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Der Nervenarzt

, Volume 84, Issue 10, pp 1183–1189 | Cite as

Prophylaxe und Therapie der posttraumatischen Belastungsstörung mit Propranolol

Evidenz und ethische Analyse
  • K. Kühlmeyer
  • R.J. Jox
Leitthema

Zusammenfassung

Der β-Blocker Propranolol wird zunehmend in klinischen Studien eingesetzt, um als Prophylaxe das Auftreten einer posttraumatischen Belastungsstörung (PTBS) zu verhindern oder die psychotherapeutische Behandlung der PTBS zu verbessern. Der vorliegende Beitrag beschäftigt sich mit der Evidenz für dessen Wirksamkeit und den ethischen Implikationen der Erforschung dieser Behandlungsansätze. Die Effektivität eines prophylaktischen wie auch eines therapeutischen Einsatzes konnte im letzten Jahrzehnt nicht bewiesen werden. Beide Einsatzmöglichkeiten des Medikaments werfen ethische Fragen auf, die bereits bei klinischen Studien mitbedacht werden sollten.

Schlüsselwörter

Gedächtnis Posttraumatische Belastungsstörung Propranolol Neuroethik Ethik 

Prophylaxis and therapy of post-traumatic stress disorder with propranolol

Evidence and ethical analysis

Summary

The beta-antagonistic agent propranolol is increasingly being used in clinical trials for the prophylaxis and treatment of post-traumatic stress disorder (PTSD). This article discusses the evidence for the effectiveness of propranolol in the prophylaxis and treatment of PTSD and the ethical implications of research on these treatment approaches. The efficacy of a prophylactic or therapeutic use could not be shown during the last decade. Both treatment approaches raise ethical questions that should already be addressed during the clinical trials.

Keywords

Memory Post-traumatic stress disorder Propranolol Neuroethics Ethics 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Kühlmeyer und R.J. Jox geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Beauchamp TL (2005) Prinzipien und andere aufkommende Paradigmen in der Bioethik. In: Rauprich O, Steger F (Hrsg) Prinzipienethik in der Biomedizin: Moralphilosophie und medizinische Praxis. Campus, Frankfurt a. Main, S 48–73Google Scholar
  2. 2.
    Beauchamp TL, Childress JF (2008) Principles of biomedical ethics. Oxford Univ Press, OxfordGoogle Scholar
  3. 3.
    Brunet A, Orr SP, Tremblay J et al (2008) Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress. J Psychiatr Res 42:503–506PubMedCrossRefGoogle Scholar
  4. 4.
    Brunet A, Poundja J, Tremblay J et al (2011) Trauma reactivation under the influence of propranolol decreases posttraumatic stress symptoms and disorder: 3 open-label trials. J Clin Psychopharmacol 31:547–550PubMedCrossRefGoogle Scholar
  5. 5.
    Buffalari DM, Grace AA (2007) Noradrenergic modulation of basolateral amygdala neuronal activity: opposing influences of alpha-2 and beta receptor activation. J Neurosci 27:12358–12366PubMedCrossRefGoogle Scholar
  6. 6.
    Cahill L, Pham CA, Setlow B (2000) Impaired memory consolidation in rats produced with beta-adrenergic blockade. Neurobiol Learn Mem 74:259–266PubMedCrossRefGoogle Scholar
  7. 7.
    Cahill L, Prins B, Weber M et al (1994) Beta-adrenergic activation and memory for emotional events. Nature 371:702–704PubMedCrossRefGoogle Scholar
  8. 8.
    Darves-Bornoz JM, Alonso J, De Girolamo G et al (2008) Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey. J Trauma Stress 21:455–462PubMedCrossRefGoogle Scholar
  9. 9.
    Debiec J, Altemus M (2006) Toward a new treatment for traumatic memories. Cerebrum 2–11Google Scholar
  10. 10.
    Guth M, Jox RJ (2013) Medikamentöse Gedächtnismodifikation zur Prävention der Posttraumatischen Belastungsstörung: eine ethische Bewertung. Ethik Med 1–15Google Scholar
  11. 11.
    Hellmann J, Heuser I, Kronenberg G (2011) Prophylaxe der posttraumatischen Belastungsstörung. Nervenarzt 82:834–841PubMedCrossRefGoogle Scholar
  12. 12.
    Henry M, Fishman JR, Youngner SJ (2007) Propranolol and the prevention of post-traumatic stress disorder: is it wrong to erase the „sting“ of bad memories? Am J Bioeth 7:12–20PubMedGoogle Scholar
  13. 13.
    Kolber A (2006) Therapeutic forgetting: the legal and ethical implications of memory dampening. Vanderbilt Law Rev 59:1561–1626Google Scholar
  14. 14.
    Lockwood AH (1989) Medical problems of musicians. N Engl J Med 320:221–227PubMedCrossRefGoogle Scholar
  15. 15.
    Pacella ML, Hruska B, Delahanty DL (2013) The physical health consequences of PTSD and PTSD symptoms: a meta-analytic review. J Anxiety Disord 27:33–46PubMedCrossRefGoogle Scholar
  16. 16.
    Parens E (2010) The ethics of memory blunting: some initial thoughts. Front Behav Neurosci 4:190PubMedCrossRefGoogle Scholar
  17. 17.
    Pitman RK, Sanders KM, Zusman RM et al (2002) Pilot study of secondary prevention of posttraumatic stress disorder with propranolol. Biol Psychiatry 51:189–192PubMedCrossRefGoogle Scholar
  18. 18.
    Poundja J, Sanche S, Tremblay J et al (2012) Trauma reactivation under the influence of propranolol: an examination of clinical predictors. Eur J Psychotraumatol 3 (Epub 2012 Feb 14)Google Scholar
  19. 19.
    Savulescu J (2006) Justice, fairness, and enhancement. Ann N Y Acad Sci 1093:321–338PubMedCrossRefGoogle Scholar
  20. 20.
    Schelling G, Briegel J, Roozendaal B et al (2001) The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry 50:978–985PubMedCrossRefGoogle Scholar
  21. 21.
    Schelling G, Kilger E, Roozendaal B et al (2004) Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry 55:627–633PubMedCrossRefGoogle Scholar
  22. 22.
    Schelling G, Roozendaal B, De Quervain DJ (2004) Can posttraumatic stress disorder be prevented with glucocorticoids? Ann N Y Acad Sci 1032:158–166PubMedCrossRefGoogle Scholar
  23. 23.
    Stapleton MP (1997) Sir James Black and propranolol. The role of the basic sciences in the history of cardiovascular pharmacology. Tex Heart Inst J 24:336–342PubMedGoogle Scholar
  24. 24.
    Strawn JR, Geracioti TD Jr (2008) Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depress Anxiety 25:260–271PubMedCrossRefGoogle Scholar
  25. 25.
    The President’s Council on Bioethics (2003) Beyond therapy: biotechnology and the pursuit of hapiness. http://bioethics.georgetown.edu/pcbe/reports/beyondtherapy/chapter5.html. Zugegriffen: 15. Mai 2013Google Scholar
  26. 26.
    Tollenaar MS, Elzinga BM, Spinhoven P et al (2009) Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiol Learn Mem 91:23–31PubMedCrossRefGoogle Scholar
  27. 27.
    Vaiva G, Ducrocq F, Jezequel K et al (2003) Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma. Biol Psychiatry 54:947–949PubMedCrossRefGoogle Scholar
  28. 28.
    Van Stegeren AH, Goekoop R, Everaerd W et al (2005) Noradrenaline mediates amygdala activation in men and women during encoding of emotional material. NeuroImage 24:898–909CrossRefGoogle Scholar
  29. 29.
    Warnick JE (2007) Propranolol and its potential inhibition of positive post-traumatic growth. Am J Bioeth 7:37–38PubMedGoogle Scholar
  30. 30.
    Weis F, Kilger E, Roozendaal B et al (2006) Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. J Thorac Cardiovasc Surg 131:277–282PubMedCrossRefGoogle Scholar
  31. 31.
    Stein MB, Kerridge C, Dimsdale JE, Hoyt DB (2007) Pharmacotherapy to prevent PTSD: results from a randomized controlled proof-of-concept trial in physically injured patients. J Trauma Stress 20:923–932PubMedCrossRefGoogle Scholar
  32. 32.
    Hoge EA, Worthington JJ, Nagurney JT et al (2012) Effect of acute posttrauma propranolol on PTSD outcome and physiological responses during script-driven imagery. CNS Neurosci Ther 18(1):21–27PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Institut für Ethik, Geschichte und Theorie der MedizinLudwig-Maximilians-Universität MünchenMünchenDeutschland

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