13 ms·

A Drug to Cure Fear

85 points by sharp11 11y ago

dawnbreez 11y ago
Title is misleading; article is about PTSD, phobias, and other mental disorders, rather than fear.
- deleted 11y ago
  [deleted]
- return0 11y ago
  Phobias and PTSD are pathological fear conditions. The title is not misleading.
  - dawnbreez 11y ago
    Fear itself is healthy, PTSD and phobia is not. The title is akin to using "Pill to Cure Talking" as a headline for a Tourette's cure.
    - return0 11y ago
      No, it's akin to "pill to cure pain".
  - lifeisstillgood 11y ago
    I agree with the OP - getting rid of fear is foolish. Most of us are fearful of rattlesnakes. This is about managing the memories of fearful situations. PTSD sufferers were right to be fearful in the original case - it's just the repeating of that fear in other situations is less helpful.
    - sridca 11y ago
      > getting rid of fear is foolish Name one instance of sensibility in retaining fear-response in this modern world.
      - lukas099 11y ago
        You need to cross a busy street. You could cross in the middle and get to your destination faster, but your fear of getting hit impels you to go to the crosswalk instead. That wasn't even hard.
        sridca 11y ago
        Is that an excuse for a chipmunk crossing the road? Seriously, as a member of intelligent species you don’t need fear to inhibit yourself from doing such a senseless and risky act of crossing in the middle of a busy street. A rephrasing of Hanlon’s razor is appropriate here: “Never attribute to lack-of-fear that which is adequately explained by stupidity.” Indeed, normal people with fear intact perform such risky acts on a daily basis (i.e., despite being fully capable of fear); I was raised in India, where busy streets with erratic traffic patterns are usual, so I should know.
      - return0 11y ago
        That is also pathological http://www.wired.com/2010/12/fear-brain-amygdala/ http://www.wired.com/2010/12/fear-brain-amygdala/
        sridca 11y ago
        What is your point exactly? I've followed stories around SM for quite a while, and she comes across as living a normal life, only without the debilitating fear-response. If curiously approaching a deadly creature is what it takes to be labelled "pathological", I would gladly allow myself to be pathological if it means the ending of fear.
        dawnbreez 11y ago
        Have fun. I'm going to stay away from that hungry, pissed-off tiger, you can play with it all you want.
        sridca 11y ago
    - LinuxBender 11y ago
      I also agree. There is a significant difference in treating anxiety vs. nullifying fear. PTSD is trauma induced conditioning and the result is irrational, but expected. Primordial instinctive fears are required for survival of all living things. e.g. fight or flight, reflexive reaction to danger, etc...
      - sridca 11y ago
        > Primordial instinctive fears are required for survival of all living things. It is one thing to regurgitate a widely believed aphorism, but an entirely another thing to justify it with facts. Primordial instinctive fear is not required for the human species. Name one example where it is required (where an intelligent response is deemed insufficient).
        dawnbreez 11y ago
        Tiger.
        LinuxBender 11y ago
        Certainly. 1. Here is an example of reckless behavior associated with a lack of fear as it pertains to humans taking anti-fear drugs. [1] http://news.nationalpost.com/news/there-was-no-fear-anymore-the-tiny-pill-fuelling-syrias-war-and-giving-fighters-superhuman-energy http://news.nationalpost.com/news/there-was-no-fear-anymore-... And then there are studies of animals changing their behavior to be more reckless. I am curious to see your thoughts on correlation of animal and human testing. [2] https://med.stanford.edu/news/all-news/2011/03/scientists-discover-anti-anxiety-circuit-in-brain-region-considered-the-seat-of-fear.html https://med.stanford.edu/news/all-news/2011/03/scientists-di...
        sridca 11y ago
        Reckless behaviour is not associated with lack of fear, as reckless behaviour is not uncommon among normal human adults with fear intact (also the aforementioned drug does more than inhibiting fear). If one is going about life "without thinking or caring about the consequences of an action", that is more a sign of being unintelligent (quite often a case of native intelligence being hampered by such strong emotions as ideological feelings) than merely being fearless. Animals (especially early primate ancestors of humans) do not have fully developed intelligence, so it not unsurprising that they unlike us require primitive emotions such as fear to survive as a species.
    - return0 11y ago
      Regardless of everyone's definition, the study of pathological fear conditions is done with animal models involving fear conditioning and the amygdala.The relevant research is fear research. Fear us used as a technical term here.
- sridca 11y ago
  How exactly? Would not taking propranolol after 2 minutes of exposure to normal fear object eventually eliminate the fear-conditioning on that object?
- sandworm101 11y ago
  Agreed. This is about "curing" disease, about dealing with abnormal fears. There is already a drug for numbing one's self to everyday fears: beer.
lifeisstillgood 11y ago
tl;dr this is about phobias and anxiety not "fear" we seem to have Discovered a drug that when a subject relieves the trigger emotion (sees a spider) the drug inhibits the reconciliation of the memory into long term storage. Something previously not thought possible It clearly has some value for phobias, but it's big value might be in PTSD treatment but from family experience this is a big difficult area and silver bullets are rare. US and UK need to do much more for long term expensive treatment of the veterans we have made - and if governments complain about the cost, we should very loudly point out they can save money in the future by simply stopping creating new veterans of wars.
- sridca 11y ago
  I don't think your summary is accurate. It is more than relieving "the trigger emotion". According to the linked study, there is an ending of the conditioned fear-response itself: "Disrupting reconsolidation of fear memory transformed avoidance behavior into approach behavior in a virtual binary fashion—an effect that persisted at least 1 year after treatment" ... which ending naturally segues into approaching.
- taurath 11y ago
  Anxiety is fear, just induced into the hippocampus by the cortex (simplification).
deleted 11y ago
[deleted]
- ajb 11y ago
  Fear of death seems unlikely to be linked to a memory.
  - deleted 11y ago
    [deleted]
DenisM 11y ago
[...] the arachnophobes who were exposed to the spider and given the drug were able to touch the tarantula within days and, by three months, many felt comfortable holding the spider with their bare hands [...] Meditation in a pill?! Where do I sign up?
kmicklas 11y ago
Weren't they having good success in clinical trials using MDMA in a similar manner?
- Synaesthesia 11y ago
  Indeed, and MDMA really can help you in a transformative, psychological manner, but it's not a drug which can be taken with regularity, and it can have major side effects. It requires careful monitoring and therapeutic assistance. This drug is much more side effect free and can be used regularly so not exactly in a similar manner.
  - kmicklas 11y ago
    Right, that's why this research is so exciting. I just found it interesting because MDMA is a stimulant which probably has the opposite effects of beta blockers. But I guess that is overridden by the serotonergic effects with respect to anxiety.
- adrusi 11y ago
  Yes, MDMA has been shown to be an effective complement to exposure therapy. As I understand, with mdma, the goal is to develop a new emotional association linking the experience to the intense euphoria the MDMA induces. As you point out in another comment, MDMA actually increases norepinephrine levels, which I suppose would enhance the strength of the new associations. As for neurotoxicity, limiting use to less than once a month is quite effective at reducing it, I've heard. This is probably not much of a problem for theraputic use, but if it needs to be administered more frequently, there's some evidence that taking an SSRI before taking MDMA will reduce toxicity (don't do this, you might risk seratonin syndrome). DXM too has been shown effective at reducing amphetamine toxicity, so it might also help (also don't do this). If MDMA is ever rescheduled to allow for research, though, these techniques might allow more frequent use in theraputic settings.
newman314 11y ago
Not being snarky but it would be nice to have a drug that cures the sort of fear associated with FUD.
tokenadult 11y ago
I feared that many participants here would react to this interesting article's headline rather than to its content, and it appears that that fear is warranted. But, seriously, this is a thoughtful article and well worth reading for better understanding of debilitating phobias and how they are currently treated. It is also good to read the whole fine article to see what the medical doctor author has to say about the trade-offs of the proposed drug treatment suggested as an addition to the currently standard exposure therapy. I don't know anyone among my close friends who has a phobia as disabling as those described in the article. There is a big difference between such phobias and the everyday caution and avoidance of rash behavior that helps keep us all safe. AFTER EDIT, AFTER OTHER COMMENTS TO THE THREAD: I remember that back in the 1980s propranolol (a beta-blocker originally prescribed to prevent heart disease) was investigated for anxiety conditions like stage fright. (The cases of stage fright among performers I know best largely resolved as the performers gain in performance competence from more coaching and practice and reduced fear of performing by performing in public more often.) So this line of research about propranolol has been going on for a long time.
- facetube 11y ago
  Yeah, I get that feeling too. The idea that someone exposed to a traumatic event (e.g. rape, child abuse) could immediately given a single dose of a drug that would prevent a possible 30-40 years of painful PTSD is, honestly, pretty compelling.
- category 11y ago
  If there are more than 3 negative reactions to an article I definitely go read it because at this point it's hugely probable that the backlash is mainly cultural/traditional rather than logical.
- nathanb 11y ago
  A fair comment. I think it's important to note that a fear or anxiety reaction may not, as you say, keep us safe. When I'm calm and rational, I make better decisions than when I'm gripped by fear. As an avid hiker and explorer, occasionally my fear of heights interferes with my enjoyment of my hobby. I try to push past it as much as possible, but when my heart is racing and my legs are shaking, a situation which would otherwise be safe can become dangerous. Also, unlike you, I do have two friends who suffer from PTSD (it's common enough that one may be surprised to find that a friend one has known for years wrestles with PTSD in some aspect of life but doesn't advertise that fact). One of those friends has gotten off an elevator early because being in an enclosed situation with a stranger gave her a panic attack. Another called me on the phone nearly in tears because she had to stay late at work and walking across the deserted, dark carpark to her car was almost more than she could handle. I think it would be great if a drug could help people like these two friends of mine go through life without feeling controlled by anxiety in situations like these. I also think it would be great if people like me whose day-to-day lives are unmarred by fear can do more things -- safely; the drug does not impair reason -- through this therapy. The tradeoffs are important to know (and as you say, the article does a great job exploring them), but to me this sounds really promising.
mcphilip 11y ago
I've been using extended release propanelol daily for the past couple years as part of the treatment for chronic mixed tension migraines. I'd been struggling with migraines leaving half of my body feeling extreme muscular tension 2-3 times a week. I can't comment on beta blockers effectiveness in treating anxiety, but it does seem to have a powerful effect on soothing the nervous system without the damaging side effects of addiction and impaired memory when I was taking Xanax or Valium.
- sridca 11y ago
  > [using extended release propanelol daily for the past couple years] seem to have a powerful effect on soothing the nervous system If you don't mind me asking could you comment on what effect this drug has had, over the past couple years, on your fear-responses? Not talking about phobias, but normal fear-responses.
  - mcphilip 11y ago
    I seem to have less nervous tics associated with stressful situations, but anxiety related racing thoughts don't seem to have changed. E.G. Propanelol doesn't seem to impact problems like laying in bed worrying about the upcoming day
    - sridca 11y ago
      Thank you for the response. Could the difference, in those two kinds of situations, be due to the presence/lack of awareness of the trigger of fear response? To explain my thinking: it appears that you are normally aware of the fear-triggers on those "stressful situations" (i.e., what triggers the fear), which awareness of trigger in combination with propanelol's inhibitiveness, leads to you have less nervous tics than usual (and less fear-responses). Whereas, it appears that on other kinds of situations, such as laying in bed running through dispersed thoughts about the upcoming day, there is no well-defined trigger (or so it seems) that can be pin-pointed in time, leading to propanelol not being as effective, thus resulting in racing thoughts. The original study[1] involved a 2-minute exposure prior to administration of propanelol for it to be effective in eliminating the fear-conditioning. And this 2-minute exposure implicitly includes awareness of the fear-trigger. [1] http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2815%2900313-3/abstract?showall=true= http://www.biologicalpsychiatryjournal.com/article/S0006-322...
sharp11 11y ago
What I found fascinating here are the implications for the neurobiology of memory. Here it is limited to highly emotional fear-based memories, but nonetheless the idea that a memory gets rewritten immediately after recall, as saving a file after edit, and that that is an opportunity to completely redefine the memory, is quite striking.
- xkcd-sucks 11y ago
  There's some evidence that recalling a memory makes it labile, and that interrupting memory reconsolidation processes during this labile period can 'erase' them, much like not getting sleep after initially forming a memory can prevent it from becoming permanent. Emotional/fear associated memories are a really easy model to work with, and are also the most clinically compelling application of memory extinction. See Cristina alberini's work, and others, as well as reviews like http://www.nature.com/nrn/journal/v8/n4/abs/nrn2090.html http://www.nature.com/nrn/journal/v8/n4/abs/nrn2090.html
  - sharp11 11y ago
    Thank you for the incisive suggestions! This is remarkable stuff. Here's a good one not behind a paywall: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056265/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056265/
marincounty 11y ago
Interesting small study of 45 people. It seems like it could be investigated quickly in the military today. Propanol is still used to treat high blood pressure. Most doctors have switched their patents to metoprolol(longer half life, and doesn't cross blood/brain barrier as easily), but propanol is still an effective way to reduce high blood pressure. It also helps a bit with anxiety-- maybe? I know a bit about it because I have taken these drugs. I also had a nervous breakdown with symptomology very similar to those that have PTSD. I took propanol for 15 years. I didn't have any complaints with the drug. I actually think beta blockers are healthy for patients high blood pressure, and prone to anxiety. I said healthy--in my case I think they might be healthy. I can't explain it, just have a feeling? That said the fear title threw me; I call it anxiety. Ever since that breakdown, I have never been the same. My fears were random. I was scared of heights on one week, and was fine/better the following week. Some months I was scared of being around people; other times I seeked out crowds of people. There was no reason to my fears. My brain just went bezerk, and I didn't get better for years. I'm still not the guy I used to be. Yes, I'm still employable, but barely. I hide my problems pretty well, or I think I do? My anxiety didn't affect my ability to learn new things--thank god! When I was younger I had consistent fears, actually only public speaking. I got through college with only one oral report, but it took a lot of planning. After that breakdown, I was fearful almost everything. I felt like I reverted back to being a child, or worse. I wasn't a fearful child. When I blew a gasket, the world became difficult, and I was scared of it. There was no rhyme, or reason to my fears. The stuff I was scared of before, like public speaking, and a slight fear of snakes--completely vanished. I guess what I'm trying to say is they still don't know much about anxiety(o.k. Fear). When I took propanol I developed new fears. Repeat--when I took a beta blocker I developed new fears. My fears would come, and go away. They weren't consistent. Yes, this is all antidotal, and I'm probally not the best subject; I don't think I'm like you guys anymore, but who knows? That said, I was hoping they would have found treatments for anxiety related disorders by now. In my case, heterocyclic, and tricyclics dugs did nothing for my anxiety. Addictive drugs, and alcohol are the only drugs that helped. I hope a beta blocker will help those with PTSD, and guys who have been hit with whatever hit me. I didn't have a bad childhood, or wasn't more nervous as a child as the other kids. I just Blew a gasket in my twenties. If you are reading this and are slightly dizzy, slightly anxious, just don't feel like you did; you have my complete sympathy. All I can say is it gets better with age. Most of you will be better a a few weeks. I have never met someone like myself, but my doctor like to say, "All my patients are different." He's right! That's why we need to study mental disorders more carefully. Right now they treat us like cattle when they set up these studies. "Oh, you have this, and this out of twenty symptoms. I'll put you in this category." No wonder we have low efficacy treatments. And yes, I know it's expensive to do quality studies. Sorry, about rambling on. I just kinda tense up with new cures for anxiety. I took so many drugs that didn't work. And the therapy--well give it a shot, I guess. You will never quite know if you don't give it a test drive.
davesque 11y ago
Attention grabbing headline aside, a very interesting read. A good reminder that there are viable treatment options for severe anxiety.
Mandatum 11y ago
It's common practice amongst professional poker players/gamblers to use beta blockers. http://www.pokernewsdaily.com/poker-players-take-performance-enhancing-substances-12074/ http://www.pokernewsdaily.com/poker-players-take-performance...

A Drug to Cure Fear

85 points by sharp11 11y ago

dawnbreez 11y ago

Title is misleading; article is about PTSD, phobias, and other mental disorders, rather than fear.

deleted 11y ago
[deleted]
return0 11y ago
Phobias and PTSD are pathological fear conditions. The title is not misleading.
- dawnbreez 11y ago
  Fear itself is healthy, PTSD and phobia is not. The title is akin to using "Pill to Cure Talking" as a headline for a Tourette's cure.
  - return0 11y ago
    No, it's akin to "pill to cure pain".
- lifeisstillgood 11y ago
  I agree with the OP - getting rid of fear is foolish. Most of us are fearful of rattlesnakes. This is about managing the memories of fearful situations. PTSD sufferers were right to be fearful in the original case - it's just the repeating of that fear in other situations is less helpful.
  - sridca 11y ago
    > getting rid of fear is foolish Name one instance of sensibility in retaining fear-response in this modern world.
    - lukas099 11y ago
      You need to cross a busy street. You could cross in the middle and get to your destination faster, but your fear of getting hit impels you to go to the crosswalk instead. That wasn't even hard.
      - sridca 11y ago
        Is that an excuse for a chipmunk crossing the road? Seriously, as a member of intelligent species you don’t need fear to inhibit yourself from doing such a senseless and risky act of crossing in the middle of a busy street. A rephrasing of Hanlon’s razor is appropriate here: “Never attribute to lack-of-fear that which is adequately explained by stupidity.” Indeed, normal people with fear intact perform such risky acts on a daily basis (i.e., despite being fully capable of fear); I was raised in India, where busy streets with erratic traffic patterns are usual, so I should know.
    - return0 11y ago
      That is also pathological http://www.wired.com/2010/12/fear-brain-amygdala/ http://www.wired.com/2010/12/fear-brain-amygdala/
      - sridca 11y ago
        What is your point exactly? I've followed stories around SM for quite a while, and she comes across as living a normal life, only without the debilitating fear-response. If curiously approaching a deadly creature is what it takes to be labelled "pathological", I would gladly allow myself to be pathological if it means the ending of fear.
        dawnbreez 11y ago
        Have fun. I'm going to stay away from that hungry, pissed-off tiger, you can play with it all you want.
        sridca 11y ago
  - LinuxBender 11y ago
    I also agree. There is a significant difference in treating anxiety vs. nullifying fear. PTSD is trauma induced conditioning and the result is irrational, but expected. Primordial instinctive fears are required for survival of all living things. e.g. fight or flight, reflexive reaction to danger, etc...
    - sridca 11y ago
      > Primordial instinctive fears are required for survival of all living things. It is one thing to regurgitate a widely believed aphorism, but an entirely another thing to justify it with facts. Primordial instinctive fear is not required for the human species. Name one example where it is required (where an intelligent response is deemed insufficient).
      - dawnbreez 11y ago
        Tiger.
      - LinuxBender 11y ago
        Certainly. 1. Here is an example of reckless behavior associated with a lack of fear as it pertains to humans taking anti-fear drugs. [1] http://news.nationalpost.com/news/there-was-no-fear-anymore-the-tiny-pill-fuelling-syrias-war-and-giving-fighters-superhuman-energy http://news.nationalpost.com/news/there-was-no-fear-anymore-... And then there are studies of animals changing their behavior to be more reckless. I am curious to see your thoughts on correlation of animal and human testing. [2] https://med.stanford.edu/news/all-news/2011/03/scientists-discover-anti-anxiety-circuit-in-brain-region-considered-the-seat-of-fear.html https://med.stanford.edu/news/all-news/2011/03/scientists-di...
        sridca 11y ago
        Reckless behaviour is not associated with lack of fear, as reckless behaviour is not uncommon among normal human adults with fear intact (also the aforementioned drug does more than inhibiting fear). If one is going about life "without thinking or caring about the consequences of an action", that is more a sign of being unintelligent (quite often a case of native intelligence being hampered by such strong emotions as ideological feelings) than merely being fearless. Animals (especially early primate ancestors of humans) do not have fully developed intelligence, so it not unsurprising that they unlike us require primitive emotions such as fear to survive as a species.
  - return0 11y ago
    Regardless of everyone's definition, the study of pathological fear conditions is done with animal models involving fear conditioning and the amygdala.The relevant research is fear research. Fear us used as a technical term here.
sridca 11y ago
How exactly? Would not taking propranolol after 2 minutes of exposure to normal fear object eventually eliminate the fear-conditioning on that object?
sandworm101 11y ago
Agreed. This is about "curing" disease, about dealing with abnormal fears. There is already a drug for numbing one's self to everyday fears: beer.

lifeisstillgood 11y ago

tl;dr this is about phobias and anxiety not "fear" we seem to have Discovered a drug that when a subject relieves the trigger emotion (sees a spider) the drug inhibits the reconciliation of the memory into long term storage. Something previously not thought possible It clearly has some value for phobias, but it's big value might be in PTSD treatment but from family experience this is a big difficult area and silver bullets are rare. US and UK need to do much more for long term expensive treatment of the veterans we have made - and if governments complain about the cost, we should very loudly point out they can save money in the future by simply stopping creating new veterans of wars.

sridca 11y ago
I don't think your summary is accurate. It is more than relieving "the trigger emotion". According to the linked study, there is an ending of the conditioned fear-response itself: "Disrupting reconsolidation of fear memory transformed avoidance behavior into approach behavior in a virtual binary fashion—an effect that persisted at least 1 year after treatment" ... which ending naturally segues into approaching.
taurath 11y ago
Anxiety is fear, just induced into the hippocampus by the cortex (simplification).

deleted 11y ago

[deleted]

ajb 11y ago
Fear of death seems unlikely to be linked to a memory.
- deleted 11y ago
  [deleted]

DenisM 11y ago

[...] the arachnophobes who were exposed to the spider and given the drug were able to touch the tarantula within days and, by three months, many felt comfortable holding the spider with their bare hands [...] Meditation in a pill?! Where do I sign up?

kmicklas 11y ago

Weren't they having good success in clinical trials using MDMA in a similar manner?

Synaesthesia 11y ago
Indeed, and MDMA really can help you in a transformative, psychological manner, but it's not a drug which can be taken with regularity, and it can have major side effects. It requires careful monitoring and therapeutic assistance. This drug is much more side effect free and can be used regularly so not exactly in a similar manner.
- kmicklas 11y ago
  Right, that's why this research is so exciting. I just found it interesting because MDMA is a stimulant which probably has the opposite effects of beta blockers. But I guess that is overridden by the serotonergic effects with respect to anxiety.
adrusi 11y ago
Yes, MDMA has been shown to be an effective complement to exposure therapy. As I understand, with mdma, the goal is to develop a new emotional association linking the experience to the intense euphoria the MDMA induces. As you point out in another comment, MDMA actually increases norepinephrine levels, which I suppose would enhance the strength of the new associations. As for neurotoxicity, limiting use to less than once a month is quite effective at reducing it, I've heard. This is probably not much of a problem for theraputic use, but if it needs to be administered more frequently, there's some evidence that taking an SSRI before taking MDMA will reduce toxicity (don't do this, you might risk seratonin syndrome). DXM too has been shown effective at reducing amphetamine toxicity, so it might also help (also don't do this). If MDMA is ever rescheduled to allow for research, though, these techniques might allow more frequent use in theraputic settings.

newman314 11y ago

Not being snarky but it would be nice to have a drug that cures the sort of fear associated with FUD.

tokenadult 11y ago

I feared that many participants here would react to this interesting article's headline rather than to its content, and it appears that that fear is warranted. But, seriously, this is a thoughtful article and well worth reading for better understanding of debilitating phobias and how they are currently treated. It is also good to read the whole fine article to see what the medical doctor author has to say about the trade-offs of the proposed drug treatment suggested as an addition to the currently standard exposure therapy. I don't know anyone among my close friends who has a phobia as disabling as those described in the article. There is a big difference between such phobias and the everyday caution and avoidance of rash behavior that helps keep us all safe. AFTER EDIT, AFTER OTHER COMMENTS TO THE THREAD: I remember that back in the 1980s propranolol (a beta-blocker originally prescribed to prevent heart disease) was investigated for anxiety conditions like stage fright. (The cases of stage fright among performers I know best largely resolved as the performers gain in performance competence from more coaching and practice and reduced fear of performing by performing in public more often.) So this line of research about propranolol has been going on for a long time.

facetube 11y ago
Yeah, I get that feeling too. The idea that someone exposed to a traumatic event (e.g. rape, child abuse) could immediately given a single dose of a drug that would prevent a possible 30-40 years of painful PTSD is, honestly, pretty compelling.
category 11y ago
If there are more than 3 negative reactions to an article I definitely go read it because at this point it's hugely probable that the backlash is mainly cultural/traditional rather than logical.
nathanb 11y ago
A fair comment. I think it's important to note that a fear or anxiety reaction may not, as you say, keep us safe. When I'm calm and rational, I make better decisions than when I'm gripped by fear. As an avid hiker and explorer, occasionally my fear of heights interferes with my enjoyment of my hobby. I try to push past it as much as possible, but when my heart is racing and my legs are shaking, a situation which would otherwise be safe can become dangerous. Also, unlike you, I do have two friends who suffer from PTSD (it's common enough that one may be surprised to find that a friend one has known for years wrestles with PTSD in some aspect of life but doesn't advertise that fact). One of those friends has gotten off an elevator early because being in an enclosed situation with a stranger gave her a panic attack. Another called me on the phone nearly in tears because she had to stay late at work and walking across the deserted, dark carpark to her car was almost more than she could handle. I think it would be great if a drug could help people like these two friends of mine go through life without feeling controlled by anxiety in situations like these. I also think it would be great if people like me whose day-to-day lives are unmarred by fear can do more things -- safely; the drug does not impair reason -- through this therapy. The tradeoffs are important to know (and as you say, the article does a great job exploring them), but to me this sounds really promising.

mcphilip 11y ago

I've been using extended release propanelol daily for the past couple years as part of the treatment for chronic mixed tension migraines. I'd been struggling with migraines leaving half of my body feeling extreme muscular tension 2-3 times a week. I can't comment on beta blockers effectiveness in treating anxiety, but it does seem to have a powerful effect on soothing the nervous system without the damaging side effects of addiction and impaired memory when I was taking Xanax or Valium.

sridca 11y ago
> [using extended release propanelol daily for the past couple years] seem to have a powerful effect on soothing the nervous system If you don't mind me asking could you comment on what effect this drug has had, over the past couple years, on your fear-responses? Not talking about phobias, but normal fear-responses.
- mcphilip 11y ago
  I seem to have less nervous tics associated with stressful situations, but anxiety related racing thoughts don't seem to have changed. E.G. Propanelol doesn't seem to impact problems like laying in bed worrying about the upcoming day
  - sridca 11y ago
    Thank you for the response. Could the difference, in those two kinds of situations, be due to the presence/lack of awareness of the trigger of fear response? To explain my thinking: it appears that you are normally aware of the fear-triggers on those "stressful situations" (i.e., what triggers the fear), which awareness of trigger in combination with propanelol's inhibitiveness, leads to you have less nervous tics than usual (and less fear-responses). Whereas, it appears that on other kinds of situations, such as laying in bed running through dispersed thoughts about the upcoming day, there is no well-defined trigger (or so it seems) that can be pin-pointed in time, leading to propanelol not being as effective, thus resulting in racing thoughts. The original study[1] involved a 2-minute exposure prior to administration of propanelol for it to be effective in eliminating the fear-conditioning. And this 2-minute exposure implicitly includes awareness of the fear-trigger. [1] http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2815%2900313-3/abstract?showall=true= http://www.biologicalpsychiatryjournal.com/article/S0006-322...

sharp11 11y ago

What I found fascinating here are the implications for the neurobiology of memory. Here it is limited to highly emotional fear-based memories, but nonetheless the idea that a memory gets rewritten immediately after recall, as saving a file after edit, and that that is an opportunity to completely redefine the memory, is quite striking.

xkcd-sucks 11y ago
There's some evidence that recalling a memory makes it labile, and that interrupting memory reconsolidation processes during this labile period can 'erase' them, much like not getting sleep after initially forming a memory can prevent it from becoming permanent. Emotional/fear associated memories are a really easy model to work with, and are also the most clinically compelling application of memory extinction. See Cristina alberini's work, and others, as well as reviews like http://www.nature.com/nrn/journal/v8/n4/abs/nrn2090.html http://www.nature.com/nrn/journal/v8/n4/abs/nrn2090.html
- sharp11 11y ago
  Thank you for the incisive suggestions! This is remarkable stuff. Here's a good one not behind a paywall: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056265/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056265/

marincounty 11y ago

Interesting small study of 45 people. It seems like it could be investigated quickly in the military today. Propanol is still used to treat high blood pressure. Most doctors have switched their patents to metoprolol(longer half life, and doesn't cross blood/brain barrier as easily), but propanol is still an effective way to reduce high blood pressure. It also helps a bit with anxiety-- maybe? I know a bit about it because I have taken these drugs. I also had a nervous breakdown with symptomology very similar to those that have PTSD. I took propanol for 15 years. I didn't have any complaints with the drug. I actually think beta blockers are healthy for patients high blood pressure, and prone to anxiety. I said healthy--in my case I think they might be healthy. I can't explain it, just have a feeling? That said the fear title threw me; I call it anxiety. Ever since that breakdown, I have never been the same. My fears were random. I was scared of heights on one week, and was fine/better the following week. Some months I was scared of being around people; other times I seeked out crowds of people. There was no reason to my fears. My brain just went bezerk, and I didn't get better for years. I'm still not the guy I used to be. Yes, I'm still employable, but barely. I hide my problems pretty well, or I think I do? My anxiety didn't affect my ability to learn new things--thank god! When I was younger I had consistent fears, actually only public speaking. I got through college with only one oral report, but it took a lot of planning. After that breakdown, I was fearful almost everything. I felt like I reverted back to being a child, or worse. I wasn't a fearful child. When I blew a gasket, the world became difficult, and I was scared of it. There was no rhyme, or reason to my fears. The stuff I was scared of before, like public speaking, and a slight fear of snakes--completely vanished. I guess what I'm trying to say is they still don't know much about anxiety(o.k. Fear). When I took propanol I developed new fears. Repeat--when I took a beta blocker I developed new fears. My fears would come, and go away. They weren't consistent. Yes, this is all antidotal, and I'm probally not the best subject; I don't think I'm like you guys anymore, but who knows? That said, I was hoping they would have found treatments for anxiety related disorders by now. In my case, heterocyclic, and tricyclics dugs did nothing for my anxiety. Addictive drugs, and alcohol are the only drugs that helped. I hope a beta blocker will help those with PTSD, and guys who have been hit with whatever hit me. I didn't have a bad childhood, or wasn't more nervous as a child as the other kids. I just Blew a gasket in my twenties. If you are reading this and are slightly dizzy, slightly anxious, just don't feel like you did; you have my complete sympathy. All I can say is it gets better with age. Most of you will be better a a few weeks. I have never met someone like myself, but my doctor like to say, "All my patients are different." He's right! That's why we need to study mental disorders more carefully. Right now they treat us like cattle when they set up these studies. "Oh, you have this, and this out of twenty symptoms. I'll put you in this category." No wonder we have low efficacy treatments. And yes, I know it's expensive to do quality studies. Sorry, about rambling on. I just kinda tense up with new cures for anxiety. I took so many drugs that didn't work. And the therapy--well give it a shot, I guess. You will never quite know if you don't give it a test drive.

davesque 11y ago

Attention grabbing headline aside, a very interesting read. A good reminder that there are viable treatment options for severe anxiety.

Mandatum 11y ago

It's common practice amongst professional poker players/gamblers to use beta blockers. http://www.pokernewsdaily.com/poker-players-take-performance-enhancing-substances-12074/ http://www.pokernewsdaily.com/poker-players-take-performance...