title: Pilot study of the effect of lipophilic vs. hydrophilic beta-adrenergic blockers being taken at time of intracardiac defibrillator discharge on subsequent PTSD symptoms.
abstract: A pathophysiological model of posttraumatic stress disorder (PTSD) posits that an overly strong stress response at the time of the traumatic event leads to overconsolidation of the event's memory in part through a central β-adrenergic mechanism. We hypothesized that the presence of a β-blocker in the patient's brain at the time of the traumatic event would reduce the PTSD outcome by blocking this effect. The unpredictable, uncontrollable discharge of an implantable intracardiac defibrillator (ICD) is experienced by most patients as highly stressful, and it has previously been shown to be capable of causing PTSD symptoms. The present pilot study evaluated a convenience sample of 18 male cardiac patients who had been taking either a lipophilic β-blocker (which penetrates the blood-brain barrier) or a hydrophilic β-blocker (which does not) at the time of a discharge of their ICD. The self- report PTSD Checklist-Specific Version quantified 17 PTSD symptoms pertaining to the ICD discharge during the month preceding the evaluation. There was a statistical trend for patients who had been taking a lipophilic β-blocker at the time of the ICD discharge to have (35%) less severe PTSD symptoms than patients who had been taking a hydrophilic β-blocker (one-tailed p=0.07, g=0.64). Further, prospective, randomized, controlled studies are suggested.
authors.affiliation: Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Chaya G
authors.initials: CG
authors.lastname: Bhuvaneswar
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.affiliation: Department of Psychiatry, Division of Psychiatric Neuroscience, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Anna Roglieri
authors.initials: AR
authors.lastname: Katzman
authors.affiliation: Department of Psychiatry, Division of Psychiatric Neuroscience, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Nellie
authors.initials: N
authors.lastname: Wood
authors.affiliation: Department of Psychiatry, Division of Psychiatric Neuroscience, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States. Electronic address: roger_pitman@hms.harvard.edu.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Pitman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000145:classification / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D006801:Humans; D057927:Hydrophobic and Hydrophilic Interactions; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Adrenergic beta-antagonists (all MeSH terms); Memory; Post-traumatic; Secondary prevention; Stress disorders