Revisiting propranolol and PTSD: Memory erasure or extinction enhancement?
Revisiting propranolol and PTSD: Memory erasure or extinction enhancement?
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DOI：
10.1016/j.nlm.2016.01.009
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发表时间：
2016-04
影响因子：
2.7
通讯作者：
Maren S
中科院分区：
文献类型：
--
作者：
Giustino TF;Fitzgerald PJ;Maren S
创伤后应激障碍（PTSD）已被描述为唯一的神经精神障碍与已知的原因，但有效的行为和药物治疗仍然难以捉摸的许多受折磨的个人。PTSD的特征是去甲肾上腺素能信号增强，以及对消退学习的抵抗。旨在促进更有效治疗创伤后应激障碍的研究集中在记忆擦除（破坏再巩固）和/或通过药理学操作增强消退保留。普萘洛尔是一种β-肾上腺素能受体拮抗剂，因其治疗PTSD的潜力而受到相当大的关注，尽管其对患者的影响并不总是有效的。在这篇综述中，我们简要地研究了β-去甲肾上腺素能操纵对啮齿动物和人类的再巩固和消退学习的影响。我们认为，普萘洛尔是一种有效的减少恐惧的药物，当心理压力高时，创伤后不久与行为治疗配对，可能会预防或抑制创伤后应激障碍的后期发展。对于那些已经患有PTSD很长一段时间的人来说，普萘洛尔在破坏强烈恐惧记忆的重新巩固方面可能不太有效。此外，当创伤后应激障碍（PTSD）已经发展时，普萘洛尔长期治疗可能比急性干预更有效，因为创伤后应激障碍（PTSD）患者往往会经历长期、升高的去甲肾上腺素能过度觉醒。
Posttraumatic stress disorder (PTSD) has been described as the only neuropsychiatric disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted individuals. PTSD is characterized by heightened noradrenergic signaling, as well as a resistance to extinction learning. Research aimed at promoting more effective treatment of PTSD has focused on memory erasure (disrupting reconsolidation) and/or enhancing extinction retention through pharmacological manipulations. Propranolol, a β-adrenoceptor antagonist, has received considerable attention for its therapeutic potential in PTSD, although its impact on patients is not always effective. In this review, we briefly examine the consequences of β-noradrenergic manipulations on both reconsolidation and extinction learning in rodents and in humans. We suggest that propranolol is effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly preventing or dampening the later development of PTSD. In individuals who have already suffered from PTSD for a significant period of time, propranolol may be less effective at disrupting reconsolidation of strong fear memories. Also, when PTSD has already developed, chronic treatment with propranolol may be more effective than acute intervention, given that individuals with PTSD tend to experience long-term, elevated noradrenergic hyperarousal.