Treatment of PTSD by Reduction of Traumatic Memory Reconsolidation by Propranolol : a Multisite Trial
Condition: Post-traumatic Stress Disorder
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study is to test whether propranolol, when given during a re-evocation of
      a traumatic memory, is capable of reducing subsequent PTSD symptoms associated with that
      memory.
    

Detailed description: 
      Post-traumatic stress disorder (PTSD) develops following an exposure to a life threatening
      event. One of the characteristic features of PTSD is the recurrence of intrusive memories of
      an experienced trauma. The persistence of disturbing traumatic memories in PTSD is often
      explained in terms of a trauma-induced enhancement of memory encoding. Several studies
      indicate that an increased noradrenergic activity during trauma enhances the encoding of
      memory. Elevated levels of norepinephrine in the cerebrospinal fluid of individuals with PTSD
      and the correlation of this elevation with the severity of PTSD symptoms suggest that
      increased noradrenergic activity is also involved in the maintenance of PTSD symptoms.
      Reactivation of memory by retrieval also renders the memory labile and susceptible to
      treatments. This latter process is referred to as memory reconsolidation. Consolidation and
      reconsolidation both occur within a distinct time window following new learning (in
      consolidation) and/or retrieval (in reconsolidation). Even well-consolidated old fear
      memories undergo reconsolidation and may be disrupted by means of pharmacological
      manipulation. Propranolol may be effective in treating PTSD long after symptoms have been
      consolidated. Propranolol given after reactivation of the memory of a past traumatic event
      reduces physiologic responding during subsequent mental imagery of the event.

      HYPOTHESE: Subjects with chronic PTSD who receive propranolol before trauma evocation will
      subsequently show decreased PTSD symptoms, compared to subjects who receive a placebo.

      METHOD: 56 participants with chronic PTSD will be recruited for participation. On Week 1, the
      subjects will complete a standardized measure of PTSD symptoms. Next, 90 minutes after the
      administration of the study medication (either propranolol or placebo), participants will
      undergo a script preparation procedure, during which they will disclose details of their
      traumatic event. Scripts portraying this event will be prepared for subsequent replay.

      On Week 2, after the administration of the study medication (either propranolol or placebo),
      participants will be asked (reading the script) to engaged in a script-driven mental imagery
      of the traumatic event. Following this procedure, PTSD symptoms will be assessed.

      The same procedure will be repeated on Weeks 3, 4, 5 and 6. On Weeks 7 and 18, the
      standardized measure of PTSD symptoms will be repeated.
    

Intervention name(s): Propranolol; Trauma reactivation; placebo
Intervention type(s): Drug; Other; Drug
Intervention description(s): Trauma reactivation: script-driven mental imagery of the traumatic event
Intervention MeSH terms: Propranolol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: PTSD, Propranolol