Is Propranolol Administration Following a Traumatic Event Effective in Reducing Symptoms of Post-Traumatic Stress Disorder?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not propranolol administration following a traumatic event is effective in reducing symptoms of post-traumatic stress disorder (PTSD). STUDY DESIGN: Review of three English language randomized, double-blind, placebo-controlled clinical trials published in 2002, 2007, and 2010. DATA SOURCES: Three randomized, double-blind, placebo-controlled clinical trials found using PubMed and Cochrane Library databases. OUTCOMES MEASURED: The incidence of PTSD symptoms was measured in patients following traumatic events after the administration of propranolol. This was done using The Screening Tool for Early Predictors of PTSD, the Clinician Administered PTSD Scale for Children and Adolescents, the Clinician Administered PTSD Scale (CAPS), Script-driven Imagery, The Acute Stress Disorder Scale, the CIDI Modules for PTSD, MDD, and panic disorder, the DSM-IV, and The Posttraumatic Stress Disorder Checklist. RESULTS: Three randomized, double-blind, placebo-controlled studies comparing propranolol to placebo were reviewed. The Nugent study demonstrated a clinical benefit of propranolol vs. placebo in PTSD symptoms in a pediatric sample. The Pitman study showed inconclusive results for using propranolol over placebo in incidence of PTSD symptoms in an adult sample. The Stein study did not show a difference in incidence of PTSD symptoms in propranolol vs. placebo in an adult sample. CONCLUSION: While it remains inconclusive at this time as to the benefit of propranolol in reducing PTSD symptoms, two of the trials support the clinical feasibility of this hypothesis. Further studies are warranted to investigate the relationship between propranolol administration and the development of PTSD symptomatology