The Use of Beta-Adrenergic Blocking Agents in Anxiety Disorders and Schizophrenia

Interactions of atenolol with alprazolam/escitalopram on anxiety, depression and oxidative stress

Anxiety and depression are highly comorbid disorders possibly sharing a common neurobiological mechanism. The dysfunction of serotoninergic, noradrenergic and dopaminergic neurotransmission, abnormal regulation in the hypothalamic-pituitary-adrenal axis (HPA), disturbance of cellular plasticity including reduced neurogenesis, or chronic inflammation connected with high oxidative damage play a crucial role in the development of anxiety and depression. The present study was aimed to investigate the effects of atenolol alone and in combination with alprazolam/escitalopram on anxiety, depression and oxidative stress. Wistar albino rats were subjected to 21 day treatment of drugs then exposed to elevated-plus maze (EPM) and modified forced swim test (MFST), and oxidative stress markers were estimated in isolated brain tissue of all groups. The results indicated that atenolol in combination with alprazolam/escitalopram exhibited antidepressant effects by significantly decreasing the immobility and increasing the swimming behavior in the MFST and anti-anxiety effects by increasing the percentage preference and number of open arm entries as well as time spent in open arm in EPM. Pretreatment with atenolol alone and combination with alprazolam/escitalopram also ameliorated tissue glutathione (GSH) and decreased malondialdehyde (MDA) level significantly which explore antioxidant properties of drugs, and combination augments the therapeutic response of monotherapy in depression. In conclusion behavioral and biological findings indicate that the combination of atenolol with alprazolam/escitalopram has the potential of being highly efficacious in treating anxiety and depressive disorders as well as oxidative stress.

Beta-blocker supplementation of standard drug treatment for schizophrenia

BACKGROUND

Many people with schizophrenia or similar severe mental disorders do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, among them beta-adrenergic receptor antagonists (beta-blockers).

OBJECTIVES

To evaluate the clinical effectiveness of beta-blockers as an adjunct to antipsychotic medication in schizophrenia or similar severe mental disorders.

SEARCH STRATEGY

Publications in all languages were searched from the following databases: Biological Abstracts, CENTRAL of The Cochrane Library, Cochrane Schizophrenia Group's Specialised Register, EMBASE, LILACS, MEDLINE, and PsycLIT. The reference section of papers included were screened.

SELECTION CRITERIA

All randomised controlled trials comparing beta-blockers with placebo as an adjunct to conventional antipsychotic medication for those with schizophrenia.

DATA COLLECTION AND ANALYSIS

Studies were selected and then data extracted, independently, by at least two reviewers. Odds ratios and 95% confidence intervals of homogeneous dichotomous data were calculated with the Peto method. A random effects model was used for heterogeneous dichotomous data. Weighted mean differences were calculated for continuous data.

MAIN RESULTS

Currently the review includes five studies but data are poorly presented and do not evidence any effect of beta-blockers as an adjunct to conventional antipsychotic medication.

REVIEWER'S CONCLUSIONS

At present beta-blockers cannot be recommended in the treatment of schizophrenia. Any possible benefit of adjunctive beta-blockers is obscured by the poor reporting of the included studies. Existing data on beta-blockers as adjunctive medication to antipsychotics for those with schizophrenia should be collected and re-analysed in order to allow confident conclusions about the effect of this treatment or the need for further trials.