Miscellaneous compounds: beta-blockers and opiate antagonists

Abstract Beta-blockers are medications that block β-adrenergic receptors and thereby influence the activation of centrally located systems that use norepinephrine and epinephrine as a neurotransmitter, as well as that of the adrenergic sympathetic nervous system. Beta-blockers have long been used in general medicine. For example, by blocking β-receptors in the heart, heart rate, cardiac output, and blood pressure are decreased. This has led to clinical applications in the treatment of hypertension, angina pectoris and cardiac arrhythmias. In psychiatry, beta-blockers have been used on the basis of the hypothesis that “overarousal,” i.e., overactivation of adrenergic systems, may underlie various psychiatric symptoms. Clinical indications in adult psychiatry for treatment with beta-blockers are mainly anxiety disorders with somatic manifestations such as palpitations and tremor (Neppe, 1989; Lader, 1988); prophylactic treatment of migraine (Evers, 1999), various forms of aggression and rage outbursts (Haspel, 1995; Silver et al., 1999); akathisia (Wells et al., 1991; Kurzthaler et al., 1997), and simple or drug-induced tremor (Henderson et al., 1995). A recent meta-analysis found insufficient support to recommend beta-blockers as an add-on to neuroleptics in the treatment of schizophrenia (Cheine et al., 2000). A small but controlled study in three adolescents and two adults found propranolol to be ineffective in Tourette’s syndrome (Sverd et al., 1983). There are limited data on the efficacy and safety of beta-blockers in children and adolescents. Possible psychiatric indications for the use of beta-blockers in pediatric populations, namely aggression, rage outbursts, and anxiety, will be discussed here.