Betaxolol, a long-acting β-adrenergic blocker that enters the central nervous system, was examined for therapeutic effects on the persistent anxiety of anxiety disorders. Prior studies of β-blockers examined only agents that were short-acting or did not enter the brain. Betaxolol was administered to 31 patients in open trials. Of 13 outpatients, 11 had generalized anxiety disorder (GAD) and 2 had adjustment disorder with anxiety. Five with GAD had concurrent panic disorder. Of 18 inpatients, 16 had GAD and 2 had adjustment disorder with anxiety. Betaxolol doses were increased until the patient responded or declined further dosage. Severity was rated on a 4-point global scale. Before betaxolol, all were moderately or severely ill. In all patients with panic disorder panic attacks stopped within 2 days (p < 0.001). Anxiety decreased to no more than marginally ill in 85% of outpatients (p < 0.0001) and all inpatients (p < 0.0001). Betaxolol doses were usually 5 mg once or twice daily; four inpatients took 10 to 20 mg twice daily. In sum, betaxolol administration was rapidly followed by improvements that were easily noticed by the doctor, even in patients with longstanding anxiety and obsessive-compulsive personality disorder. Preliminary observations in posttraumatic stress disorder are similar.

Posttraumatic stress disorder is a debilitating anxiety disorder that can develop in the aftermath of a traumatic or life–threatening event involving extreme horror, intense fear or bodily harm. The disorder is typified by a symptom triad consisting of re–experiencing, hyperarousal and avoidance symptoms. Approximately 15–25% of trauma–exposed individuals go on to develop PTSD, depending on the nature and severity of the trauma. Although dysfunctional adaptive responses exist in multiple neurobiological pathways in the disorder, e.g. glutamate, GABA, glucocortocoids and serotonin, the noradrenergic system is particularly prominent and represents an important pharmacological target in attempts at preventing the development of PTSD posttrauma. However, current literature shows opposing and conflicting results regarding the effect of selective noradrenergic agents in memory processing, and the effect of modulation of selective noradrenergic receptors are spread over diverse protocols and paradigms of learning and fear also employing different strains of animals. Fear conditioning is a behavioural paradigm that uses associative learning to study the neural mechanisms underlying learning, memory and fear. It is useful in investigating the underpinnings of disorders associated with maladaptive fear responses. Performing fear conditioning experiments with the aim of applying it to an animal model of PTSD, and relating these behavioural responses to a defined neural mechanism, will assist both in the elucidation of the underlying pathology of the disease, as well as the development of more effective treatment. This project has set about to re–examine the diverse and complex role of noradrenergic receptors in the conditioned fear response with relevance to PTSD. To the best of my knowledge, this study represents the first attempt at studying a range of noradrenergic compounds with diverse actions and their ability to modify conditioned fear in a single animal model. This work thus introduces greater consistency and comparative relevance not currently available in the literature, and will also provide much needed pre–clinical evidence in support of treatment strategies targeting the noradrenergic system in the prevention of PTSD posttrauma. The first objective of this study was to set up and validate a passive avoidance fear conditioning protocol under our laboratory conditions using the Gemini Avoidance System. The noradrenergic system plays a prominent role in memory consolidation and fear conditioning, while administration of –adrenergic blockers, such as propranolol, have been shown to abolish learning and fear conditioning in both humans and animals. Propranolol has also demonstrated clinical value in preventing the progression of acute traumatic stress syndrome immediately posttrauma to full–blown PTSD. To confer predictive validity to our model, the centrally active –adrenergic antagonist, propranolol, and the non–centrally acting –adrenergic antagonist, nadolol, were administered to Wistar rats after passive avoidance fear conditioning training in the Gemini Avoidance System. Wistar rats were used because of their recognised enhanced sensitivity to stress. Evidence from this pilot study confirmed that propranolol 10 mg/kg significantly inhibits the consolidation of learned fear in rats, whereas nadolol is ineffective. This effectively validated our protocol and the apparatus for further application in this study and also confirmed the importance of a central mechanism of action for –adrenoceptor blockade in the possible application of these drugs in preventing the development of PTSD posttrauma. The second objective of this study was to investigate the role of 1–, 2–, 1–, and 2–receptors in a conditioned fear passive avoidance paradigm. This was done in order to investigate how selective pharmacological modulation of these receptors may modify the conditioned fear response, and whether any of these receptor systems might exert opposing effects in passive fear conditioning. Various centrally active noradrenergic agents were employed over a 3–tiered dose response design, including the 1–antagonist, prazosin, the 2–agonist, guanfacine, the 2–antagonist, yohimbine, the 1–antagonist, betaxolol and the 2–antagonist ICI 118551. The effect of post–exposure administration of these drugs on conditioned fear was compared to that of propranolol 10 mg/kg. Selected doses of betaxolol (10 mg/kg) and ICI 118551 (1 mg/kg) attenuated fear conditioning to an extent comparable to propranolol, as did prazosin (0.1 mg/kg). Yohimbine tended to boster fear learning at all doses tested, albeit not significantly, while guanfacine did not produce any significant effect on memory retention at any of the doses studied. This latter observation was surprising since yohimbine tended to bolster fear conditioning while earlier studies indicate that 2–agonism impairs conditioned fear. Concluding, this study has conferred validity to our passive avoidance model and has provided greater insight into the separate roles of noradrenergic receptors in contextual conditioned fear learning. The study has provided supportive evidence for a key role for both 1– and 2–antagonism, as well as 1–antagonism, in inhibiting fear memory consolidation and hence as viable secondary treatment options to prevent the development of PTSD posttrauma. However, further study is required to delineate the precise role of the 2–receptor in this regard. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2012.

Posttraumatic stress disorder is a debilitating anxiety disorder that can develop in the aftermath of a traumatic or life–threatening event involving extreme horror, intense fear or bodily harm. The disorder is typified by a symptom triad consisting of re–experiencing, hyperarousal and avoidance symptoms. Approximately 15–25% of trauma–exposed individuals go on to develop PTSD, depending on the nature and severity of the trauma. Although dysfunctional adaptive responses exist in multiple neurobiological pathways in the disorder, e.g. glutamate, GABA, glucocortocoids and serotonin, the noradrenergic system is particularly prominent and represents an important pharmacological target in attempts at preventing the development of PTSD posttrauma. However, current literature shows opposing and conflicting results regarding the effect of selective noradrenergic agents in memory processing, and the effect of modulation of selective noradrenergic receptors are spread over diverse protocols and paradigms of learning and fear also employing different strains of animals. Fear conditioning is a behavioural paradigm that uses associative learning to study the neural mechanisms underlying learning, memory and fear. It is useful in investigating the underpinnings of disorders associated with maladaptive fear responses. Performing fear conditioning experiments with the aim of applying it to an animal model of PTSD, and relating these behavioural responses to a defined neural mechanism, will assist both in the elucidation of the underlying pathology of the disease, as well as the development of more effective treatment. This project has set about to re–examine the diverse and complex role of noradrenergic receptors in the conditioned fear response with relevance to PTSD. To the best of my knowledge, this study represents the first attempt at studying a range of noradrenergic compounds with diverse actions and their ability to modify conditioned fear in a single animal model. This work thus introduces greater consistency and comparative relevance not currently available in the literature, and will also provide much needed pre–clinical evidence in support of treatment strategies targeting the noradrenergic system in the prevention of PTSD posttrauma. The first objective of this study was to set up and validate a passive avoidance fear conditioning protocol under our laboratory conditions using the Gemini Avoidance System. The noradrenergic system plays a prominent role in memory consolidation and fear conditioning, while administration of –adrenergic blockers, such as propranolol, have been shown to abolish learning and fear conditioning in both humans and animals. Propranolol has also demonstrated clinical value in preventing the progression of acute traumatic stress syndrome immediately posttrauma to full–blown PTSD. To confer predictive validity to our model, the centrally active –adrenergic antagonist, propranolol, and the non–centrally acting –adrenergic antagonist, nadolol, were administered to Wistar rats after passive avoidance fear conditioning training in the Gemini Avoidance System. Wistar rats were used because of their recognised enhanced sensitivity to stress. Evidence from this pilot study confirmed that propranolol 10 mg/kg significantly inhibits the consolidation of learned fear in rats, whereas nadolol is ineffective. This effectively validated our protocol and the apparatus for further application in this study and also confirmed the importance of a central mechanism of action for –adrenoceptor blockade in the possible application of these drugs in preventing the development of PTSD posttrauma. The second objective of this study was to investigate the role of 1–, 2–, 1–, and 2–receptors in a conditioned fear passive avoidance paradigm. This was done in order to investigate how selective pharmacological modulation of these receptors may modify the conditioned fear response, and whether any of these receptor systems might exert opposing effects in passive fear conditioning. Various centrally active noradrenergic agents were employed over a 3–tiered dose response design, including the 1–antagonist, prazosin, the 2–agonist, guanfacine, the 2–antagonist, yohimbine, the 1–antagonist, betaxolol and the 2–antagonist ICI 118551. The effect of post–exposure administration of these drugs on conditioned fear was compared to that of propranolol 10 mg/kg. Selected doses of betaxolol (10 mg/kg) and ICI 118551 (1 mg/kg) attenuated fear conditioning to an extent comparable to propranolol, as did prazosin (0.1 mg/kg). Yohimbine tended to boster fear learning at all doses tested, albeit not significantly, while guanfacine did not produce any significant effect on memory retention at any of the doses studied. This latter observation was surprising since yohimbine tended to bolster fear conditioning while earlier studies indicate that 2–agonism impairs conditioned fear. Concluding, this study has conferred validity to our passive avoidance model and has provided greater insight into the separate roles of noradrenergic receptors in contextual conditioned fear learning. The study has provided supportive evidence for a key role for both 1– and 2–antagonism, as well as 1–antagonism, in inhibiting fear memory consolidation and hence as viable secondary treatment options to prevent the development of PTSD posttrauma. However, further study is required to delineate the precise role of the 2–receptor in this regard. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2012.