PTSD: How this Drug and Talk Therapy Can Help

The disturbing memories of traumatic events by survivors of abuse, rape, crime, war, or accidents who are afflicted with post traumatic stress disorder (PTSD) might respond to a little-known experimental treatment that combines a well-known drug with talk therapy.

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The drug is the beta-blocker propranolol (a trade name is Inderal), which is already given to some patients with abnormal heart rhythms, migraines, or performance anxiety. The talk therapy is several sessions of describing the traumatic event in a therapeutic setting 1 to 1 1/2 hours after administrating the drug by mouth. That's when it’s most available to nerve cells in the brain.

The results after six sessions showed a significant decrease in PTSD symptoms compared to a control group, as reported by Brunet and colleagues.

PTSD has been in the news so much that it can be taken for granted, but that doesn't make it easy for people to cope with. It follows a major stressful experience, and its symptoms can include re-experiencing the event in memories, dreams, or flashbacks, avoiding reminders of the event, excessive arousal that might for example lead to sleep problems or irritability, and a delayed onset after the stressful event.

In contrast to too many studies that boast of neuroscience findings about trivial topics—something like "Your brain lights up on bingo"—or based on flawed methods, these studies targeted a serious problem and were done by competent investigators.

They based their work on neuroscience evidence that threatening memories were saved for the long term by the amygdala—an almond-sized structure in the brain—with the help of noradrenaline or its cousin, adrenaline, the same chemical transmitter that can stimulate the heart or combat a serious allergic reaction. That means that opposing such effects in amygdala nerve cells with the beta-blocker drug can reduce the long-term storage of threatening memories after they have been reactivated in a controlled therapeutic manner.

Cognitive behavioral therapy can be a beneficial treatment in itself. Another treatment method is eye movement desensitization and reprocessing (EMDR). Drugs can improve the mood and sleep problems that can accompany PTSD. But what I'm describing is a new combination of a specific drug followed by psychotherapy sessions, an experimental treatment that may be applied more widely in the future. Current research, although limited, suggests propranolol to be an effective option for PTSD treatment.

Propranolol is a beta-adrenergic blocker, blocking the effects of adrenaline or noradrenaline. The amygdala has received a great deal of attention recently, but Joseph LeDoux, a well-known researcher in this field, suggests that it is only part of a "threat detection system." More is being learned about its connections to the cerebral cortex, including this one.

Another drug that blocks a different type of adrenergic effect is the alpha-adrenergic blocker Prazosin, which can be used to lower blood pressure. It's been found to reduce the frequency of nightmares that can interfere with sleep, and sleep is a problem in over 70% of PTSD patients. This has been offered in some VA facilities with positive effects.

More recently, a completely different drug, D-cycloserine, together with virtual reality, was used in another study of PTSD. The drug was given prior to therapeutic exposure in which trauma-related stimuli were presented in virtual reality. In a randomized pilot study by Difede and others in 2014, this treatment given for six weeks led to a significant improvement in symptoms compared to a placebo group. The idea here is that the drug may enhance learning that extinguishes fear responses. "These results suggest a promising new treatment for PTSD," according to the authors.

This is not medical advice, and to avoid adverse effects, consult your physician when considering these types of therapies. Do not try them on your own.

Antidepressants like Zoloft (sertraline) are drugs often used in treating the mood symptoms of PTSD. But the drugs described here are focused on the causes of the disorder rather than just the symptoms.