Treating Anxiety with either Beta Blockers or Antiemetic Antimuscarinic Drugs: A Review

Abstract

Beta adrenergic receptor antagonists and antiemetic muscarinic receptor antagonists are useful for mental health in primary care and family medicine settings, as they provide favorable risk/benefit profiles, and especially so relative to benzodiazepines. Beta blockers (e.g., propranolol) prescribed off-label have been known for decades to provide some, albeit limited, anxiolytic benefit for patients affected by social anxiety disorder (social phobia), including performance anxiety. Blockage of adrenaline's binding to cardiovascular beta adrenergic receptors inhibits tachycardia, reduces blood pressure, and thus diminishes palpitations in acute anxiety and panic. However, beta blockers are not effective against the psychic (CNS) symptoms, such as anxiousness, fear, and avoidance. Another approach involves antiemetic muscarinic receptor antagonists that are available by prescription (e.g., scopolamine) or over-the-counter (e.g., meclizine) for the treatment of non-cardiovascular symptoms that manifest in anxiety disorders. Antiemetic agents inhibit nausea, vomiting, sweating, and in some instances other psychic (CNS) symptoms. The symptoms affected by antimuscarinic agents represent the "inverse" of the symptoms of acute anxiety affected by beta blockers. Thus, anxiety disorders can be treated by alternative biochemical pathways, as well as by affecting alternative symptoms thereof. The results of human clinical studies are summarized for both classes of anxiolytic agents that display complementary pharmacologic approaches to a diverse array of symptoms.

The effects of methylphenidate and propranolol on the interplay between induced-anxiety and working memory

“…Findings revealed that PRO failed to influence anxiety or cognitive performance. This negative finding could be due to insufficient dose amount (40 mg single dose) (Dooley 2015) or time of administration (90 min prior to task) (Müller et al 2005), or it could be specific to the experimental design, i.e., PRO has no effect on anxiety induced by threat of shock.…”

The role of beta-adrenolytic drugs in treating anxiety disorders

“…This paper initiated a debate on pharmacotherapy using beta blockers in hypertension, which continues until today. Later, research was conducted which demonstrated that beta blockers are a safe therapeutic option in treating arrhythmia and chronic congestive heart failure [29].…”

“…Praca zainicjowała dyskusję nad tematem farmakoterapii z zastosowaniem adrenolityków typu beta w nadciśnieniu, która trwa do chwili obecnej. W późniejszym czasie wykonano badania, z których wynikało, iż betaadrenolityki są bezpieczną opcją terapeutyczną w leczeniu arytmii serca oraz przewlekłej, zastoinowej niewydolności serca [29].…”

Survey of Pharmacological Activity and Pharmacokinetics of Selected β-Adrenergic Blockers in Regard to Their Stereochemistry

“…β-blockers have been used as drugs for more than 50 years in the therapy of several diseases of the cardiovascular system [1] as well as in other disorders connected with an increase in sympathetic tone, such as glaucoma [2,3], anxiety [4], thyrotoxicosis [5], osteoporosis [6], and migraine prophylaxis [7]. The study of this drug group is substantiated by high incidence rate of cardiovascular diseases [8], such as ischemic heart disease, hypertension [9][10][11][12], heart arrhythmia, hypertrophic cardiomyopathy [13], and heart failure [8,14], all of which have been brought into connection with β-adrenergic receptors.…”