Beta-Blockers Ineffective for Treating Psychological Symptoms of Anxiety
A systematic review found no evidence of a beneficial effect from beta-blockers in treating anxiety symptoms in patients with social phobia or panic disorder with or without agoraphobia compared to either placebo or benzodiazepines, according to study results published in the Journal of Affective Disorders.
“Beta-blocker prescriptions for patients with anxiety increased substantially between 2003 and 2018, yet there is no clinical guidance concerning their use,” wrote corresponding author Charlotte Archer, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK, and study coauthors.
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The researchers conducted a systematic review of 10 studies (total N = 293), including randomized controlled trials (RCT), non-randomized control group comparative studies, and crossover trials. The included studies used self- or clinician-reported anxiety symptoms data to better understand the efficacy of beta-blockers in treating anxiety disorders in adults. Cochrane's Risk of Bias (RoB 2) tool was used to measure study quality. Five of the studies were also included in meta-analyses (total N = 179) using random-effects models.
The review found no evidence of beneficial effect from the beta-blockers on anxiety symptoms or number of panic attacks when compared to placebo or benzodiazepines in patients with social phobia or panic disorder with or without agoraphobia (p-value for all meta-analyses ≥0.54). Of the included studies, 6 were rated as having an unclear risk of bias, while 4 were rated as having high overall risk of bias.
“Although beta-blockers may help control the physical symptoms of anxiety, they do not act directly on the psychological symptoms,” the researchers wrote.
The study was limited by the small number of included trials, impacting the reliability of its effect estimates and confidence intervals. Furthermore, many of the selected studies had small sample sizes and were conducted over 30 years ago, potentially limiting the relevance of the findings.
“There is a lack of robust evidence of the effectiveness of beta-blockers for the treatment of anxiety. However, beta-blockers are increasingly prescribed routinely for the treatment of anxiety in primary care, despite some safety concerns,” the authors wrote. “Therefore, there is a need to understand firstly, when and why primary care practitioners are using this drug for anxiety, and secondly, to conduct a large multi-center RCT to assess whether beta-blockers are an effective and safe first-line treatment for anxiety.”
