Monday, September 29, 2008

Beta blockers and post-traumatic stress disorder

One of my family members watched another person die suddenly, violently, and unexpectedly this weekend. I think I'm more freaked than my near and dear one is, but here's my doctorly thought processes after I was done flipping out.

Norepinephrine (NE, aka noradrenaline) is a neurotransmitter integral to the stress response and the formation of emotional memories. The beta-sympathetic nervous system (the automatic 'fight or flight' response that occurs without conscious activation) is mediated by NE which enhances the vivid but not necessarily accurate memories associated with highly emotional experiences. Think of a moment that was a charged one for you, say where you were when President Kennedy was shot (if you're old enough) or when you first heard about the World Trade Centers, and notice the details of that memory compared with other, blander recollections.

Experts call the development of post-traumatic stress disorder (PTSD) a 'derailment of memory process.' Not everyone is prone to an exaggerated or detrimental response to strongly charged experiences, but those who are can develop stubborn and destructive behavior patterns that ripple way beyond the actual trauma over time. While bioethicists argue over the morality of supressing intense and unpleasant memories, for better or worse it is possible to attenuate these memories through the use of beta-blockers. Amazingly, not only do the benefits of such therapy accrue when the medication is used shortly after the traumatic even, but also when the event is re-enacted through scripted imagery after some time has passed.

Should I offer beta-blockers (such as propranolol or metoprolol) to my family member? Perhaps I should just take a deep breath and take some myself.


Anne said...

A family member was on Metoprolol. In his experience,there was both long and short term, and significant, memory loss--in a number of areas. No way would I willingly try to soften this traumatic memory by jeopardizing other personal memories. And, again judging by his experience, you are risking the possible loss of not only personal memories, but also the loss of substantive information that you have acquired over the years--some with real effort.
Secondly, IMHO, if you do remember a traumatic event, you have more emotional control than if you vaguely know that something bad happened--because you don't worry that perhaps it was actually worse than you remember or imagine.

kenju said...

Well, maybe that explains the little bits of memory loss I am having. I was attributing it to age and stress, but I've been on metoprolol for about 2-3 years now. So is mr. kenju (since his stroke).

JeanMac said...

First of all, I am so sorry for your family.
If there is something which would help, I'd take it - and offer it:)
Life is challenging enough.

dorsey said...

NLP can also alter the memory, take away the shock to let one move on with life, and with it you can stay specific to the event. (you remember the event without being traumatized by it). You have to be willing to meet and talk with a practitioner, however, and your near and dear one may not be willing to do that (don't know their opinion re. meds). As for you, isn't this a drug you pop now and then anyway? Why not now, unless the huperzine is calming enough.
speaking of which, huperzine is on the store shelf next to DHEA, which I take when I remember, and something else I have somewhere, is the huperzine helping with clarity, focus? I don't think my mind is racing so much as wandering off in the wrong direction. (and I couldn't find the test on that site so I must need something more). What's your opinion after a week or so with it?

femail doc said...

Anne: Thanks for your info. I am unfamiliar with metoprolol causing memory troubles. It certainly can cause depression and lassitude, so I have no doubt that memory could also be affected.

In no way did I mean that beta-blockers would erase the memory, they may just take away the bright orange adrenalin-generated highlights that keep it flashing into everyday events. Unfortunately, traumatic recall can take on irrational, out-of-control qualities that interfere, for some susceptibles, with the conduct of ordinary life. There are definitely controversial aspects to messing with memories. I appreciate your opinion, and both my family member and I have decided that medications are not warranted.

KJ: You might want to consider, with your doctor, 'cardioselective' beta-blockers such as carvedilol or Bystolic which may have less brain interference.

JM: I'm with you life is challenging enough. If medication can ease some of the trials that interfere with the satisfaction and conduct of ordinary life, why not? I guess I wouldn't be an internist if that wasn't my attitude. That said, I was appalled today when the 'psychiatry team' at University Hospital roared in to talk to another family member who recently had surgery quickly proposing medication to deal with her anxiety surrounding post-operative pain. That seemed entirely inappropriate at the end of their brief discussion with her.

Dorsey: I think techniques like EMDR, somatic experiencing (I've tried both of those) and NLP (don't know anything about that except what you've just told me) are a fabulous alternative to drugs. I'm hopeful that family member would agree to such a thing if they find they're not doing as well as they think they are.

Yes, I do take beta-blockers when I need calming without tranquilizing. They're great for performance anxiety as well as keeping the blood pressure and pulse down under stressful conditions such as meetings with irritating people who get to call all the shots.

Huperzine seems to do that as well. Hard to say about the focus and clarity thing. On average, I'm pretty focused and clear when I'm not flipping out over things that are out of my control. You have to go into the book previews on McCleary's site to find the test; I should've mentioned that. It's just after the introduction.

justhinkin said...

RE PTSD, medication, and memory loss, it may depend on the case, but really severe PTSD can't be "trumped" by anything for memory loss ... and a lot of other loss of (or "scrambling of") mental process ... over the long term in some cases.

I really think there is great deal about PTSD that is not known, at least in worst cases. In me, over a period of years, my entire mental existence has been, literally, scrambled.

It may take a case that is severe enough to be accompanied by a dissociative disorder for such things, I don't know, but my admonition is to be aware that PTSD is ever EVER so much more than "bad memories", and that it can persist or get worse, not better, with time (even with treatment).

One must watch a "patient" or acquaintance for signs of continuing difficulty, and one may have to "dig" for signs of such (especially in the patient relationship). I think uncharacteristic flashes of anger (and perhaps aggression) may be a hallmark (but not likely seen on a patient level except in intensive therapy ... and who gets that?). This especially true if a breach of trust and/or fiduciary duty is involved in the traumatic stressor(s).

Dissociation (a loss of and/or detachment from self, or even something approaching "multiple selves", though that is apparently believed to actually happen only in childhood incidents) can mask/hide a steady or worsening mental deterioration ... "can mask" unless it, itself, becomes so pronounced that it is a pathology unto itself (as well it can be ... and can bewilder the patient as much as the other aspects of PTSD!).

Medication for PTSD may be preferable to long term effects if the problem is bad enough, even with "memory loss".

Finally, if your PTSD sufferer ever encounters another PTSD-level stressor, watch out, especially if close in time (months later, as opposed to hours, days, or years later), in time of occurrence; especially if the stressors have common features; and most especially if both of those conditions obtain. Thus "war" is the ideal situation for this to happen (but not my case).

Worst case scenario? If more than one such stressor is caused by similar situations involving a breach of trust rising to criminal level (a breach of fiduciary duty, for example). Combat is its own special hell, but at least you only trust your enemy to try to kill you (not, for example, to help you). I guess "fragging" (deliberate attack by one's own soldiers) would be an equivalent trust relationship breached.

PTSD is a troll under one's bridge that, one day, comes out and swallows the world whole.