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Reduction in the occurrence of distressing involuntary memories following propranolol or hydrocortisone in healthy women

Published online by Cambridge University Press:  14 May 2019

Sunjeev K. Kamboj Open the ORCID record for Sunjeev K. Kamboj [Opens in a new window] ,
An Tong Gong ,
ZhiHui Sim ,
Adrihani A. Rashid ,
Ami Baba ,
Georges Iskandar ,
Ravi K. Das  and
H. Valerie Curran
Sunjeev K. Kamboj*
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
An Tong Gong
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
ZhiHui Sim
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
Adrihani A. Rashid
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
Ami Baba
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
Georges Iskandar
Affiliation:
Department of Anaesthesia and Perioperative Medicine, UCLH, London, UK
Ravi K. Das
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
H. Valerie Curran
Affiliation:
Clinical Psychopharmacology Unit, UCL, LondonWC1E 6BT, UK
*
Author for correspondence: Sunjeev K. Kamboj, E-mail: [email protected]
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Abstract

Background

Pharmacological treatments targeting the neuroendocrine stress response may hold special promise in secondary prevention of posttraumatic stress disorder (PTSD). However, findings from clinical trials have been inconsistent and the efficacy of specific drugs, their temporal window of efficacy, effective doses and the characteristics of likely treatment responders remain unclear.

Method

Using an experimental human model of distressing involuntary memory formation, we compare the effects of two drugs that have theoretical or empirical support as secondary preventive agents in PTSD. Eighty-eight healthy women (average age: 23.5 years) received oral propranolol (80 mg), hydrocortisone (30 mg), or matched placebo immediately after viewing a ‘trauma film’. They then completed daily, time-stamped intrusion diaries for 1 week, at the end of which, voluntary memory was tested.

Results

While neither drug affected voluntary memory for the trauma narrative, propranolol treatment was associated with 42% fewer, and hydrocortisone with 55% fewer intrusions across the week, relative to placebo. Additionally, propranolol reduced general trauma-like symptoms, and post-drug cortisol levels were negatively correlated with intrusion frequency in the hydrocortisone group.

Conclusions

Overall, this study shows substantial reductions in intrusive memories and preserved voluntary narrative-declarative memory following either propranolol or hydrocortisone in an experimental model of psychological trauma. As such, despite some inconsistencies in clinical trials, our findings support continued investigation of propranolol and hydrocortisone as secondary preventive agents for re-experiencing symptoms of PTSD. The findings also suggest that it is critical for future research to identify the conditions governing the preventive efficacy of these drugs in PTSD.

Keywords

Acute stress disorderglucocorticoidhydrocortisoneintrusionsinvoluntary memorynoradrenergicposttraumatic stress disorderpropranololsecondary prevention
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1148 - 1155
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

ATG, ZS and AAR contributed equally to this work.

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