The use of beta-adrenergic blocking agents in anxiety disorders and schizophrenia

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.