Preventative Treatment

The First Preventative Treatment in Psychiatry

Although there is some disagreement about this, there is exciting evidence that propranolol (Inderal), a generic beta blocker, prevents PTSD from developing. The procedure is to start the propranolol in the first few days after the trauma.

What is propranolol? Propranolol is a cheap, generic medicine that blocks the effects of adrenelin in the body. Many of your cells have adrenelin receptor sites. You might visualize these receptor sites as iron teacups sitting on, say, your heart cells. Visualize an adrenelin molecule as a tennis ball floating around in your bloodstream until it finds that iron teacup and drops into it. When it does so, it activates the heart cell to beat faster and harder, so you can run or climb stairs. Now visualize propranolol as a refrigerator magnet. Propranolol molecules (refrigerator magnets) love adrenelin receptor sites (iron teacups). When propranolol finds an adrenelin receptor site, it sticks to it like a refrigerator magnet. Propranolol does not do anything to the adrenelin receptor site. It just keeps adrenelin from doing to the receptor site what adrenelin usually does, by blocking the adrenelin from entering the receptor; just as the refrigerator magnet over the teacup blocks the tennis ball from entering the teacup. So, a person who has been startled by a loud unexpected noise, “Boo!” from behind by a prankster in a spooky place will have a surge of adrenelin which will trigger the heart to beat harder and faster. That is unless, the victim has taken a propranolol pill an hour before the “Boo!”. The propranolol will block that person’s adrenelin surge from causing their heart to race and pound. Propranolol does not do anything to the victim; it just keeps adrenelin from doing would have done to the victim of the prank.

Propranolol is used in medicine for many unrelated conditions such as prevention of migraine headaches, treatment of tremor in persons who work with their hands like surgeons, woodcarvers, watchmakers, tailors and so on.

I have learned that not all beta blockers work in psychiatric use. Propranolol was the first beta blocker. It works well in such psychiatry uses. Surprisingly, modern beta blockers usually don’t work so well as “Old Reliable” propranolol. Why is that? I think it is because the newer ones (with one exception) do not pass through the blood-brain barrier, a membrane which keeps molecules of a certain size or type from passing from the blood into the cerebral spinal fluid (CSF). Beta blockers can’t affect brain cells if it can’t get out of the blood. Cardiologist like beta blockers which stay out of the brain CSF, since they will not cause brain side effects. Well-intentioned cardiologists are always changing my pateint’s propranolol to something more “up-to date” only to cause my patient to relapse with their psychiatric problem which was doing just fine before.

In treating PTSD victims with propranolol, the thinking is that the brain and the body of the victim is being flooded with adrenelin from the fear and excitement they endured and to which they continue to react, even after they are safe. Somehow this excess adrenelin injures, so to speak, the neurons in the brain. (There is evidence of permanent biological changes in the body of  persons with PTSD. A scientific advisor for NAF, Dr. Rachel Yehuda discovered that tissue from PTSD sufferers had increased numbers of glucocorticoid receptors even decades after the trauma.)

Propranolol blocks adrenelin from stimulating adrenelin receptors on brain neurons just as it does in heart cells. The thinking is that the propranolol protects the brain neurons from this surge of brain adrenelin that exists for the first month of PTSD. The dose of propranolol varies from practitioner to practitioner but 20 mg three times a day is common. Others may use 40 mg three or four times a day. The medicine is stopped after 30 days.

It is the first time is psychiatry that we have had a preventative treatment. Usually propranolol is a very safe medicine, although persons with severe pulmonary problems who are on adrenelin-like medicines to be able to breathe may not be able to be prescribed propranolol, as it would be at cross purposes with their asthma or breathing medication.

Do a google search for “PTSD propranolol” and you will get the pro’s and the con’s about this idea of using propranolol to prevent the traumatized person from developing PSTD. I have listed examples for you below. I personally think this is a real benefit. It must be started immediately after the trauma if it is to work permanantly as a prevention. Sadly, by the time PTSD people see a psychiatrist it is often too late for the person to benefit from this regimen of prevention. I hope that emergency medicine departments at hospitals will incorporate this treatment as they are the ones who see most of the traumatized PTSD individuals the frst 24 hours of their PSTD course.

It is very exciting that a simple, non-addicting, $4 for a month supply medicine could prevent a lifetime of horid PTSD emotional pain as disability.
If you are a doctor, please study this area and decide for yourself if you think this may be right for some of your PTSD patients. If you are a PTSD sufferer, ask your doctor about this.

Good luck and God bless.
Propranolol a Promising Treatment for PTSD, Kate Johnson Medscape Medical News, October 5, 2010
Immediate Treatment with Propranolol Decreases Posttraumatic Stress Disorder Two Months after Trauma, Guillaume Vaiva, Franc¸ois Ducrocq, Karine Jezequel, Benoit Averland, Philippe Lestavel, Alain Brunet, and Charles R. Marmar, Biol Psychiatry 2003;54: 947–949 © 2003 Society of Biological Psychiatry