
Single-dose propranolol tied to ‘selective erasure’ of anxiety disorders - lelf
https://www.mdedge.com/psychiatry/article/191908/anxiety-disorders/single-dose-propranolol-tied-selective-erasure-anxiety
======
petercooper
As someone who has used propranolol on and off over the past few years, the
thing that intrigues me here is that propranolol works well in this instance
_due to crossing the blood /brain barrier_ as opposed to other beta blockers
that do not.

The use of beta blockers in anxiety is commonly associated with reducing the
effects of stress on heart rate and blood pressure, not necessarily on
affecting the brain directly which appears to be happening here. That is, beta
blockers are usually a _band aid_ rather than a fix, so this discovery is
exciting.

(As an aside, if you suffer from unusual levels of physical response to
certain stimuli while intellectually remaining calm or indifferent,
propranolol may be worth investigating for you as it has helped me a lot. At
your own risk, of course.)

~~~
ransom1538
If you are out there and suffer daily 'stage fright' or serious social anxiety
- propranolol is the drug for you. That weird fear that sweeps over you before
a conversation - just doesn't happen. Need to talk in front of 50 people in 25
minutes? No problem. If you are crippled by social anxiety - this pill will
turn you into Bradley Cooper in Limitless.

~~~
IAmGraydon
Maybe I’m an outlier, but it had absolutely no effect on me for public
speaking or social situations. I was prescribed a lot of it, tried for years
and even still have some sitting around. I envy those who get the effects you
describe.

~~~
hnzix
Yeah it slows my heart rate and chills me out a little but it's no magic cure
for generalized social anxiety in my case. I've had better outcomes from
eliminating caffeine.

I do like that (for me) Propranolol has minimal side effects other than mild
drowsiness.

~~~
grezql
yes same, caffeine was one of the culprits for me too. i kicked it out
entirely. much much better nowadays

~~~
mistermann
Cutting out caffeine reduced social anxiety? I guess I can see the connection,
but I don't think I've ever heard this mentioned before, or I just haven't
heard about it.

~~~
blablabla123
Yes of course because it makes one less jittery. But I think the positive side
effects outweigh the negative: drinking coffee is social and so is staying
awake long.

~~~
tekknik
after heavily consuming caffeine for some time it no longer keeps you awake (I
can drink a monster energy drink and immediately go to sleep). If you’re just
drinking coffee socially I’d be willing to bet you’re not having any symptoms
that affect your daily life

------
johnisgood
These effects are due to the fact that it readily crosses the BBB because of
its high lipophilicity. It is also responsible for various other CNS side-
effects such as: brain fog, sedation, vivid dreams, sleep disturbances, and
rarely, depression and short-term memory issues. In contrast, low lipid
solubility is associated with a lower incidence of CNS adverse effects due to
the fact that it makes it difficult to cross the BBB.

Additionally, these effects may actually elicit anxiety in some individuals
(especially those who get anxious over changes in their mental state and
whatnot), which in turn also affects its effects on the heart rate. In such
cases hydrophilic beta-blockers would do the job. I prefer labetalol as it has
alpha-blocking properties and counters the catecholamine-induced (from
anxiety) alpha stimulation which contributes to the increased heart rate as
well.

------
mchannon
Living with someone with crippling PTSD and anxiety disorders, I'm thrilled to
hear about this study.

As someone who's dealt with an oppressive government (which is where the PTSD
and anxiety came from), I wonder if this therapy can be weaponized by the
powerful to oppress the powerless. The rise of the warrior cop is bad enough,
but what about a crack squad that has been chemically desensitized to killing
in cold blood, taking orders from corrupt officials? Great for the warrior
cop's medical prognosis, not so great if you're his target.

I believe many people in prison got there through some form of fear. Fear
they'd get found out, fear they'd lose something, fear for their life, fear
from their childhood they lost the ability to deal with, fear they self-
medicated leading to a crime. If this technology makes it out of the
proverbial Petri dish, I'm hoping we as a society could substitute a session
for 10+ years of incarceration. We'd end up safer, less poor, and more just.

~~~
JulianMorrison
That worry feels like a stretch, because right now, the many oppressive
governments of the world are not in the least suffering logistical
difficulties due to their stormtroopers getting PTSD.

There are I think 2 main reasons why not:

\- Stormtroopers are people who have non functioning empathy, by nature or
nurture, they don't experience killing in cold blood as horrific.

\- Stormtroopers are a cheap commodity. The oppressive government doesn't mind
using them up.

On the other hand the people who _are_ subject to crippling PTSD are victims
of stormtroopers, directly and via losing friends. And a few doses of this
stuff smuggled in might effectively reignite the fire in a resistance
movement.

~~~
tomc1985
Isis grunts were regularly given stimulants to keep them awake and alert. The
future he/she describes isn't _that_ far off

~~~
debatem1
This goes back much further. In the Vietnam war the US issued amphetamines to
soldiers, and the British used it by the truckload during WWII.

~~~
jacobush
And the nazis.

------
wycy
Propranolol massively improved my quality of life. I used to get panicked at
the prospect of public speaking, but with propranolol I feel like I could give
a nationally televised State of the Union address with no problem.

I take it only before public speaking, not regularly. The only downside is it
leaves me with dry eyes and exhaustion at the end of the day, but it’s a small
price to pay for the huge QoL improvement.

~~~
whatshisface
Do you think that eliminating the extreme fear -> everything is fine sequence
would prevent you from learning to naturally handle public speaking?

~~~
wycy
Honestly, there is a chance I’m dependent on it now. But I’m still okay with
that being a trade off. So long as I always have at least 40 minutes notice
before having to do public speaking, I should be fine.

~~~
sizzle
What if you have poor speaking mannerisms or public speaking/story telling
mechanics (e.g. applying emphasis to words, voice inflection, intonation,
etc.) to engage a crowd or simply lack social awareness from being on the
spectrum, will the drug make you confidently make a fool of yourself in front
of a crowd if you haven't practiced the art of public speaking?

Thanks for sharing your experience!

~~~
wycy
Exactly, it’d just let you confidently make a fool of yourself, it won’t
automatically make you a skilled orator.

The ideal approach would be to take propranolol, then use that confidence to
take public speaking classes.

------
Uptrenda
This does not surprise me one bit. I was prescribed beta blockers for "heart
problems" that turned out to be panic attacks and I noticed the same effects.
On beta blockers you're able to talk about unpleasant memories as casually as
one would note the weather. It's a surreal experience, but a useful one.

Before this it was easy to shut down and avoid confronting bad memories. Now I
can just brush away everything. Another great property to propranolol is it
reduces the jitteriness from caffeine. Granted, if your anxiety is bad enough
to need beta blockers that's definitely not a good thing, but at least the
medication works well for what it does.

This kind of medication is far superior to benzos for anxiety disorders. It
was pure luck to have been prescribed this instead of getting put on some
horrible downer, developing a tolerance in a few months, and then having to
detox with rebound symptoms that are worse than the illness being treated.
There seems to be a lot of promising developments in psychiatry recently.

~~~
defertoreptar
If caffeine makes you jittery, try out those time-release caffeine pills and a
tall glass of water. I've replaced morning coffee this way, and it's great.

~~~
TACIXAT
Why not just cut out caffeine? You'll be in a slump for a month but once
you're past that energy levels and alertness will be back to normal. I used to
drink caffeinated water after I gave up soda until I realized it was kind of
ridiculous. Taking a caffeine pill strikes me similarly.

~~~
copperx
If you really like the effects of caffeine, with a pill you don't have to
worry about the carcinogens (acrylamide) in toasted coffee. Also, pills can be
cheaper than any bought or made-at-home coffee It's not ridiculous.

------
gchamonlive
This is also pictured in NOVA: memory hackers on Netflix (last accessed in
Brazil, in case it is region locked). It documents the process of treating
arachnophobia in a patient that clearly has an extreme aversion to spiders and
it is incredible.

~~~
ckarmann
Stupid question: can you watch it if you have arachnophobia yourself?

~~~
gchamonlive
sorry I was late to answer. Yep, it just shows one tarantula by itself and the
participant is asked to try to touch the spider, and that is it. I guess if
you are triggered that easily you could skip the scene, but the spider scene
is very mild

------
rjth
I have been taking low dosage Propranolol for about a year now. It was
prescribed for me for my hemiplegic migraines. Combined with exercise and
occasional CBD oil it has completely eliminated migraines from my life.

This medication is absolutely brilliant and harmless. Also keeps my resting
heart rate around 55.

If you struggle with migraines, talk to your neurologist, for me it was a life
changer.

~~~
andrewingram
My resting heart rate is about 55, and I don't do a lot (arguably not any) of
cardio. I'm probably in the group of people who shouldn't take propranolol.

~~~
RyJones
my resting heart rate was high 30s-low 40s. I was put on propranolol and now
my resting heart rate is in the mid 40s. I am the exact opposite of an
athlete.

------
tokyodude
I'm really curious where social anxiety comes from. I get it though not
crippling most of the time. But for example public speaking I can logically
see that I publicly speak any time I'm at dinner with friends or voice my
thoughts in a meeting so it's strange to me that officially speaking would
have so different a feeling but it does.

~~~
andrewingram
For me it's the anticipation of putting myself on the line. I can speak up in
meetings where I know i'm an authority, but struggle to do so when I don't
have that role. Social situations with people I don't know well will nearly
always have me looking for ways to avoid it, even though I've been told
repeatedly that I'm very personable. I've done group salsa performances in
front of hundreds (possibly thousands) of people, but I need to get very drunk
to do regular club (not salsa) dancing.

My best guess as to the origin is the environment at home when growing up.
Without going into too much detail, it was very stressful and I felt like I
didn't have a voice.

------
Causality1
I'm curious if it affects emotional reconsolidation of other emotions and not
just fear. If someone takes a dose before reminiscing about, say, their
wedding day, will it remove or flatten those emotional associations as well?

------
julien_c
NYT article from 2016: A Drug to Cure Fear
[https://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-
to-...](https://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-to-cure-
fear.html)

------
emit_time
I take propranolol with ADHD medication to help negate some of the
anxiety/raised heart rate effects.

I'm not sure if I've noticed a difference with anxiety while on it, other than
the mitigation of anxiety from ADHD medication.

I guess I should try taking it alone.

That being said, a large part of my psychological issues are due to anxiety,
but I haven't seen any treatments that have been compelling enough for me to
try (SSRI's/benzos mainly).

I do exercise, try to be good about sleep, try to force myself to get out with
friends or family every other week or so.

Additionally, I've noticed meditation to be a large help for me with anxiety.
It took me a while to where I really notice the difference, but I've reached a
point where I can say I notice if I've meditated the night before or not.

(I'm not advocating for or against any medication, individual situations vary,
and people should consider treatment in the context of their situation with
their doctor)

~~~
joshmn
> I take propranolol with ADHD medication to help negate some of the
> anxiety/raised heart rate effects.

Happy to hear someone else does this as well. It's really done wonders and has
helped me think more clearly in stressful situations — whereas, with
stimulants alone, things can become a little more stressful when you're
stressed due to increased heart rate and blood pressure.

------
peteretep
Propanalol has been a life-saver for me as a non-narcotic anxiety and stress
reliever.

------
layoutIfNeeded
From Wikipedia:

“In a 1987 study by the International Conference of Symphony and Opera
Musicians, it was shown that 27% of interviewed members admitted to using beta
blockers such as propranolol for musical performances.[70] For about 10–16% of
performers, their degree of stage fright is considered pathological.[70][71]
Propranolol is used by musicians, actors, and public speakers for its ability
to treat anxiety symptoms activated by the sympathetic nervous system.[72] It
has also been used as a performance-enhancing drug in sports where high
accuracy is required, including archery, shooting, golf[73] and snooker.[73]
In the 2008 Summer Olympics, 50-metre pistol silver medalist and 10-metre air
pistol bronze medalist Kim Jong-su tested positive for propranolol and was
stripped of his medals.[74]”

------
blattimwind
> “The effects are pretty amazing,” Dr. Soeter said. “Everything is treatable.
> It’s almost too good to be true, but these are our findings.”

Honestly yes. And it even sounds a bit scary, to me, that a drug that is very
un-selective produces such a selective effect (erasing a _specific_ kind of
memory under very specific conditions). It sounds a little bit like striking a
welding arc a couple times in just the right way next to a computer to flip a
few specific bits in it's main memory -- absolutely astounding that it works,
but who knows what else happened in there?

That being said I very much hope that this turns out to not produce
{short,long}-term damage, because anxiety orders are very difficult to treat
and are a huge waste of human ability.

~~~
peteretep
> erasing a specific kind of memory under very specific conditions

Why do you think it erases the memory?

~~~
blattimwind
> Propranolol achieves selective erasure: It targets the emotional component,
> but knowledge is intact. They know what happened, but they aren’t scared
> anymore. The fear association is affected, but not the innate fear response
> to a threat stimulus [...] This single-session therapy addressing what
> psychologists call fear memory reconsolidation

emotional/fear association sounds like a type of memory to me.

~~~
thrav
Read “The Body Keeps the Score”, it is. Your entire nervous system has a
memory, not just your brain.

[https://www.newscientist.com/article/mg22429941-200-the-
life...](https://www.newscientist.com/article/mg22429941-200-the-lifelong-
cost-of-burying-our-traumatic-experiences/amp/)

------
taurath
I've used it about once every other week to chill myself out in the morning
when I am too worried about other things to focus on what I need to. Side
effect of nausea though can hit me like 1 in 4 times, so I am really selective
about when I take it. Its helpful as an adjunct (for me), but not curative,
and not something I feel like I could take every day long term.

------
Benjamin_Dobell
> _The propranolol must be given within roughly an hour before to 1 hour after
> therapeutic reactivation of the fear memory to be effective._ [...] _when
> subjects were rechallenged 12 hours after taking propranolol the previous
> day – that is, after a night’s sleep – the fear memory was gone_

Oh wow, I'd be keen to give it a go:

1\. Standing next to an edge of a tall building.

2\. In a tightly enclosed space.

~~~
cgriswald
The idea of not having a fear of heights is generating a mild anxiety in me.

~~~
Broken_Hippo
Yeah, but that just makes one careful. On the other hand, not being able to
climb a ladder, be too close to a window on the 3rd floor, or other such
things would suck. You can then keep the knowledge that some heights are
dangerous without actually having the fear.

------
Ozzie_osman
A lot of people are saying it's "erasing" the memory. I actually think the way
it works is much simpler. I've read that when you relive any memory your brain
essentially unloads it, then rewrites it (sometimes in a modified form).

So like think loading a block of memory then rewriting it, but this time you
rewrite the memory without the associated anxiety.

~~~
vharuck
As a person with depression and anxiety, I've definitely noticed my memories
change based on my mood whenever I recall them. I'd remember professors having
harsh tones and cold body language, but then see them acting completely
different in a class a year or two later. They hadn't changed; it was that,
during my depressive episodes, I'd always obsess over classes I skipped or
failed.

I took it as a product of not having a photographic memory. When my mind
recalled the memory, there were a lot of parts missing: hand gestures, voice
volume, other students, etc. So my brain filled in those gaps with
"reasonable" guesses. And, during a depressive episode, it was reasonable to
assume other people didn't like me. These additions became part of the memory.

Even with the depression and anxiety under control, I keep in mind that
memories can be emotionally altered. So I'm more willing to believe my
memories are wrong. And I don't let myself obsess over a memory, which was
never productive, anyway.

------
zackbloom
> Fifteen received 40 mg of propranolol after spending 2 minutes in proximity
> to a large tarantula, 15 got placebo, and another 15 received propranolol
> without exposure to a tarantula.

What about a group who was exposed to the tarantula without the propranolol?

~~~
tigershark
The 15 that got placebo didn’t get propranolol

~~~
johnmaguire2013
But it's not clear if they were exposed to the tarantula.

~~~
shlant
from the punctuation and sentence structure, it is saying that "15 got
placebo" meaning in the same situation as the previous statement (with
tarantula). Also, what purpose would there be to having people take a placebo
and be in a normal situation?

Coincidentally, I recently listened to an interesting Revisionist History
episode that covered the importance and controversy of a semicolon in the
interpretation of a section of the constitution

[http://revisionisthistory.com/episodes/21-divide-and-
conquer](http://revisionisthistory.com/episodes/21-divide-and-conquer)

------
Para2016
Use in anxiety disorders is not really a new phenomenon. It's a non-selective
beta blocker that's been used in performance anxiety for decades. I have to
give a talk in 6 months and I'm going to prescribe myself propranolol so I can
give the talk without feeling adrenergic sympathetic activation/fight or
flight. So if I can't feel a sympathetic response centrally or peripherally,
I'm going to have minimal performance anxiety and therefore no fearful
memories of the event. Hopefully it goes smoothly. I would hate to be calm and
give a pathetic shitshow of a talk and then not feel bad about it later..

------
mistercow
This sounds extremely similar to results discovered a while back about the
antibiotic D-cycloserine. The referenced paper does briefly mention
D-cycloserine, but indicates that the effect is different without going into
much detail.

------
iw4i5
I've read a lot of comments about taking propranolol before an anxiety
inducing event. I agree it is incredibly useful there. But for me, it is also
useful afterwards. It causes amnesia of fear memories. Instead of having my
mind race and thinking of all the small mistakes I may have made, I can think
normally and actually focus on things after a tough event.

------
JVerstry
I bet this discovery is related to another recent discovery: "Blocking IgSF9b
in pathologically anxious mice has an anxiolytic effect and normalises anxiety
behaviour in these animals." (see [https://www.mpg.de/12620765/anxiety-
protein-amygdala](https://www.mpg.de/12620765/anxiety-protein-amygdala))

------
cliffreich
I was temporally prescribed metoprolol for some palpitations but also
discovered it does helps with anxiety symptoms, so I still use it sometimes.
At first it gave me nightmares but they stopped. I wanted to try propranolol
(probably better) but I read the side effects are worse than those of
metoprolol so I didn’t.

Edit: I read the side effects are basically the same, including ED.

~~~
floatingatoll
As described at the link above, it would be inappropriate/harmful for a
physician to prescribe more than a single dose of propranolol for this purpose
— to be taken in concert with a therapeutic session and likely never again —
but absolutely not as a take-home prescription of more than a single pill.
This is the same type of prescribing regimen that we’re finding out psilocybin
works with too, and you wouldn’t get a take-home supply of that either.

That you can acquire the drug readily for other medical reasons is not in any
way a reason to start self-prescribing it for anxiety. Without the trauma-
inducing psych session, the anti-PTSD benefit they describe has no chance to
occur. And it’s a bad plan to give yourself traumatic recall flashbacks - a
bad trip by any definition - without some sort of competent mental support
from competent human beings.

------
obahareth
I wouldn't have been able to do any kind of public speaking without
propranolol, it takes away all my anxiety.

------
leshow
I've taken this before for anxiety and while I do think it helps massively, it
certainly isn't a single dose silver bullet. IMO you need to take it every
time before the thing that causes you anxiety.

------
Nasrudith
I take propranolol for migraine prevention - I found it really did have a fear
and anxiety erasing effect at first - however eventually I became "accustomed"
to it. It still seems to help some though.

------
miguelrochefort
> The researchers next conducted a randomized, double-blind clinical trial in
> 45 individuals with arachnophobia. Fifteen received 40 mg of propranolol
> after spending 2 minutes in proximity to a large tarantula, 15 got placebo,
> and another 15 received propranolol without exposure to a tarantula. One
> week later, all patients who received propranolol with spider exposure were
> able to approach and actually pet the tarantula.

~~~
oskarpearson
Please refrain from simply quoting the article, adding nothing to the
conversation. It’s a blatant attempt at upvote harvesting from the TLDR crowd,
and doesn’t belong on HN

~~~
miguelrochefort
The article is behind a paywall and I thought this snippet properly summarized
it.

~~~
blattimwind
> The article is behind a paywall

I didn't see one.

~~~
ada1981
I had access at first. On reload it redirected to a paywall.

[https://outline.com/VRzuMJ](https://outline.com/VRzuMJ)

------
amelius
Don't some people who have, say, a social anxiety disorder already take a dose
of propranolol one hour before a social event? So isn't this discovery already
widely known among propranolol users?

~~~
roland00
Yes, but this research (even though similar research occurred prior) is about
"guided therapy" where the therapist is trying to specifically trigger a
memory but also help the patient figure out new coping strategies and turning
those new coping strategies into habits so the automatic anxiety induced habit
is not the only coping mechanism.

Taking a dose of propranolol prior to a stressful situation is a different
type of environment with different goals for how will interact with the
environment.

\----

This is not new research for we had replication research of the connection
with specific Beta receptors in the amygdala and the hippocampus in 2004 with
fear and Yadda, Yadda, Yadda... with prior breakthrough research happening
even earlier. But there are so many interactions with so many systems that
research after 2004 is about learning the "best practices and best
applications" of how to treat patients. Science and Medicine is a continuous
undertaken process. This researcher M Soeter has a dozen important scientific
papers on the detail of this process from 2009 to 2018.

------
IAmGraydon
Is there some way to see this without the paywall?

I realize I’m just one data point, but as someone with anxiety, I studied up
on the use of propranolol in fear extinction and was able to get my doctor to
prescribe it around 5 years ago. It had absolutely no positive effect on me. I
may as well have been taking aspirin. It did, however seem to have some
negative effects on my memory. If I met someone while on it, I would often not
recognize them if we met again. It’s like it prevented my brain from recording
their face to my long term memory.

I was on nothing else but blood pressure medication, by the way.

~~~
ada1981
[https://outline.com/VRzuMJ](https://outline.com/VRzuMJ)

------
ada1981
Nonpaywalled > [https://outline.com/VRzuMJ](https://outline.com/VRzuMJ)

------
jfletch25
Soma anyone?

------
ada1981
Weird. I had access and then a paywall Came up the next time I accessed it.

------
DanielBMarkham
Incredible, amazing, wonderful -- and a bit scary.

Imagine this being used to erase more complex memories, like that person you
dated for two weeks that broke your heart.

~~~
dvfjsdhgfv
No knowledge is lost, just the emotional reaction.

~~~
ada1981
How would it work if instead of thinking of spiders, you thought of your wife?

Would you lose your feelings of love?

This seems like an incredible drug, I’d like to do some self experimentation.

Also, if people have been taking this for anxiety, why haven’t they been
cured?

------
pgreenwood
Maybe also useful for training suicide commandos.

