Propranolol Use in the Prevention and Treatment of Posttraumatic Stress Disorder in Military Veterans: Forgetting Therapy Revisited

The alarming number of military service members returning from combat suffering from posttraumatic stress disorder (PTSD) has stimulated research into the treatment and prevention of PTSD, using pharmacological agents including the beta-adrenergic blocker propranolol. Propranolol use has been examined in three phases of memory, including acquisition, formation, and encoding; emotional response and consolidation; and retrieval and reconsolidation. Early research focused on acquisition and consolidation with encouraging but inconsistent results, with more recent research directed towards memory reconsolidation, and dissociation of emotion and fear from memories. Ethical opposition to this research and therapy came from the President's Council on Bioethics, who argued in Beyond Therapy (2003) that this type of therapy disrupts sense of self, and from a target article and ensuing discussion in theAmerican Journal of Bioethics in 2007. These arguments preceded research on the effects of propranolol on reconsolidation, which impacts the ethical discussion. If propranolol use in dissociation of emotion and fear from memory is effective in individuals with PTSD, much of the argument against propranolol use is moot. Veterans who cannot function in society due to PTSD have essentially already lost their sense of self. The ethical issue is not how treatment may affect them, but whether withholding research and treatment that may alleviate the condition is justifiable.