Propranolol for anxiety
How do the authors of “Do beta blockers cause depression?” (Medicine in Brief, Current Psychiatry, May 2010) feel about using propranolol augmentation for patients with anxiety who are already taking a selective serotonin reuptake inhibitor and a benzodiazepine? I often prescribe propranolol because it has a different mechanism of action—but I am curious if others would consider doing more of this, provided the patient is at low risk for suicidal thoughts and attempts.
Corey Yilmaz, MD
Adult and child psychiatrist
The authors respond
In 1966 Drs. Granville-Grossman and Turner published a seminal article on propranolol for anxiety disorders.1 Their study included 16 patients who used propranolol, 20 mg/d, which had a beneficial effect on anxiety by alleviating autonomically mediated symptoms. This article also provided evidence for a belief that beta blockers are beneficial in anxiety mainly because they reduce somatic symptoms, a finding that has been supported by review articles.2,3 We found only 2 studies examining adjunctive use of propranolol.4,5 In these studies, propranolol combined with alprazolam was found to be well tolerated and effectively reduced somatic anxiety symptoms. Based on available evidence, the addition of a beta blocker could benefit patients who continue to experience physical symptoms of anxiety despite being treated with psychotropics.
Andrew J. Muzyk, PharmD
Campbell University School of Pharmacy
Clinical specialist in internal medicine/psychiatry
Department of pharmacy
Duke University Hospital
Jane Gagliardi, MD
Assistant professor of psychiatry and behavioral sciences
Assistant clinical professor of medicine
Duke University School of Medicine
1. Granville-Grossman KL, Turner P. The effect of propranolol on anxiety. Lancet. 1966;1:788-790.
2. Hayes PE, Schulz SC. Beta-blockers in anxiety disorder. J Affect Disord. 1987;13:119-130.
3. Tyrer P. Anxiolytics not acting at the benzodiazepine receptor: beta blockers. Prog Neuropsychopharmacol Biol Psychiatry. 1992;16:17-26.
4. Shehi M, Patterson WM. Treatment of panic attacks with alprazolam and propranolol. Am J Psychiatry. 1984;141(7):900-901.
5. Mendels J, Chernoff RW, Blatt M. Alprazolam as an adjunct to propranolol in anxious outpatients with stable angina pectoris. J Clin Psychiatry. 1986;47(1):8-11.