The question concerns a female patient who has been treated with Inderal (propranolol) 10 mg 1-2 ta

Fråga: The question concerns a female patient who has been treated with Inderal (propranolol) 10 mg 1-2 tablets when needed for recurrent symptoms of phobia with palpitations and tremor. Is there any documentation that a selective beta-blocking drug like metoprolol would have efficacy in phobias?

Sammanfattning: Most of the studies on the use of beta-adrenoceptor blockers in the treatment of somatic symptoms of anxiety disorders or phobias have been performed with propranolol. Metoprolol has also been reported to be effective in some cases, but controlled clinical trials are lacking.

Svar: Beta-adrenoceptor blocking agents have been used for the treatment of various psychiatric disorders including acute stress reactions, adjustment disorders, generalized anxiety, panic disorder, phobias and performance anxiety. In general, they have been reported to be effective in these disorders when somatic or autonomic symptoms such as palpitations, sweating, blushing and tremor are prominent (1-2). The effect is believed to be mediated mainly by peripheral beta-blockade although central mechanisms have also been discussed (3).

Most of the studies on the use of beta-adrenoceptor blockers in psychiatric disorders have been performed with propranolol (3). In some review articles it is stated that it seems to make little difference which beta-blocker is chosen (2,3); no hard data to support this view is however given. No adequate comparative studies with different beta-blockers have been performed. Moreover, evaluation of the literature in this field is difficult because of unclear diagnostic criteria used for the different disorders. According to some case reports, atenolol in doses of 50 to 100 mg per day would provide significant relief in some patients with social phobia (4). Metoprolol has also been reported to be effective in some cases (5). On the other hand, there is some evidence that selective beta-blockers such as atenolol might be less effective in reducing the somatic symptoms of anxiety (6, cited in 2). 1 Levin AP, Liebowitz MR: Drug treatment of phobias. Efficacy and optimum use. Drugs 1987; 34: 504-514 2 Tyrer P: Current status of beta-blocking drugs in the treatment of anxiety disorders. Drugs 1988; 36: 773-783 3 Lader M: Beta-adrenoceptor antagonists in neuropsychiatry: An update. J Clin Psychiatry 1988; 49: 213-223 4 Gorman JH, Liebowitz MR, Fyer AJ et al: Treatment of social phobia with atenolol. J Clin Psychopharmacol 1985; 5: 298-301 5 Chaturvedi SK: Propranolol versus metoprolol in anxiety disorders. Can J Psychiatry 1987; 32: 250-251 6 Jefferson D, Jenner P, Marsden CD: Beta-adrenoceptor antagonists in essential tremor. J Neurol Neurosurg Psychiatry 1979; 42: 904-909