Metoprolol anxiety
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Metoprolol and Its Effects on Anxiety: A Comprehensive Review
Introduction to Metoprolol and Anxiety
Metoprolol, a selective beta-1 adrenoceptor antagonist, has been explored for its potential benefits in managing anxiety disorders. Unlike non-selective beta-blockers like propranolol, metoprolol targets beta-1 receptors primarily in the heart, which may result in fewer side effects and make it a preferable option for certain patients, including those with respiratory issues1.
Metoprolol's Efficacy in Reducing Anxiety Symptoms
Clinical Studies on Anxiety Reduction
Several studies have demonstrated the efficacy of metoprolol in reducing anxiety symptoms. A pilot study indicated that metoprolol significantly reduced heart rate and systolic blood pressure in response to mental stress, suggesting its potential in managing anxiety neurosis1. Another study involving patients undergoing elective surgery found that those premedicated with metoprolol reported significantly lower anxiety levels compared to those given a placebo2. This was corroborated by both patient self-assessments and evaluations by anesthetists3.
Long-Term Effects on Anxiety
In a study focusing on chronic heart failure (CHF) patients with clinical mental disorders, metoprolol was shown to significantly decrease anxiety scores over a 12-month period. This anxiolytic effect was independent of heart rate reduction, highlighting metoprolol's direct impact on anxiety symptoms4.
Comparative Analysis with Other Beta-Blockers
Advantages Over Propranolol
Metoprolol's selective action on beta-1 receptors may result in fewer side effects compared to non-selective beta-blockers like propranolol. This selectivity is particularly beneficial for patients with obstructive respiratory illnesses, as metoprolol is less likely to exacerbate respiratory symptoms1. Additionally, metoprolol's limited ability to cross the blood-brain barrier may reduce the incidence of central nervous system side effects, such as depression and nightmares, which are more commonly associated with propranolol1 6.
Metoprolol in Specific Populations
Pre-Operative Anxiety Management
Metoprolol has been found effective in managing pre-operative anxiety. In a double-blind study, patients who received metoprolol before surgery were significantly less anxious and better sedated compared to those who received a placebo3. This suggests that metoprolol can be a valuable drug for premedication in surgical settings.
Anxiety in Bereavement
A randomized controlled trial investigated the effects of metoprolol on recently bereaved individuals. The study found that metoprolol, combined with aspirin, significantly reduced anxiety levels without adversely affecting the intensity of bereavement7. This indicates that metoprolol may offer psychological benefits during periods of heightened emotional stress.
Potential Adverse Effects
Neuropsychiatric Reactions
While metoprolol is generally well-tolerated, there have been reports of neuropsychiatric adverse reactions, particularly in elderly patients. An 81-year-old patient developed sleep disorders, nightmares, depression, and anxiety as probable side effects of low-dose metoprolol6. This underscores the importance of monitoring for such reactions, especially in older populations.
Impact on Depression and Burnout
In CHF patients, metoprolol treatment was associated with worsening depressive and burnout symptoms, despite its anxiolytic benefits4. This suggests that while metoprolol can be effective for anxiety, it may not be suitable for patients with co-existing depression or burnout, necessitating careful patient selection and monitoring.
Conclusion
Metoprolol has shown promise in reducing anxiety symptoms across various settings, including pre-operative care and chronic heart failure management. Its selective action on beta-1 receptors offers advantages over non-selective beta-blockers like propranolol, particularly in terms of side effect profile. However, potential neuropsychiatric adverse effects, especially in elderly patients, warrant careful consideration. Overall, metoprolol represents a viable option for managing anxiety, with its benefits and risks needing to be balanced based on individual patient profiles.
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Most relevant research papers on this topic
Metoprolol, a new selective beta-blocker in anxiety neurosis
Metoprolol shows potential in reducing anxiety and improving blood pressure in patients with anxiety neurosis, potentially with fewer side effects than propranolol.
Non-RCT
Rigorous JournalPre‐operative assessment of anxiety and measurement of arterial plasma catecholamine concentrations The effect of oral β‐adrenergic blockade with metoprolol
Metoprolol provides greater relief of anxiety in patients undergoing elective hysterectomy, but there is no correlation between anxiety and catecholamine concentrations or relief of anxiety and haemodynamics.
RCTEffect of metoprolol and diazepam on pre‐operative anxiety
Metoprolol combined with diazepam significantly reduces pre-operative anxiety and improves sedatedness in patients undergoing hysterectomy or orthopaedic surgery.
RCTImpact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders
Metoprolol treatment worsens depressive and high burnout symptoms in chronic heart failure patients with mental disorders, but provides anxiolytic benefits independent of heart rate reduction.
Observational StudyRigorous JournalEfficacy of Metoprolol in Anxiety Disorders
Metoprolol is an effective and minimally side-effects alternative to propranolol for treating anxiety symptoms in patients with moderate to severe anxiety.
Sleep disorders, nightmares, depression and anxiety in an elderly patient treated with low-dose metoprolol.
Low-dose metoprolol can cause sleep disorders, nightmares, depression, and anxiety in elderly patients, which can easily be missed due to their age.
Case ReportThe effect of metoprolol and aspirin on cardiovascular risk in bereavement: A randomized controlled trial.
Low dose metoprolol and aspirin for 6 weeks reduces cardiovascular risk markers and anxiety in early bereavement without adversely affecting bereavement intensity.
RCTRigorous JournalEffects of β-blockers and anxiety on complication rates after acute myocardial infarction.
Anxious patients after acute myocardial infarction had more complications and longer stays, and metoprolol administration did not eliminate this relationship, possibly due to insufficient doses.
Observational StudyMETOPROLOL IN MANAGEMENT OF PATIENTS WITH DEPRESSION AND HYPERTENSION
Metoprolol has the potential therapeutic advantage over propranolol for treating depression and hypertension, with its beta 1 selectivity potentially offering a therapeutic advantage over less selective agents.
Impact of metoprolol treatment on cardiac function and exercise tolerance in heart failure patients with neuropsychiatric disorders
Depressive and high burnout symptoms, but not anxiety, lower the improvement of cardiac and motor function by metoprolol treatment in chronic heart failure patients.
Non-RCT