/kilogram.
In a future blog I will discuss the PTSD symptoms that were lowered by the propranolol and the changes to much more successful coping strategies that my patients were able to utilize.
