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This week’s issue of Nature Neuroscience has an article entitled “Beyond extinction: erasing human fear responses and preventing the return of fear.” Well if the title of the article wasn’t enough to get your juices rolling I can tell you that they basically claim that they have discovered a pill that will erase traumatic memories and that could represent a miracle cure for PTSD. Needless to say the journalist hoi poloi have had a field day over this one as they always do whenever they get a sniff of something that smells like a pill that can eliminate the misery of the human condition. The pill, of course, is propranolol, a beta blocker drug that blocks the norepinephrine beta receptors in the brain and has been noted to specifically block these receptors in a brain area called the amygdala, the seat of fear responses in the brain. Giving this drug in rats has been shown to interfere with the development of fear memories.
Most of the hype about propanolol’s effects on fear and other emotions is based on research in rats, which leads me to ask the question, could it have been, perhaps, this particular rat?
This rat is pissed that his, well, humanity is not recognized.
He wouldn’t have been the best cuz he would have had a, er, whadya call it, bad attitude? Having been the giant inflatable rat that made an appearance outside of Pfizer headquarters which led us to send the lolcats We Sel Drugz to the reskew.
Fast forward to humans and whether this drug can prevent the development of PTSD. Harvard psychiatrist Roger Pitman MD did a study of propranolol in ER trauma victims and the data showed that it did not have a statistically significant effect on PTSD symptoms, although it did have an effect on heart rate and blood pressure responses. This didn’t stop the popular press from blowing their horns about this new magic pill that could be used to prevent PTSD. The next study by Vaiva et al also proposed that it demonstrated that propranolol prevented PTSD in acute trauma victims. However this study did not use a randomized, placebo controlled design. It showed that one patient out of 11 developed PTSD on propanolol versus 3/8 who “refused” propanolol in the ER. This is obviously a miniscule difference in a small group, factors that could influence who would “refuse” might affect treatment response, and obviously people who chose the active drug probably believed it would work, leading to a robust placebo response.
Enter the current study. In the background of studies that have been over hyped as preventing PTSD (when they don’t) we now have a study showing that giving propranolol (a drug which lowers heart rate and blood pressure response) to normal people in the context of being re exposed to an upsetting film will result in lower heart rate and blood pressure response the next time they see the film.
And of course their conclusion is that this has major implications for PTSD patients and other trauma survivors.
This is starting to solidify my belief that they shouldn’t allow people from The Netherlands to do research. Oops! I take that back. Don’t want to get cut out on my invitations to Amsterdam, har har har! (and it’s NOT what YOU are thinking! Stop that!)
Let me cut through the bullshit here folks. Propranolol is not the magic bullet for the slings and arrows of outrageous fortune. All they did is show that if you can give a drug that hold down your blood pressure response to a traumatic film that the next time you see the film your blood pressure response will be lower. They also fail to cite the work of Larry Cahill. Who did a pretty similar experiment, as far as I can tell, ten years ago.
You can’t take a pill after a trauma or a grievous loss and make the pain go away.
Propranolol is not the magic pill. Get over it. You need psychotherapy to heal your hurting.
Hat tip to the Beyond Meds blog.
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Ah, the curse of bad science by overstepping the bounds of external validity (and thus overgeneralizing their results to something unrelated!).
The false hope that studies like this provide sends a pain through me for the survivors of trauma… I want to do trauma research/therapy in the future and the inane promises of a panacea sicken me. Not to mention bad science always irks me.
That is a scary rat!
How can they do these studies without normalizing for brain types, Dr. B? In other words, not everyone is going to develop PTSD, so wouldn’t you have to study only those that are more likely to?
My understanding is that untreated ADHD is a risk factor in PTSD. And, if you look at ADHD simplistically, as an overactive amygdala/underactive prefrontal cortex, then perhaps stimulant medication (which regulates the fear response, you could say) would be a preventive measure in soldiers who have ADHD.
Another study out the other day looked at the differences between soldiers who stayed cool under fire and those who didn’t.
Kathryn here from American Lake VA. Can you speak to the connection between the anti-malarial Lariam and psychiatric symptoms such as depression and anxiety? I understand the military is giving it to our soldiers in Afghanistan even though there are effective, less expensive meds. It may be implicated in the Ft. Bragg case of 4 soldiers who killed their wives upon their return from duty.
I don’t have PTSD that I know of so maybe I’d feel differently if I did, but I do not WANT my bad memories erased by a pill. I would have been in the group that refused the pill. Bad memories give a texture to life and add a counterpoint to happiness. Bad memories help us understand ourselves and are a part of what separates adults from children.
Kathryn: Studies show that Lariam causes psychiatric symptoms in about half of people that take it. Someone described the feeling of being on Lariam like you are going to come out of your skin. There are other alternatives that work equally well but don’t have these side effects.
Gina: I guess the point of the post is that I don’t think there is good evidence that this drug prevents PTSD, in spite of the way it has been portrayed in the popular press and in the current article.
I’m not so sure, that bad memories are what separates adults from children. But certainly bad experiences and working out their impact on one’s being in this world gives “a texture to life”, as Therapy Patient says. And it is the energy source for personal growth and development. – While our culture clearly prefers “stability”, i.e. stagnation, to growth and development when it comes to awareness.
This is not to glorify or diminish the suffering of people with trauma issues. I was a victim of trauma myself. Today, I’m no longer a victim, but a survivor, and with Wayne Dyer, I use to say: It was just perfect.
Has anyone actually read the studies?
I must say this was a blog that should not even be allowed on the internet.
The reason I am saying this is because I have read all the studies related to this, even Dr. Cahill’s study on beta-adrenergic receptors, and all these studies have NOT suggested a pill that will erase bad memories. Actually it’s a little more interesting then just having some pill erase memories.
The studies have suggested that when a person has a very traumatic event, the brain starts to re-live this stressful event and thus firing more stress hormones. Hence the idea that if a person who fires more stress hormones might someday develop PTSD, why not stop the stress hormones from firing to much, before it gets to PTSD. Therefore the “pill” Dr. Pitman was talking about will only reduce the excess firing of stress hormones so that the victims will not enter the state of PTSD.
I am not sure if all of you are that ignorant and are easily persuaded by a person who obviously does not know what they are talking about.
If anyone had that power to erase memories with a pill, then trust me, it will be used on people like the person who wrote this because he deserves to lose the ability to write on the internet because it’s obvious that he lost the ability to think.
Gregory, first off, yes I have read the studies, as you should be able to tell by my detailed description of them. Secondly, your naive remarks show that haven’t figured out that, in fact, there is no reason to think that blocking physiological reactions can prevent PTSD, because in the published studies THEY HAVEN’T SHOWN THAT THEY CAN PREVENT THE DEVELOPMENT OF PTSD.
Additionally, your remarks seem to imply that you advocate forced drugging as well as censorship, hardly the products of a liberal and inquiring mind.
Furthermore, my objections are to the over the top news coverage this and similar studies gets, and the failure of the scientists involved to offer countering logical responses, hence I decided to take it upon myself to do so, to wit:
Fox News, “Study finds blood pressure pill could erase bad memories”
http://www.foxnews.com/story/0,2933,493244,00.html
The Guardian “Painful memory? forget it. Take a pill, re-invoke the memory, and it disappears”
http://www.guardian.co.uk/commentisfree/2009/feb/17/psychology-drugs
Finally, the paper specifically discussed in the post stated in the first paragraph:
“If emotional memory could be weakened or
even erased, then we might be able to eliminate the root of many
psychiatric disorders, such as post-traumatic stress disorder.”
I’d say that is overly optimistic, wouldn’t you? If not I guess we can all sit back and watch PTSD vanish from the sake of the earth.
Till then,
Cheers.
Doug
I find it with great interest that you are arguing this subject with me, not only because I, by your contrary disbelief, agree with the liberal and inquiring mind, but also because I happen to be a student of these great Doctors.
I will first start off by saying that the drug is a start in trying to help people. Imagine that you just had a very traumatic experience, now imagine a researcher comes up to you and asks if you could be in a double-blind study of a drug that may or may not work for your traumatic event.
1st problem arises with actually finding participants. It sounds like a great experiment and there are reasons to believe it should work, as founded in Dr. Cahill’s experiments, but what is the possibility people that have just been raped, seen a murder, etc., will be willing to cooperate in this experiment and are actually ready to talk to a person about that event.
2nd The beta-blockers must be taken right after the event had happened. Again, going to #1, not many people are willing to even talk about it.
3rd. This experiment by Dr. Pitman took many years to actually get enough people into a group. His break through work is what we need in this world to find some possibility for these people.
I am not sure how to emphasize that this drug does not make memory disappear. In the work of many people including, Dr. Cahill, Dr, Mcgough, and Dr. Pitman, this is a drug that, hypothetically speaking, should work to bring the memory of a traumatic event down to a normal event that will not be remembered more or less then any other day.
The reason why the beta-blocker should work like that is because it should impair the extra stress hormones given by the Amygdala, and through the work of Dr. Cahill, that has suggested that the Amygdala helps with the consolidation of emotional memory.
So, in another example, you watched a scary movie while you were on beta-blockers, which stops the Amygdala from firing stress hormones, then a week later when you take a quiz on what you recall from that movie, you will be able to recall it the same way you would recall a neutral movie because for memory it is known that you need to use your Hippocampus to store information not the Amygdala, the Amygdala is needed to remember emotional events in more detail. In this example you are able to see that you do not lose the memory of the scary movie but instead you are able to recall the same amount of information from the non-emotional part of the movie (boring) to the emotional part of the movie.(scary) This was one of Dr. Cahill’s experiment.
Now with that said, the drug therefore should work in the same manner with people who’ve entered a traumatic event. If the drug was given to them they should be able to remember what happened but no more then what they ate that morning. Thus reducing the stress a person endures of re-living that horrible event, which happens when a person has PTSD. Therefore, Dr. Pitman’s idea of the reverberating loop for PTSD. Which states that when a person has a stressful event they think about it and add more stress hormones, and every time they recall it they add more and more thus finally to the point were the brain can’t take it anymore and creates PTSD. If this was true then we are able to see that when disrupting this cycle a person will not generate PTSD.
On a side note, I like how you claim to be more liberal and you read very biased New’s Networks.
It would be best if we could keep an open mind that maybe there could be something out there that could help people and not rule this out just because you don’t agree with them.
I don’t wish harm on anyone but if this really works then I hope they are able to get help so they won’t be worse of later.
Gregory