How do you treat sympathetic nervous system calming, also known as sympatholytic (sympathetic nervous system inhibition) therapy?

From the Guidelines

To calm the sympathetic nervous system, beta blockers such as bisoprolol, sustained-release metoprolol, or carvedilol are effective in reducing the risk of death in patients with chronic heart failure, as they inhibit the adverse effects of the sympathetic nervous system. These medications work by blocking the effects of norepinephrine on alpha-1–, beta-1–, and beta-2–adrenergic receptors, which can increase ventricular volumes and pressure, impair sodium excretion, induce cardiac hypertrophy, and provoke arrhythmias 1.

In addition to beta blockers, other approaches can be used to calm the sympathetic nervous system. Deep breathing exercises, regular meditation or mindfulness practice, progressive muscle relaxation, and regular moderate exercise can help reduce baseline sympathetic activity and promote relaxation. For immediate calming, cold exposure or limiting caffeine, alcohol, and processed foods while maintaining proper hydration can also be effective.

In cases of severe sympathetic overactivity, medications like propranolol, clonidine, or benzodiazepines for short-term use may be prescribed, as they can directly inhibit sympathetic activity or enhance parasympathetic tone 1. However, the use of these medications should be guided by the most recent and highest quality evidence, and the potential benefits and risks should be carefully considered.

Some key points to consider when treating sympathetic nervous system overactivity include:

• The use of beta blockers, such as bisoprolol, sustained-release metoprolol, or carvedilol, which have been shown to reduce the risk of death in patients with chronic heart failure 1
• The importance of lifestyle modifications, such as deep breathing exercises, regular meditation or mindfulness practice, progressive muscle relaxation, and regular moderate exercise, in reducing baseline sympathetic activity and promoting relaxation
• The potential benefits and risks of medications like propranolol, clonidine, or benzodiazepines for short-term use in cases of severe sympathetic overactivity 1
• The need to carefully consider the potential benefits and risks of any treatment approach, and to prioritize the most recent and highest quality evidence in guiding treatment decisions.

Overall, a comprehensive approach that incorporates lifestyle modifications, medications, and careful consideration of the potential benefits and risks of each treatment option is necessary to effectively calm the sympathetic nervous system and promote relaxation.

From the FDA Drug Label

Patients receiving catecholamine-depleting drugs, such as reserpine should be closely observed for excessive reduction of resting sympathetic nervous activity, which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic hypotension To treat sympathetic nervous system calming, also known as sympatholytic therapy, beta-blockers such as propranolol can be used.

• Key points:
  • Propranolol is a competitive inhibitor of beta-receptor agonists
  • Its effects can be reversed by administration of such agents, e.g., dobutamine or isoproterenol
  • Patients on long-term therapy with propranolol may experience uncontrolled hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation
  • Catecholamine-depleting drugs, such as reserpine, should be used with caution as they may result in excessive reduction of resting sympathetic nervous activity 2
  • Clonidine, an alpha-2 adrenergic agonist, can also be used to calm the sympathetic nervous system, but its overdose may result in rapid development of CNS depression 3

From the Research

Sympatholytic Therapy Methods

• Nonpharmacological methods:
  • Behavioral therapy (e.g., meditation, relaxation, and biofeedback techniques) 4
  • Weight reduction and avoidance of particular foods and agents that stimulate sympathetic activity (including caffeine and alcohol) 4
  • Regular physical exercise, which has been shown to reduce hypertension and decrease elevated SNS activity 5
  • Yoga practices, which can correct underactivity of the parasympathetic nervous system and GABA systems, and reduce allostatic load 6
  • Mindfulness meditation, which has been shown to lower muscle sympathetic nerve activity and blood pressure in African-American males with chronic kidney disease 7
• Pharmacological therapy:
  • Centrally acting drugs such as alpha-methyldopa, clonidine, and reserpine 4
  • Ganglionic blockers such as hexamethonium 4
  • Agents acting on sympathetic nerve terminals such as guanethidine and debrisoquine 4
  • Drugs that may act at multiple sites, such as the beta-adrenergic blockers 4

Mechanisms of Sympatholytic Therapy

• Reduction of sympathetic activity through various mechanisms, including decreased activation of neurons within cardiovascular regions of the brain 5
• Correction of underactivity of the parasympathetic nervous system and GABA systems, which can help to reduce allostatic load and improve symptoms of stress-related disorders 6
• Reduction of muscle sympathetic nerve activity, which can help to lower blood pressure and improve hemodynamics 7

Effects of Sympatholytic Therapy on Various Conditions

• Hypertension: sympatholytic therapy can help to reduce blood pressure and improve cardiovascular health 4, 5
• Anxiety disorders: sympatholytic therapy can help to reduce symptoms of anxiety and improve autonomic flexibility 8
• Chronic kidney disease: mindfulness meditation, a form of sympatholytic therapy, has been shown to lower blood pressure and reduce muscle sympathetic nerve activity in African-American males with CKD 7
• Epilepsy, depression, and post-traumatic stress disorder: yoga practices, a form of sympatholytic therapy, can help to reduce symptoms and improve quality of life 6