Propranolol in the treatment of anxiety

Since 1964, of 725 patients presenting with anxiety syndromes, 513 were treated with propranolol for periods of several days to over 10 years, some intermittently, others virtually without interruption. Of these, 237 had previously received or were receiving psychotropic drugs, mostly benzodiazepines and/or phenothiazines, which had proved ineffective or deleterious. Dosage was adjusted to achieve an optimum clinical response and a relatively high degree of beta-blockade, as judged by the virtual abolition of orthostatic and hyperventilatory tachycardia. As a rule, 80-320 mg daily sufficed, but increments up to 1200 mg were temporarily required to control bizarre or unusually intense symptoms. With few exceptions, the somatic and psychic symptoms were relieved or moderated and overall functional capacity was restored. Depression, evident in 50% of the patients, usually lifted, but persisted in one-third as a lone symptom responsive to antidepressants. Propranolol requirements usually diminished and lasting remissions were not infrequent. The effects of propranolol contrasted sharply with those experienced by the patients receiving tranquillizers. Single-blind placebo trials involving 76 cases endorsed the specificity of the response to beta-blockade. This long term study reveals that effective control of the somatic and psychic symptoms of anxiety can be achieved with propranolol in appropriate dosage.