Abstract
Background
Beta-blocker prescriptions for patients with anxiety increased substantially between 2003-2018, yet there is no clinical guidance concerning their use. A previous review of propranolol – a beta-blocker – in the treatment of anxiety concluded there was insufficient evidence to support its use. Additional data have been published in the eight years since that review including some evidence for other beta-blockers. We aimed to synthesise all available data on the effectiveness of beta-blockers in the treatment of anxiety disorders in adults.
Methods
We searched Medline, Embase, PsycINFO, Web of Science, and Trial Registries (September 2023), including randomised controlled trials (RCT), non-randomised control group comparative studies and cross‐over trials reporting self- or clinician-reported anxiety symptoms. Study quality was assessed using Cochrane’s Risk of Bias tool, with meta-analyses conducted by comparator group using random-effects models.
Results
Searches produced 3,068 records, with 10 studies included, of which five were included in meta-analyses (n=179). There was no evidence for a beneficial effect of beta-blockers compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia (p-value for all meta-analyses ≥ 0.54).
Limitations
Many of the included studies had small sample sizes, missing data and high or unclear risk of bias.
Conclusion
Beta-blockers are increasingly prescribed for anxiety, yet there is a lack of robust evidence of effectiveness. There is a need to understand when and why practitioners are using these drugs, and to undertake a large RCT to provide definitive evidence of whether beta-blockers are an effective and safe treatment for anxiety.
Beta-blocker prescriptions for patients with anxiety increased substantially between 2003-2018, yet there is no clinical guidance concerning their use. A previous review of propranolol – a beta-blocker – in the treatment of anxiety concluded there was insufficient evidence to support its use. Additional data have been published in the eight years since that review including some evidence for other beta-blockers. We aimed to synthesise all available data on the effectiveness of beta-blockers in the treatment of anxiety disorders in adults.
Methods
We searched Medline, Embase, PsycINFO, Web of Science, and Trial Registries (September 2023), including randomised controlled trials (RCT), non-randomised control group comparative studies and cross‐over trials reporting self- or clinician-reported anxiety symptoms. Study quality was assessed using Cochrane’s Risk of Bias tool, with meta-analyses conducted by comparator group using random-effects models.
Results
Searches produced 3,068 records, with 10 studies included, of which five were included in meta-analyses (n=179). There was no evidence for a beneficial effect of beta-blockers compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia (p-value for all meta-analyses ≥ 0.54).
Limitations
Many of the included studies had small sample sizes, missing data and high or unclear risk of bias.
Conclusion
Beta-blockers are increasingly prescribed for anxiety, yet there is a lack of robust evidence of effectiveness. There is a need to understand when and why practitioners are using these drugs, and to undertake a large RCT to provide definitive evidence of whether beta-blockers are an effective and safe treatment for anxiety.
| Original language | English |
|---|---|
| Pages (from-to) | 90-99 |
| Number of pages | 10 |
| Journal | Journal of Affective Disorders |
| Volume | 368 |
| Early online date | 11 Sept 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 11 Sept 2024 |
Bibliographical note
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