Traumatic memory reactivation with or without propranolol for PTSD and comorbid MD symptoms: a randomised clinical trial

Abstract

Post-traumatic stress disorder (PTSD) is difficult to treat but one promising strategy is to block memory reconsolidation of the traumatic event. This study aimed to evaluate the efficacy of traumatic memory reactivation under the influence of propranolol, a noradrenergic beta-receptor blocker, in reducing PTSD symptoms as well as comorbid major depression (MD) symptoms. We conducted a double blind, placebo-controlled, randomised clinical trial in 66 adults diagnosed with longstanding PTSD. Propranolol or a placebo was administered 90 min before a brief memory reactivation session, once a week for 6 consecutive weeks. Measures included the SCID PTSD module, the PTSD Check List (PCL-S) and the Beck Depression Inventory-II (BDI-II). PTSD symptoms decreased both in the pre-reactivation propranolol group (39.28%) and the pre-reactivation placebo group (34.48 %). During the 6 treatment sessions, PCL-S and BDI-II scores decreased to similar extent in both groups and there were no treatment differences. During the 3-month follow-up period, there were no treatment effects for the mean PCL-S and BDI-II scores. However, in patients with severe PTSD symptoms (PCL-S ≥ 65) before treatment, PCL-S and BDI-II scores continued to decline 3 months after the end of treatment in the propranolol group while they increased in the placebo group. Repeated traumatic memory reactivation seemed to be effective for PTSD and comorbid MD symptoms. However, the efficacy of propranolol was not greater than that of placebo 1 week post treatment. Furthermore, in this traumatic memory reactivation, PTSD symptom severity at baseline might have influenced the post-treatment effect of propranolol.

Trial registration: ClinicalTrials.gov NCT01713556.

Fig. 1. Participant flow diagram.

Eligible participants were randomly assigned to group treatments (propranolol = “traumatic memory reactivation + propranolol” group; placebo = “traumatic memory reactivation + placebo” group). Four patients did not meet the inclusion criteria (no PTSD n = 1 and PCL-S < 45 at W1 n = 3). W week.

Fig. 2. Change in PTSD and MD symptoms during the treatment period.

A Mean PCL-S score. 33 patients attended the first treatment session and 29 during week 7 for both groups. B Change in MD symptoms during the treatment period. PCL-S = PTSD Checklist; BDI-II = the Beck Depression Inventory-II, propranolol = “traumatic memory reactivation + propranolol” group; placebo = “traumatic memory reactivation + placebo” group.

Fig. 3. Change in PTSD and MD symptoms based on initial PTSD severity before treatment.

A Change in PTSD symptoms during the treatment period depending on the initial level of PTSD (mean PCL-S score), B change in MD symptoms during the treatment period depending on the initial level of PTSD (mean PCL-S score). Propranolol = “traumatic memory reactivation + propranolol” group; Placebo = “traumatic memory reactivation + placebo” group. *p < 0.05, **p < 0.01.