Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis

Serge A Steenen, Arjen J van Wijk, Geert J M G van der Heijden, Roos van Westrhenen, Jan de Lange, Ad de Jongh, Serge A Steenen, Arjen J van Wijk, Geert J M G van der Heijden, Roos van Westrhenen, Jan de Lange, Ad de Jongh

Abstract

The effects of propranolol in the treatment of anxiety disorders have not been systematically evaluated previously. The aim was to conduct a systematic review and meta-analysis of randomised 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. Eight studies met the inclusion criteria. These studies concerned panic disorder with or without agoraphobia (four studies, total n = 130), specific phobia (two studies, total n = 37), social phobia (one study, n = 16), and posttraumatic stress disorder (PTSD) (one study, n = 19). Three out of four panic disorder trials qualified for pooled analyses. 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.

Keywords: Propranolol; anxiety disorders; meta-analysis; panic disorder.

Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2015.

Figures

Figure 1.
Figure 1.
Flow of information through the different phases of the systematic search.
Figure 2.
Figure 2.
Risk of bias summary figure.
Figure 3(a).
Figure 3(a).
Meta-analysis I. Propranolol versus benzodiazepines in panic disorder with or without agoraphobia (outcome: number of panic attacks after 2 weeks of treatment).
Figure 3(b).
Figure 3(b).
Meta-analysis II. Propranolol versus benzodiazepines in panic disorder with or without agoraphobia (outcome: HAM-A after 2 weeks treatment).
Figure 3(c).
Figure 3(c).
Meta-analysis III. Propranolol versus benzodiazepines in panic disorder with or without agoraphobia (outcome: HAM-A after 2–6 weeks treatment).
Figure 3(d).
Figure 3(d).
Meta-analysis IV. Propranolol versus alprazolam in panic disorder with or without agoraphobia (outcome: HAM-A after 6 weeks treatment).
Figure 3(e).
Figure 3(e).
Sensitivity analysis. Meta-analysis III with one study with high risk of selective outcome reporting included and excluded (Ravaris et al., 1991).

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