Effect of a Beta-adrenergic Blocking Agent on Dental Anxiety Propranolol in chronic anxiety disorders. A controlled study. Comparative efficacy of propranolol, chlordiazepoxide, and placebo in the treatment of anxiety: a double-blind trial. Comparative effects of propranolol and chlordiazepoxide in anxiety states. Alprazolam, Propranolol, and Placebo in the Treatment of Panic Disorder and Agoraphobia with Panic Attacks Oxprenolol and propranolol in anxiety states. A double-blind comparative study. A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. Propranolol reduces the anxiety associated with day case surgery. Propranolol in schizophrenia: a double blind, placebo controlled trial of propranolol as an adjunct to neuroleptic medication. Does Acute Propranolol Treatment Prevent Posttraumatic Stress Disorder, Anxiety, and Depression in Children with Burns? The efficacy of early propranolol administration at reducing PTSD symptoms in pediatric injury patients: a pilot study. Pilot study of secondary prevention of posttraumatic stress disorder with propranolol Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial. Effect of beta-receptor blockade on anxiety with reference to the three-systems model of phobic behavior. The effect of propranolol versus placebo on resident surgical performance. Imipramine versus propranolol for the treatment of panic attacks: a pilot study. Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma
The effect of propranolol was studied on 23 dental phobics in a double-blind , placebo-controlled clinical trial involving actual dental treatment . The subjects were selected because they showed high physiological reactivity in the dental situation . Twelve subjects received the test drug and 11 subjects received the placebo at individualized doses of either 80 or 120 mg . A significant difference in self-reported anxiety at the injection phase of treatment and less overall pain intensity and aversiveness were observed for the propranolol as compared with the placebo group . No differences were detected for behavior ratings . Beta-adrenergic blocking agents may have utility for reducing anxiety in individuals fearful of dental treatment In a double-blind crossover study the beta-adrenergic blocking drug propranolol hydrochloride reduced symptoms in 17 of 26 patients with chronic anxiety disorders . Both somatic and psychic symptoms improved as judged by patient and observer ratings . The most frequent side effects ( dizziness , fatigue , and insomnia ) were difficult to distinguish from anxiety symptoms and were , for the most part , mild . The therapeutic and side effects observed suggested CNS activity of the drug . Although propranolol is of benefit to patients with anxiety , its efficacy , compared with that of other antianxiety drugs , has not been established The efficacy and safety of propranolol in the treatment of anxiety was compared with those of chlordiazepoxide and placebo in a 3-week , double-blind study of 212 patients . After a 1-week , single-blind placebo-washout period , patients were r and omized to receive either propranolol ( 80 , 160 , or 320 mg/day ) , chlordiazepoxide ( 30 , 45 , or 75 mg/day ) , or placebo . Patients were evaluated by three physician-rated scales -- Hamilton Rating Scale for Anxiety ( HAM-A ) , Covi Anxiety Scale ( CAS ) , and Clinical Global Impressions scale-- and two patient-rated scales -- Symptoms Checklist 90 and Profile of Mood States . Patients in all groups demonstrated significant improvement in their level of anxiety at all time points compared with their baseline level . At Week 1 propranolol and chlordiazepoxide patients were significantly better than placebo patients , as measured by the HAM-A and CAS . At Week 2 only propranolol was superior to placebo , based on HAM-A and CAS scores . Fifteen patients prematurely terminated because of adverse reactions ( 4 taking propranolol , 4 taking placebo , and 7 taking chlordiazepoxide ) . The incidence of side effects was similar for the two active drugs ; fatigue , drowsiness , and change in libido were significantly more frequent with chlordiazepoxide and drowsiness and indigestion were more frequent with propranolol compared with placebo The trial showed propranolol to be as effective as  chlordiazepoxide overall in the treatment of these cases of anxiety states , but in  depression and sleep disturbance  chlordiazepoxide was better . Nevertheless , the new drug may have some part to play in the treatment of anxiety as an alternative to tranquillizers , and it may be possible in future to define more precise indications for its use Fifty-five patients completed a 5-week double-blind study comparing alprazolam , propranolol , and placebo in the treatment of panic disorder and agoraphobia with panic attacks . There was no concomitant behavioral treatment . Patient and therapist rating scales included Sheehan 's Panic and Anxiety Attack Scales , the Marks-Sheehan Phobia Scale , the Hamilton Anxiety Scale , the Hamilton Depression Scale , and the Side Effects Checklist . The results generally support the efficacy of alprazolam , but not propranolol , in the treatment of panic disorder and agoraphobia with panic attacks . The significance of the results are discussed , as well as a number of the unique aspects of our procedures and patient population The efficacy of oxprenolol ( Trasicor ) and propranolol in controlling anxiety was compared in a double-blind study of patients with anxiety and tension .  Efficacy was assessed by the investigator with the aid of a psychiatric rating scale consisting of 19 items , bythe patients using visual analogue scales , and by the investigator 's and the patients ' over-all assessment s. Tolerance to the drugs was evaluated by over-all assessment and by means of a checklist of signs and symptoms which emerged during treatment . Little difference in the efficacy of the two drugs was observed . Both were effective in the treatment of anxiety and tension . In general , oxprenolol was significantly better tolerated than propranolol . Evidence of the intrinsic sympathomimetic activity of oxprenolol emerged during the course of the study or , alternatively , evidence that propranolol had a greater cardiac-depressant effect We studied the efficacy of propranolol ( Inderal ) compared to alprazolam ( Xanax ) in 29 patients with a diagnosis of agoraphobia with panic disorder or panic disorder with or without limited phobic avoidance in a 6-week double-blind controlled experiment . Alprazolam is effective in those syndromes , whereas to date only negative or ambiguous results had been reported for propranolol .  Fourteen patients received a mean daily dose of 5.0 + /- 2.3 mg of alprazolam and 15 patients received 182.0 + /- 60.5 mg mean daily dose of propranolol . We found both drugs to be effective to suppress panic attacks and reduce avoidance behavior . The only significant between-drug difference was a more rapid onset of alprazolam 's panicolytic effect .  Propranolol merits further study . We suggest patients worthy of a clinical trial OBJECTIVE To find out if propranolol , a non-cardioselective beta-blocker , can reduce the anxiety associated with day case surgery . DESIGN Prospect i ve r and omized double blind trial . SETTING University hospital , Irel and . SUBJECTS An unselected group of 53 patients undergoing day case surgery . INTERVENTION Subjects r and omised to receive either propranolol ( 10 mg ) or placebo on the morning of operation . MAIN OUTCOME MEASURES Blood pressure ; pulse , anxiety , pain score and patient satisfaction . RESULTS Mean ( SD ) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group ( 2.5 ( 0.7 ) compared with 4.6 ( 0.7 ) , p < 0.0001 ) before discharge . CONCLUSION A low dose of propranolol given on the morning of day case surgery significantly reduced patients ' anxiety A double blind , placebo controlled trial was carried out to examine the contribution of propranolol as an adjunct to neuroleptic medication in the treatment of chronic schizophrenic patients whose florid symptoms had not remitted with neuroleptic medication alone .  Propranolol was shown to have a more beneficial effect than placebo , but the results were much less dramatic than those which have been described in previous studies . Recent work has shown that there may be a pharmacokinetic interaction between propranolol and neuroleptics , and this should be considered as one possible explanation of our findings OBJECTIVE This study examined whether acute propranolol treatment prevented posttraumatic stress disorder ( PTSD ) , anxiety , and depression in children hospitalized in the pediatric intensive care unit for large burns . We hypothesized that the prevalence of PTSD , anxiety , and depression would be significantly less in the  propranolol  than nonpropranolol groups . METHODS Children who had previously participated in a r and omized controlled clinical trial of acute propranolol and nonpropranolol controls were invited to participate in long-term follow-up interviews . Eligible participants from 1997 to 2008 were identified from the electronic medical records , and data were collected in 2010 - 2011 . Measures included the Missouri Assessment of Genetics Interview for Children to assess lifetime PTSD , Revised Children 's Manifest Anxiety Scale to assess anxiety , and two depression inventories Children 's Depression Inventory and Beck Depression Inventory-II . RESULTS Of 202 participants , 89 were in the propranolol group and 113 were nonpropranolol controls . Children were an average of 7 years postburn . The average total body surface area burned was 56.4 + 15.1 % ( range = 24%-99 % ) . The mean dose of propranolol was 3.64 ± 3.19 mg/kg per day ( range = 0.36 - 12.12 ) . The duration of propranolol inpatient treatment days varied , mean days 26.5 ± 19.8 . The prevalence of lifetime PTSD in the propranolol group was 3.5 % and controls 7.2 % , but this difference was not statistically significant . We controlled for administration of pain medications , anxiolytics , and antidepressants overall and no significant differences were detected in the rates of PTSD , anxiety , or depression . CONCLUSIONS The prevalence of PTSD , anxiety , and depression was similar in children who received propranolol acutely and those who did not . This may be influenced by the st and ard of care that all children received timely pharmacotherapy for pain and anxiety management and psychotherapy beginning in their acute phase of treatment Initial research supports the use of propranolol to prevent posttraumatic stress disorder ( PTSD ) ; research has not examined pharmacological prevention for children . Twenty-nine injury patients ( ages 10 - 18 years old ) at risk for PTSD were r and omized to a double-blind 10-day trial of propranolol or placebo initiated within 12 hours postadmission . Six-week PTSD symptoms and heart rate were assessed . Although intent-to-treat analyses revealed no group differences , findings supported a significant interaction between gender and treatment in medication-adherent participants , Delta R(2 ) = .21 . Whereas girls receiving propranolol reported more PTSD symptoms relative to girls receiving placebo , Delta R(2 ) = .44 , boys receiving propranolol showed a nonsignificant trend toward fewer PTSD symptoms than boys receiving placebo , Delta R(2 ) = .32 . Findings inform gender differences regarding pharmacological PTSD prevention in youth BACKGROUND Pre clinical considerations suggest that treatment with a beta-adrenergic blocker following an acute psychologically traumatic event may reduce subsequent posttraumatic stress disorder ( PTSD ) symptoms . This pilot study addressed this hypothesis . METHODS Patients were r and omized to begin , within 6 hours of the event , a 10-day course of double-blind propranolol  ( n = 18 ) versus  placebo ( n = 23 ) 40 mg four times daily . RESULTS The mean ( SD ) 1-month Clinician-Administered PTSD Scale ( CAPS ) score of 11 propranolol completers was 27.6 ( 15.7 ) , with one outlier 5.2 SDs above the others ' mean , and of 20 placebo completers , 35.5 ( 21.5 ) , t = 1.1 , df = 29 , p = .15 . Two propranolol patients ' scores fell above , and nine below , the placebo group 's median , p = .03 ( sign test ) . Zero of eight propranolol , but six of 14 placebo , patients were physiologic responders during script-driven imagery of the traumatic event when tested 3 months afterward , p = .04 ( all p values one-tailed ) . CONCLUSIONS These pilot results suggest that acute , posttrauma propranolol may have a preventive effect on subsequent PTSD OBJECTIVE The authors assessed the efficacy of trauma memory reactivation performed under the influence of propranolol , a noradrenergic beta-receptor blocker , as a putative reconsolidation blocker , in reducing symptoms of  posttraumatic stress disorder ( PTSD ) . METHOD This was a 6-week , double-blind , placebo-controlled , r and omized clinical trial in 60 adults diagnosed with long-st and ing PTSD .  Propranolol or placebo was administered 90 minutes before a brief memory reactivation session , once a week for 6 consecutive weeks . The hypothesis predicted a significant treatment effect of trauma reactivation with propranolol compared with trauma reactivation with placebo in reducing PTSD symptoms on both the Clinician-Administered PTSD Scale ( CAPS ) and the patient-rated PTSD Checklist-Specific ( PCL-S ) in an intention-to-treat analysis . RESULTS The estimated group difference in posttreatment CAPS score , adjusted for pretreatment values ( analysis of covariance ) , was a statistically significant 11.50 . The within-group pre- to posttreatment effect sizes ( Cohen 's d ) were 1.76 for propranolol and 1.25 for placebo . For the PCL-S , the mixed linear model 's estimated time-by-group interaction yielded an average decrease of 2.43 points per week , for a total significant difference of 14.58 points above that of placebo . The pre- to posttreatment effect sizes were 2.74 for propranolol and 0.55 for placebo . Per protocol analyses for both outcomes yielded similar significant results . CONCLUSIONS Pre-reactivation propranolol , a treatment protocol suggested by reconsolidation theory , appears to be a novel and efficacious treatment for PTSD . Replication studies using a long-term follow-up in various trauma population s are required 14 phobic subjects were given propranolol ( Inderal ) , atenolol ( Tenormin ) and placebo in a double-blind fashion according to a repeated measurement design . Subjects were exposed to their source of fear while their anxiety and cardiovascular responses ( heart rate , blood pressure and peripheral temperature ) were recorded . In accordance with the Three-Systems Model of fear and phobias , the subjects were divided into two groups of high and low physiological reactors , operationalized by the cardiovascular items in their anxiety pattern from a revised version of the Autonomic Perception Question naire ( APQ ) . It was found that beta-blockade had the predicted effect on heart rate and peripheral temperature while diastolic blood pressure was unaffected . The systolic blood pressure finally was lowered for the low cardiovascular reactors . The subjectively rated anxiety rose consistently during exposure . There was no general effect of the beta-blocking drugs on subjective anxiety . For the high cardiovascular reactors propranolol was associated with a higher anxiety level PURPOSE To determine whether propranolol can decrease surgical tremor and anxiety in residents performing ocular microsurgery without impairing patient or physician safety . METHODS In this r and omized , double-masked , crossover study , 5 third-year ophthalmology residents ingested a capsule containing either propranolol , 40 mg , or placebo 1 hour prior to performing ophthalmic microsurgery . All residents were healthy men under age 30 years . Prior to commencement of the study , all participants had successfully been administered a test dose of propranolol without side effects . The study took place over a 10-week period . At the conclusion of each case , both the resident and attending surgeon observer independently completed a form grading , on a sliding scale : ( 1 ) amount of overall tremor ; ( 2 ) amount of tremor during placement of the first 3 sutures after lens or nucleus extraction ; ( 3 ) anticipated difficulty of the case ; ( 4 ) actual difficulty with the case ; and ( 5 ) anxiety ( surgeon only ) . In addition , the type of procedure performed , complications encountered , and surgeon side effects were recorded . The data were analyzed with a 2-way analysis of variance for unbalanced data . RESULTS A total of 73 surgical cases were performed ; the surgeons were administered propranolol for 40 cases and placebo for 33 . As judged by the resident surgeon , there was a highly significant effect of propranolol in decreasing anxiety ( P = .0058 ) , reducing surgical tremor overall ( P < .0001 ) , and reducing tremor while placing the first 3 sutures following lens extraction ( P < .0001 ) . There was no treatment-by-surgeon interaction for any of the measures . Complications and difficulty of the case , as judged by both the resident and attending surgeons , were not significantly different in the propranolol versus placebo groups ( P > .05 ) . There were no side effects reported or observed in any of the surgeons . CONCLUSIONS Propranolol , 40 mg , administered 1 hour prior to surgery , significantly decreases tremor and anxiety in the surgeon without untoward effects to the surgeon and the patient . However , it is unknown whether decreased tremor and anxiety improved surgical outcome Abstract Thirty-eight patients agreed to participate in a preliminary crossover trial comparing imipramine to propranolol for the treatment of panic disorder and agoraphobia with panic attacks .  An independent blind assessor was used as well as several st and ard rating scales . There was no placebo group . Twenty-three patients completed a trial of both drugs . Approximately half of the patients lost their panic attacks completely , both on imipramine and propranolol . Other patients were partially , but not completely improved . The implication s and limitations of this finding and others are discussed BACKGROUND This study investigated the efficacy of propranolol prescribed shortly after trauma exposure in the prevention of  posttraumatic stress disorder ( PTSD ) symptoms and diagnosis . METHODS Eleven patients received 40 mg of propranolol 3 times daily for 7 days , followed by a taper period of 8 - 12 days . They were compared with eight patients who refused propranolol but agreed to participate in the study . Though nonr and omized , the two groups did not differ on demographics , exposure characteristics , physical injury severity , or peritraumatic emotional responses . RESULTS Posttraumatic stress disorder rates were higher in the group who refused propranolol ( 3/8 ) compared with those who received the medication ( 1/11 ) , as were the levels of PTSD symptoms ( U = 85 , p = .037 ) . CONCLUSIONS Our results are consistent with earlier findings and suggest that propranolol may be useful for mitigating PTSD symptoms or perhaps even preventing the development of PTSD
These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia .
Also , no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation .
In conclusion , the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders
The effects of propranolol in the treatment of anxiety disorders have not been systematic ally evaluated previously .
The aim was to conduct a systematic review and meta- analysis of r and omised controlled trials , addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders .