a pill for PTSD?

In my research on PTSD blogs and due to my own tendency to keep up with PTSD-related news, I keep coming across articles regarding a “pill” for treating PTSD.  It’s not a new idea; a bit of research into it reveals articles as far back as 2004.  So, why is it suddenly popping up everywhere now? Because the US Department of Veteran Affairs is currently recruiting for a clinical trial continuing the research into a pill that, as the popular press has put it, “erases bad memories.” The drug in question is propranolol, a beta-blocker used to control blood pressure.  I was a bit shocked when I read the name of the medication, having been previously prescribed it as a migraine prophylactic. If I knew more about neurophysiology, I could probably explain how a beta-blocker could also function as a preventative for migraines and a treatment for PTSD.  But I don’t.  What I can do is explain the process and assumptions behind this clinical trial.

Designed based on two previous studies, this trial will examine the effect of a 24-hour oral dose of propranolol as opposed to that of a placebo.  The participants, comprised of male and female combat veterans previously stationed in Iraq and Afghanistan, all meet DSM-IV criteria for Post Traumatic Stress Disorder.  The basic protocol of the study is thus: during each of six “memory reactivation sessions,” participants will be asked to spend ten minutes relating the traumatic memory of the event that they believe “caused” their PTSD to a trained psychiatrist, who will then continue to provoke the “reactivation” of the memory by asking questions, “keeping the participant focused on the traumatic event and encouraging him/her to identify aspects of the traumatic event that continue to provoke emotional distress“.  Immediately following the “memory reactivation sessions.” participants will be administered either propranalol or its placebo.  Following the treatment sessions, the protocol efficacy will be determined by measuring the physiological response that particpants have in response to recollections of the traumatic event.  They will also measure the presenting symptoms by using the Clinician Administered PTSD Scale (CAPS), which was previously used to diagnose participants.  The effects of the treatment will be determined based on the physiological response and a comparison between the two CAPS.

The treatment protocol relies on the reconsolidation hypothesis, which states that “a consolidated memory could again become unstable and susceptible to facilitation or impairment for a discrete period of time after a reminder presentation.”  In other words, for the purposes of this study, immediately following the memory reactivation the memory is susceptible to alteration.  Alterations of fear responses have already been accomplished in studies on animals.

So, what’s my problem?  My first response is that I don’t want anyone monkeying around with my memories.  Removal of the memory or even the fear-related response doesn’t necessarily include healing from the traumatic event nor does the erasure of symptoms necessarily include successful treatment of the underlying condition.  My other issue concerns the exclusion criteria for the study, one of which is:

Current participation in any psychotherapy (other than supportive). Subjects will be asked not to initiate psychotherapy during the course of the proposed study except in clinically urgent circumstances; if this becomes necessary, a decision will be made on a case-by-case basis whether to retain the subject in the study or terminate participation.

I understand the need to eliminate variables in research studies, but I’m also a firm believer in “do no harm.” In my opinion, restricting access to health care constitutes harm.  Of course, this is just my layperson’s opinion.  I’m not trained in medicine or psychology, though I do know a fair amount about the psychology of trauma.  Still, there are certainly nuances that I am missing due to a lack of training in the aforementioned areas. If anyone can explain it in a more satisfactory way, please post a comment here.