PTSD

@.nyquist The fact that something is used off-label doesn't mean there is enough evidence to support its use. Lots of meds are used off-label that may or may not be effective. And there are studies that suggest propanolol may be effective soon when given chronically soon after the initial trauma. Unfortunately, these studies have small sample sizes and there are also other studies that contradict these. Hence, the lack of enough evidence to support its use. If someone is struggling after trying 1st and 2nd line meds, then sure it may be worth a try. But physicians should NOT provide medications that lack evidence of effectiveness when there are medications proven to be effective that can be used first (except when they have informed consent from the patient for research). Maybe in the future beta blockers will be used more often in PTSD. Right now, beta blockers are only known to be useful for certain symptoms of PTSD such as hyperarousal. And telling someone to ask for a specific medication is clearly giving medical advice. @TheSailingTeacup that's awesome. We work with dieticians often in the hospital and they are great for the patients.

@drmario: Er, there are several drugs that are used off-label and have a strong consensus among researchers that they are effective. An example that comes to mind? SSRIs for anxiety. What I'm getting at is that there is a large rift between what is considered efficacious by the scientific community and what is formally approved by the FDA. Especially considering the average time in the drug pipeline is ~15 years. I think this is where you are making your mistake. Policy is usually slow to catch up to research. You make it sound as if off-label drug use requires informed consent and IRB approval. As you have hinted at, drugs are used off-label all the time. Whether a psychiatrist chooses to employ them is at their discretion; a choice hopefully informed by the literature. While you're right that there are several studies that contradict each other in the efficacy of a single drug...that could be said for almost anything. So that is sort of a moot point and I don't like the idea of engaging in a literature crawl to see who could produce the most papers citing the (in)effectiveness of propanolol. Admittingly, I did sort of jump the gun in my suggestion of asking for propanolol, as it is, by definition, a non-traditional use of the drug. But it isn't such an absurd suggestion, especially considering that the patient has been dealing with PTSD after 9 years. It wasn't as if I was suggesting asking for experimental drugs after being newly-diagnosed. Now, for the final subject on whether my suggestion could be considered medical advice? Poh-tay-toe, poh-tah-toe. I would hope that TheSailingTeacup is an intelligent enough woman to recognize that any advice she receives on the Internet is to be taken with a grain of salt, I am not a doctor, and I had intended to inform her of an option she might not have not been aware of. Tends to be much more constructive than offering her a pat on the shoulder and a bunch of empty platitudes.

I hope your therapy is going well and I'm positive that you'll be new and improved once you're done. It takes a lot of courage and strength to go. I couldn't do it, I can't even speak of it to any one. It would trigger and destroy me mentally, over and over again every single day. Through many addictions and dark places, I've ended up in a worst position but at least I can't feel the pain any more.

I have a good friend with PTSD, but I honestly can't imagine how it must feel though. I don't really have any advice, and I just wanted to offer my sympathy. Do what you think is best for you, and I hope you manage. You have friends here if you need to talk.