Does metoprolol cause anxiety
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Metoprolol and Its Impact on Anxiety: A Comprehensive Review
Introduction to Metoprolol and Anxiety
Metoprolol, a selective beta-1 adrenoceptor antagonist, is commonly prescribed for cardiovascular conditions such as hypertension and heart failure. However, its effects on mental health, particularly anxiety, have been a subject of research and debate. This article synthesizes findings from multiple studies to understand whether metoprolol causes anxiety or alleviates it.
Metoprolol and Anxiety Symptoms in Elderly Patients
A case study involving an 81-year-old man treated with low-dose metoprolol (25 mg/day) reported the development of sleep disorders, nightmares, depression, and anxiety as probable adverse effects. This suggests that in some elderly patients, metoprolol may induce anxiety and other neuropsychiatric symptoms, although such reactions are relatively uncommon and often associated with overdose or poisoning.
Metoprolol as an Anti-Anxiety Agent
Contrary to the above case, several studies have explored metoprolol's potential to alleviate anxiety. A pilot study indicated that metoprolol could reduce heart rate and systolic blood pressure following mental stress, implying fewer side effects compared to propranolol due to its selective action and limited passage through the blood-brain barrier. Another study demonstrated that metoprolol significantly reduced pre-operative anxiety in patients undergoing elective surgery, as assessed by both anaesthetists and patients .
Clinical Trials and Anxiety Reduction
Further clinical trials have reinforced metoprolol's anxiolytic properties. In a study involving patients with anxiety neurosis, metoprolol administration resulted in significant improvement in anxiety symptoms over a period of 6 weeks, with minimal side effects. Additionally, a randomized controlled trial found that metoprolol, combined with aspirin, reduced anxiety and other cardiovascular risk markers in recently bereaved individuals without adversely affecting bereavement intensity.
Metoprolol in Chronic Heart Failure Patients
In patients with chronic heart failure (CHF) and clinical psychological disorders, metoprolol treatment was associated with a significant decrease in anxiety scores, although it worsened depressive and burnout symptoms. This indicates that while metoprolol may offer anxiolytic benefits, its impact on other mental health aspects needs careful consideration.
Conclusion
The relationship between metoprolol and anxiety is complex. While there are instances where metoprolol may induce anxiety, particularly in elderly patients, a substantial body of research supports its efficacy in reducing anxiety symptoms in various clinical settings. Physicians should weigh the benefits and potential neuropsychiatric side effects when prescribing metoprolol, especially in patients with pre-existing mental health conditions. Further research is warranted to fully understand the mechanisms and scope of metoprolol's impact on anxiety.
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