Effect of Propranolol on Preventing Posttraumatic Stress Disorder

Massachusetts General Hospital43 enrolled

Overview

This study will assess the effectiveness of taking propranolol soon after a traumatizing incident in reducing the incidence and severity of posttraumatic stress disorder in acutely traumatized individuals.

Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur following exposure to a traumatic event in which grave physical harm occurred or was threatened. PTSD is marked by clear biological changes as well as psychological symptoms. Many people with PTSD repeatedly relive the trauma in the form of flashback episodes, memories, nightmares, or frightening thoughts. This study will assess the effect of post-trauma propranolol on reducing the incidence and severity of PTSD. The study will also evaluate propranolol's effectiveness as a preventive measure against subsequent PTSD symptoms. Participants in this double-blind study will be recruited upon admission to the Massachusetts General Hospital Emergency Department after exposure to a psychologically traumatic event. Baseline psychometric and psychobiologic measurements will be collected. Within 6 hours following the traumatic event, participants will be randomly assigned to receive either 40 mg of short-acting propranolol or placebo and 60 mg of either long-acting propranolol or placebo. For the next 10 days, participants will receive 120 mg of either long-acting propranolol or placebo twice daily. A 9-day medication tapering will follow. Participants will undergo psychophysiologic, psychodiagnostic, and psychometric testing for PTSD 1 and 3 months following the traumatic event.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

DOUBLE

Enrollment

Conditions

Post-Traumatic Stress Disorder

Interventions

PropranololDRUG

Propranolol short-acting or long-acting capsule

PlaceboDRUG

Placebo-matching propranolol short-acting or long-acting capsule

Eligibility

Sex: ALLMin age: 18 YearsMax age: 55 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Experienced an acute psychological traumatic event * Heart rate of 80 beats per minute (bpm) or greater * Understands English Exclusion Criteria: * Traumatic event that occurred more than four hours before arrival to emergency department * Physical injury that may affect safe participation (e.g., head injury) * Systolic blood pressure less than 100 mm Hg * Medical or surgical condition that poses a risk of shock * Medical condition that may affect the safe administration of propranolol * Previous adverse reaction to, or non-compliance with, a beta-blocker * Current use of medication that may react badly with propranolol * Elevated saliva alcohol level * Presence of salivary opiates, marijuana, cocaine, or amphetamines * Pregnant or breastfeeding * Traumatic event reflecting ongoing victimization * Psychiatric condition that may affect safe participation * Unwilling or unable to commute to Boston for research visits * Attending physician in emergency department does not advise participation

Locations (2)

Massachusetts General Hospital

Boston, Massachusetts, United States

Brigham and Women's Hospital

Boston, Massachusetts, United States

Outcomes

Primary Outcomes

Physiological Posterior Probability of Posttraumatic Stress Disorder (PTSD) as Determined From Psychophysiologic Responses During Script-Driven Mental Imagery at Month 1

The posterior probability of developing PTSD was determined for each participant from a composite of psychophysiological responses during script-driven mental imagery of traumatic events (two exemplars) that included assessments of heart rate response in beats per minute, skin conductance response in microSiemens, and corrugator and left lateral frontalis facial muscle electromyogram (EMG) responses in microVolts. Responses for the two traumatic scripts were averaged and square-root transformed for analysis. Responses during personal traumatic imagery of previously studied individuals with and without current PTSD were used to calculate each participant's posterior probability of being classified as PTSD.

Time frame: Month 1

Physiological Posterior Probability of PTSD as Determined From Psychophysiologic Responses During Script-Driven Mental Imagery at Month 3

Time frame: Month 3

Secondary Outcomes

Clinician-Administered PTSD Scale (CAPS) Total Score

The clinician evaluated the overall frequency and intensity/severity of the participant's PTSD symptoms using the CAPS. 17 Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) PTSD symptoms were assessed using a 5-point scale for intensity where 0=none to 4=extreme and a 5-point scale for frequency where 0=never to 4=most or all of the time. The intensity score and the frequency scores were added together for a total possible score of 0 (best) to 136 (worst).

Data from ClinicalTrials.gov

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