From the Guidelines
Atenolol is not recommended as a first-line treatment for anxiety disorders, as SSRIs and SNRIs are more effective for comprehensive anxiety treatment. While atenolol, a beta-blocker, can help reduce physical symptoms of anxiety like rapid heartbeat, trembling, and sweating, it doesn't address the psychological aspects of anxiety 1, 2, 3. Atenolol is primarily prescribed for cardiovascular conditions such as hypertension and angina. For anxiety, it may be used off-label at doses of 25-100mg daily, particularly for performance anxiety or situational anxiety where physical symptoms are predominant. However, medications like SSRIs (such as sertraline or escitalopram), SNRIs, or benzodiazepines are generally more effective for comprehensive anxiety treatment, as shown in 126 placebo-controlled RCTs of adolescents and adults in 3 systematic reviews 1.
Key Points to Consider
- Atenolol works by blocking the effects of adrenaline, reducing heart rate and blood pressure, which can help manage the physical manifestations of anxiety but not the underlying psychological causes.
- The first-line pharmacologic therapies for anxiety disorders in adults are SSRIs and SNRIs, which have been shown to be effective in improving symptoms and decreasing relapse rates in adolescents and adults 2.
- If considering atenolol for anxiety, it should be discussed with a healthcare provider, as it may not be suitable for people with certain conditions like asthma, diabetes, or certain heart problems, and can cause side effects including fatigue, dizziness, and cold extremities.
- Psychological therapy, predominantly CBT, is the initial treatment approach for most patients, and has been shown to be effective in improving symptoms and decreasing relapse rates compared with waitlist controls, active treatment groups, usual care, or psychological placebos 3.
Important Considerations for Treatment
- The effectiveness of treatments for anxiety has been evaluated by trials summarized in systematic reviews of psychological and pharmacologic therapies.
- The harms of treatment, including common adverse events and discontinuation rates, should be carefully considered when selecting a treatment for anxiety.
- The strength of evidence for the accuracy of brief questionnaires administered by clinicians or patients themselves to identify women with anxiety is high, based on 33 studies and 2 reviews evaluating 27 clinical screening instruments and their variations 1.
From the Research
Efficacy of Atenolol for Anxiety Treatment
- Atenolol may be effective in treating anxiety disorders, with a study showing that 86% of patients reported a positive effect and continued to take the medication 4.
- Another study found that atenolol was effective in the symptomatic treatment of generalized anxiety, although the study was not placebo-controlled nor double-blinded 5.
- However, other studies have raised concerns about the use of beta-blockers, including atenolol, in treating anxiety disorders, citing limited evidence and potential side effects 6, 7.
Comparison to Other Treatments
- Atenolol may be more effective and better tolerated than propranolol, another beta-blocker commonly used to treat anxiety, although more research is needed to confirm this 4.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are currently considered first-line treatments for anxiety disorders, with cognitive behavioral therapy also showing strong evidence of efficacy 8.
Limitations and Future Research
- The current evidence for atenolol's effectiveness in treating anxiety is limited, and more rigorously controlled empirical studies are needed to further substantiate its use 4, 6.
- Further research is also needed to determine the exact role of beta-blocking agents in treating anxiety and to evaluate their potential side effects and interactions with other medications 6, 7.