From the Guidelines
Propranolol is the preferred beta-blocker for anxiety due to its established use in treating panic disorder and performance anxiety, as noted in a 2022 study published in Hypertension 1. When considering propranolol vs bisoprolol for anxiety, several factors come into play.
- Propranolol is typically used at doses of 10-40mg taken 30-60 minutes before anxiety-provoking situations or 40-80mg daily for ongoing symptoms.
- It works quickly to reduce physical symptoms like trembling, racing heart, and sweating by blocking adrenaline receptors.
- Bisoprolol, while also a beta-blocker, is more commonly prescribed for cardiovascular conditions and has a longer duration of action (24 hours).
- If using bisoprolol for anxiety, typical doses range from 2.5-5mg once daily. Key considerations for using these medications include potential side effects such as fatigue, dizziness, and cold extremities, and the importance of combining them with therapy approaches like cognitive behavioral therapy for optimal anxiety management. It's also crucial to exercise caution in patients with certain health conditions, such as asthma, heart conditions, or diabetes, as noted in guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.
- The choice of beta-blocker should be based on pharmacokinetic and side effect criteria, as well as physician familiarity.
- Beta blockers without intrinsic sympathomimetic activity are preferred, and agents like metoprolol, propranolol, and atenolol have been studied in various settings.
From the Research
Comparison of Propranolol and Bisoprolol for Anxiety
- There is limited direct comparison between propranolol and bisoprolol for anxiety in the provided studies.
- Propranolol has been studied for its efficacy in treating anxiety disorders, with some studies suggesting its effectiveness in alleviating somatic symptoms associated with anxiety 2, 3.
- However, a systematic review and meta-analysis found insufficient evidence to support the routine use of propranolol in the treatment of anxiety disorders 4.
- Another study found no evidence for a beneficial effect of beta-blockers, including propranolol, compared with placebo or benzodiazepines in patients with social phobia or panic disorder 5.
- Bisoprolol is not mentioned in the provided studies as a treatment for anxiety disorders.
- The most commonly prescribed medications for generalized anxiety disorder are selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, with benzodiazepines being the most effective drug 6.
Efficacy of Beta-Blockers for Anxiety
- The quality of evidence for the efficacy of beta-blockers, including propranolol, in the treatment of anxiety disorders is insufficient to support their routine use 5, 4.
- Beta-blockers may be effective in alleviating somatic symptoms associated with anxiety, but their efficacy in treating anxiety disorders is unclear 2, 3.
- Further research is needed to determine the effectiveness of beta-blockers, including propranolol and bisoprolol, in the treatment of anxiety disorders 5.