From the Research
For daytime PTSD symptoms, propranolol is generally preferred over hydroxyzine due to its ability to specifically target hyperarousal symptoms without causing significant sedation. Propranolol, typically started at 10-20mg twice daily and titrated as needed up to 40mg three times daily, blocks the effects of adrenaline, reducing physical symptoms like racing heart, trembling, and heightened startle response that commonly occur during daytime 1. Hydroxyzine, while sometimes used for anxiety, is primarily an antihistamine with sedating properties that may cause daytime drowsiness, potentially interfering with daily functioning.
Key Considerations
- Propranolol works by blocking beta-adrenergic receptors, reducing the physical manifestations of anxiety without causing significant sedation, making it particularly effective for situational anxiety and can be taken 30-60 minutes before anticipated triggers.
- However, propranolol should be used cautiously in patients with asthma, diabetes, or certain heart conditions, and should not be stopped abruptly.
- Blood pressure and heart rate should be monitored regularly during treatment.
- The most recent and highest quality study on pharmacotherapy for PTSD suggests that SSRIs are the first-line agents for the pharmacotherapy of PTSD, but does not provide direct comparison between propranolol and hydroxyzine 2.
Evidence Summary
- A 2021 study found that propranolol may be effective in reducing PTSD symptoms, particularly in patients with severe symptoms 1.
- A 2022 systematic review found that SSRIs are the most effective medication for PTSD, but did not provide direct comparison between propranolol and hydroxyzine 2.
- Other studies have highlighted the importance of considering the individual patient's needs and medical history when selecting a treatment for PTSD 3, 4.