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Forget Something? We Wish We Could

'Therapeutic forgetting' helps trauma victims endure their memories.

Acting Fast to Forget

The first to treat PTSD patients with propranolol was Roger K. Pitman, MD, a psychiatrist at Massachusetts General Hospital and Harvard Medical School. He'd just as soon forget the term "therapeutic forgetting."

"We think of PTSD as an exaggeration of the emotional response to trauma," Pitman tells WebMD. "Something so significant, so upsetting, so provocative has happened that there has been a rush of stress hormones, the hormones that act to burn a memory into the brain, to the point that the memory becomes maladaptive. Our theory is that the adrenaline rush is burning the memory too deeply."

Timing is critical. Once PTSD has developed, it's too late to change stored memory, says Pitman. "It's important to intervene soon enough to affect memory consolidation."

In his study, Pitman gave propranolol to emergency room patients within six hours of a traumatic event. He found that six months later they had significantly fewer signs of PTSD.

"It's not that they couldn't remember the accident," McGaugh explains. "They couldn't remember the trauma of the accident. They didn't have as many symptoms of PTSD. It's a very important distinction."

Making Sense of Trauma

Propranolol was used to treat PTSD, with fairly good success, in a small study treating sexually abused children. It's also prescribed for specific phobias like public speaking, says Jon Shaw, MD, a PTSD expert and director of child and adolescent psychiatry at the University of Miami School of Medicine.

The drug "erases the acute emotionality of the situation so people can function," he tells WebMD. "It's the "deer in the headlights phenomenon. The intense emotionality paralyzes and interferes with the memory-integration process."

When someone has been exposed to trauma, "the more intense the emotion is, the more fragmentation there is in the memory," Shaw explains. "They don't have a realistic, coherent narrative of what happened. Some aspects are heightened, others are diminished. They're left with an overwhelming sense of the event, yet they can't really piece it together, so they can't really achieve mastery over it. They lose their rational ability to understand it."

Propranolol could be used to "immunize" someone against trauma only in a minority of cases, says Pitman. "We can't use it in combat because soldiers need adrenaline to fight. But if they have just returned from a terrible battle, and they're traumatized, then it has potential application."

The Ethical Concerns

McGaugh has no problem with this use of propranolol. After all, "every pill that goes into your body does something to change you," he tells WebMD. "Antidepressants, antipsychotics -- all of these are designed to help people function better. Society crossed that bridge years ago."

He offers a more graphic example: If a soldier is wounded on a battlefield, is he left to suffer so that he can learn from that experience? "Imagine it: Do you just let him lie there and bleed to death because he needs to suffer the consequences of having killed another human being in battle? We give him first aid, pain medication, we do everything can. But if he's having an emotional disturbance because of that trauma, we can't do anything about that because that would change the nature of who they are. Doesn't losing a leg change the nature of who they are?"

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