The Use of Beta‐Adrenergic Blocking Agents in Anxiety Disorders and Schizophrenia

Abstract

In the 1960s, several studies reported that propranolol and other beta‐blocking drugs appeared especially useful in patients with physical symptoms of anxiety. However, subsequent reports produced conflicting findings, and at this time the efficacy of propranolol in anxiety disorders is not clearly established. Propranolol's utility in anxiety states may be entirely restricted to those anxiety patients whose physical symptoms have not adequately responded to benzodiazepine therapy. This places the beta‐blockers among the least useful drugs in treating anxiety disorders. A major problem in assessing propranolol's antianxiety properties has been a virtual lack of well‐designed studies addressing the issue; the studies reviewed here contained a surprising number of study design problems. Several guidelines regarding study design are included to assist the reader in evaluating studies of antianxiety agents. High dose (e.g., 2,000 mg) propranolol may have a role as an alternative to traditional antipsychotic therapy in neuroleptic‐resistant patients. During the last decade a number of studies have demonstrated symptomatic improvement in schizophrenic patients using propranolol alone or combined with neuroleptics. However, four recent double‐blind reports have failed to replicate this finding. Future research should focus on possible identification of propranolol‐responsive patients and their characteristics. The use of propranolol and other beta‐blockers in schizophrenia should remain in the research or medical center setting.

Beta Blockers in Mental Retardation and Developmental Disorders

“…This high-dose requirement suggests that β-blockers are acting centrally rather than peripherally (see Neppe 1989). Such high doses have been reported to cause serious side effects, including delirium, gastrointestinal symptoms, and paradoxical acute hypertension (Hayes and Schulz 1983). The improvements reported with propranolol generally have been in negative symptoms such as poor socialization, emotional withdrawal, and anergia, as well as on agitation, assaultiveness, and irritability, rather than on hallucinations or delusions.…”

“…The doses needed for central β 1 blockade appear considerably higher than required for peripheral β-blockade (e.g., Hayes and Schulz 1983).…”

Potentiation of Haloperidol-induced Catalepsy by Beta-Adrenoceptor Antagonists in Mice

“…of beta-adrenoceptor antag onists have been suggested in therapeutic areas such as psychiatry and neurology (1). However, the mechanism of action of beta antagonists on the central nervous system is still unclear.…”

Concomitant medication of psychoses in a lifetime perspective

“…Another group of drugs having certain importance in treatment of patients with schizophrenia is cardiovascular agents. In the 1970s and early 1980s beta-adrenergic blocking drugs, such as propranolol, used in high doses, were supposed to be effective as alternative antipsychotics in neuroleptic resistant patients ( Hayes and Schulz, 1983 ). It has also been suggested that beta-adrenergic antagonists are effective in the treatment of acute akathisia ( Lipinski et al , 1988 ; Kornischka et al , 2007 ) and aggression associated with schizophrenia ( Haspel, 1995 ).…”