Most trauma occur in low- and middle-income countries (LMICs) where mental health resources are scarce. Although pharmacotherapy is recommended for PTSD, side effects lead patients to abandon their treatment. Psychotherapy can be effective for PTSD but requires highly qualified personnel, is slow, costly and culture- bound. The β-adrenergic blocker propranolol interferes with the reconsolidation of a recalled traumatic memory, so as to reduce its strength over time. This study explores the feasibility, cross-cultural social acceptability and efficacy of a new treatment for PTSD in a non-western LMIC country using local mental health resources.
With minimal side-effects, we hypothesized that six weekly session of reconsolidation impairment using Pro- pranolol would be well-accepted, and its effectiveness would be non-inferior to the anti-depressant typically recommended to treat PTSD: Paroxetine. In order to test this, a repeated measures 2 (intervention group) x 3 (assessment time) ANOVA was conducted on the data of the treatment completers (n = 43) for each of the following outcome measures (alpha set at .05, two-sided test): PTSD symptoms (PCL), psychological distress (SCL-25), clinical global impression (CGI), coping, quality of life (QOL) and disability score (DAS-II).Double-blind randomized controlled trial involving three measurement times (pre-, mid- and post-treatment). Men and women Nepalese adults (18-65 y.o.), reporting torture and civil-war related traumatic events were recruited in a rural health post in Nepal.
As expected, a robust main effect for time (from pre- to post-treatment assessment) was obtained on all outcome measures, p < .001. As expected, no main effect for group was obtained, and no group by time interaction was observed on any of the outcome measures. Furthermore, the two treated groups did not differ from each other on the following indexes at baseline and after treatment: PTSD rate, functional disability rate, psychological distress rate, illness severity ratings, improvement ratings, and treatment efficacy. Specifically, the proportion of individuals considered only `mildly ill' or `remitted' at the end of the treatment was 95%. The proportion of individuals experiencing psychological distress went down from 100% before treatment to 19-25% at the end of the study.
Funding & No Conflicts Declaration
Funding was received from Grand Challenges Canada. The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.