Action of d-propranolol in manic psychoses

Six manic patients were treated with high doses of d-propranolol or d- and dl-propranolol in a double-blind, placebo controlled study. The following variables were measured: propranolol dosage, propranolol serum concentration, pulse frequency, blood pressure, and psychotic behavior. In all cases an improvement was noticed. High dosages were necessary to obtain sufficient effect. The antimanic property of d-propranolol was approximately 50% smaller than the antimanic property of dl-propranolol. We conclude that at least some part of the antimanic action of beta-blockers is independent from the beta-blocking property.