Propranolol-induced depression and psychosis.

Area of Science:

• Pharmacology
• Neuroscience
• Cardiology

Background:

• Propranolol hydrochloride, a lipophilic beta-blocker, can cross the blood-brain barrier.
• Central nervous system side effects, including depression and psychosis, have been associated with propranolol.
• Understanding the relationship between lipophilicity and adverse psychiatric events is crucial for patient safety.

Purpose of the Study:

• To report two cases of depression and psychosis potentially induced by propranolol hydrochloride.
• To review existing literature on propranolol-induced psychiatric adverse effects.
• To evaluate the efficacy of switching to a less lipophilic beta-blocker, atenolol, in managing these adverse events.

Main Methods:

• Case report of two patients experiencing psychiatric symptoms (depression, psychosis) while on propranolol hydrochloride.
• Dose modification and rechallenge with propranolol hydrochloride to assess causality.
• Substitution of propranolol hydrochloride with atenolol to evaluate treatment efficacy.

Main Results:

• Patient 1 developed severe depression, anorexia, and apathy on propranolol, which resolved upon dose reduction and switching to atenolol.
• Patient 2 experienced agitation and psychosis after propranolol dose increase, with rapid improvement upon dose reduction and subsequent switch to atenolol.
• Both patients remained symptom-free on atenolol therapy, indicating a likely link between propranolol and the psychiatric symptoms.

Conclusions:

• Propranolol hydrochloride's high lipophilicity may contribute to central nervous system side effects like depression and psychosis.
• Atenolol, a weakly lipophilic beta-blocker, appears to be a safer alternative for patients experiencing such adverse effects.
• Careful consideration of beta-blocker lipophilicity is important when managing patients requiring continuous beta-blockade.