New Treatment for PTSD:
Cushioning Hard Memories
The more you love a memory," Vladimir Nabokov once declared, "the stronger and stranger it is." Certainly we never forget the details of our beloved moments: first kisses, college graduations, our children's births. "That kind of thing," said Nabokov, "is absolutely permanent, immortal." But some ineradicable memories are of things we desperately want to forget.
For those who suffer from post-traumatic stress disorder (PTSD), vivid recollections of the horrific events they survived or witnessed ?- wars, rapes, accidents, injuries, concentration camp internments ?- often return relentlessly for years, evoking the same fear, helplessness, horror, and consequent anguish that accompanied the initial experience. This creates a disabling cycle that can be difficult, if not impossible, to break.
But encouraging new research suggests that the beta-blocker drug propranolol, by inhibiting the release of certain stress-related hormones, may stop such unwanted memories from being reinforced in our brains. Unlike the creepy device that erases undesirable recalls just like files on a computer in the recent film Eternal Sunshine of the Spotless Mind, propranolol won't cause PTSD sufferers to forget their ghastly memories, "but it can take out the sting," says professor of psychiatry Roger K. Pitman.
For a double-blind pilot study published in Biological Psychiatry, Pitman recruited 41 emergency-room patients who had just survived a traumatic event (most were car crashes). Eighteen patients received a 10-day course of oral propranolol; the rest received a placebo. When the patients returned one and three months later for psychometric assessments (like measuring their heart rates while they listened to previously tape-recorded descriptions of the initial event), those who had received propranolol were less likely to show signs of PTSD.
The results are promising for PTSD prevention, which has traditionally been limited to psychological debriefing, a method increasingly regarded as ineffective. And although Pitman is excited about the results, he readily admits propranolol is imperfect, particularly because it exacerbates asthma. (Propranolol, a hypertension drug, is widely marketed as Inderal. It is far from winning approval from the Food and Drug Administration for easing stressful memories.)
The biological reason why we never forget significant experiences involves the amygdala, an almond-shaped portion of the temporal lobe. Highly emotional events stimulate the amygdala to release so-called stress hormones, such as adrenaline, into our hippocampus. These hormones strengthen the recollections, gruesome or lovely, of the events that prompted their release. In PTSD, graphic memories ?- frequently including flashbacks and nightmares ?- not only remain intense over time, but are self-perpetuating. Each time a sufferer relives the traumatic experiences, the amygdala re-releases stress hormones into the brain, and consequently reinforces already unwanted memories. But propranolol interferes with the amygdala's receptors and "takes it off-line," Pitman says. "It blocks the consolidation of memory."
Since the amygdala doesn't release stress hormones in response to ordinary situations, it's not surprising we forget where we placed our keys or parked our car. "You are likely to remember in fair detail what you were doing on the morning of September 11, 2001," says Pitman. "But do you remember what you were doing on the morning of September 10?" This reaction, he maintains, is firmly based in natural selection. "If a primitive hominid decided to take a new route to a watering hole and on her way encountered a crocodile," he says, "should she fail to remember in the future that a crocodile inhabited that route, she would be more likely to take it again and be eliminated from the gene pool."
As a society, we place tremendous value on recollection ?- from court testimonies to cherished reminiscences of childhood ?- so a drug capable of affecting memory may raise thorny legal and ethical concerns. If, for example, a woman takes propranolol following an assault, is she jeopardizing the validity of future testimony because her memory has been altered? Pitman agrees propranolol could threaten successful prosecutions, but "Medical concerns trump legal concerns," he says. "Would you withhold morphine, which can affect memory, from a mugging victim with broken bones?" He emphasizes that propranolol does not eliminate memories, but allows victims "to maintain a level of memory similar to that of a bystander."
But if propranolol, or drugs like it, become an emergency-room staple, will we soon be tinkering with memories of those experiences that, while painful, serve to define who we are, and teach us valuable lessons? "This is a legitimate ethical concern," says Pitman. "But it is speculative and I wouldn't let speculation block the ability to help someone. Most people who have PTSD are so debilitated, they would prefer to have their memories tinkered with."
If tinkering is to be done, then it must be done quickly. Propranolol must reach the amygdala before a memory has had time to settle in; even 24 hours following trauma may be too late. Pitman has yet to determine the size of "the window of opportunity," but it will almost certainly be too short for emergency-room doctors to evaluate a patient's likelihood of developing PTSD (some people, such as those with smaller hippocampi, may be predisposed to the disorder). In other words, if propranolol begins to be routinely prescribed, some percentage of those who receive it may not really need it. "You will have to decide," Pitman says, "if the damage is worse than the benefit."
~Catherine Dupree
Harvard Magazine
Mental Decline & Dependency/Coping With Aging Loved Ones
I went over earlier than for previous evening visits, and found that what the other family member had told me was perfectly true. I arrived well before visiting hour officially begin, and stayed, undisturbed, for about 45 minutes. Of course, it may depend to some extent on who's on duty; some people are less given to rule-bending than others, but all the staff that I've met have been kind, helpful, accommodating and really nice, so I don't really anticipate trouble.
Nothing is supposed to happen tomorrow - Sunday, after all - but Monday everyone there will get together and see what is to be done. Then they'll invite me to make my contribution and everyone will know more. I hope.
I also hope they don't lay too much stress on the favorite medical theory that they must prolong life. At this stage, says one of my cousins who went through the slow lingering death of her diabetic husband, that's really just prolonging dying.
Mental Decline & Dependency/Coping With Aging Loved Ones
I have to give a lecture on Wednesday which is also our 37th anniversary. I hope I don't break down...
It's been a long and happy marriage, and I'm grateful for it.
Ah, Tomkitten, what a week that was. We'll be listening.
Tomkitten--
Does your husband have a Living Will?
You have the right to tell the doctors that you do not want his life prolonged past a time when his life is worth living.
As for visiting hours--if he is calmer with you there, then the staff can devote time to the unhappy, demanding patients without visitors.
Hold your dominion.
Mental Decline & Dependency/Coping With Aging Loved Ones
Noddy - you bet he does. With other documents to back it up and spell out precisely what he wants and doesn't want. I'm his proxy, and as far back as a year ago I was asked about a ventilator when he was hospitalized for passing out in public places - I mean the temple, the Chestnut Hill Mall. I mean PUBLIC. It's an awful, maybe awesome is a better word, responsibility and I exercised it then, and have made things clear now.
Our lawyer drew up the Living Will, and it includes the warning that artificial feeding or hydration of any sort will be taken as a physical assault, and treated as such under the law.
All we can do now is hope that the hospital will honor his desires and my decisions, if the need arises.
Tomkitten--
The Living Will should protect you both--and give you one less thing to worry about.
Sunday is a day of rest in hospitals. May Monday bring some answers.
Hold your dominion.
Quote:artificial feeding or hydration of any sort will be taken as a physical assault,
While tube feeding may be withheld, I don't think that fluids (IV) will be.
Miller--
I've lived through several "no heroic measures" hospital deaths. Care is determined by the provisions of the Living Will and the wishes of the proxy so the patient can die as comfortably as possible.
Mental Decline & Dependency/Coping With Aging Loved Ones
Well, the question arises of who should be where my husband is - him or ME? Our anniversary is Tuesday, not Wednesday, at all.
However, I'm still correct about the lecture - it's always on the 3rd Wednesday and that's the 15th of August. So I'm safe, there.
I'm glad you won't be giving the lecture on your anniversary, Tomkitten. I'm sure you would have pushed yourself to meet the challenge, but it's better that you don't have the conflict.
Tomkitten--
I've felt for some time now that senility is highly contageous. Of course I'm the sort of high-strung, sensitive neurotic who has an acclaimed talent for being Driven Distracted.
Good that you'll be able to spend your wedding anniversary with your Beloved on Tuesday. Then on Wednesday, you'll be able to lecture with a free heart.
Hold your dominion.
Mental Decline & Dependency/Coping With Aging Loved Ones
Two thing to say:
First, and most important is that the doctor is pretty sure Bob can come home, though not yet.
Second, thank God for the lecture - last-minute preparation is taking my mind off other things.
There's always a let-down after the lecture, but I can start work on the next poetry reading; that's going to be a bit tricky, because I've used up so many of what I consider the best bits, but it will all come together and be alright on the night".
Tomkitten--
Excellent news about Bob being able to come home. This must give you hope.
I'm glad your Second Life is coming together. You need--and deserve--a bit of diversion and intellectual stimulation.
Happy anniversary.
Mental Decline & Dependency/Coping With Aging Loved Ones
Thank God for A2K. All your support is vital.
Tomkitten--
Happy Anniversary. May the doctors come up with some pharmaceutical soothing so that your Beloved can come home quickly.
Mental Decline & Dependency/Coping With Aging Loved Ones
Oh Noddy - Thank you!
He seems to be doing better; I think he's much more alert. He's on Seroquel and now we're just keeping our fingers crossed and trying to be patient.
Tom Kitten, I've been following along with your experiences, feeling the utmost sympathy and respect for your strength.
Good news that your husband is coming home. My question is, whether or not you will have help--visiting nurse, etc?
