One More Look at Propranolol for the Treatment of Refractory Schizophrenia

Abstract

Propranolol, a beta-adrenergic blocking agent, has been proposed previously as potentially useful in the treatment of certain otherwise treatment-unresponsive psychotic patients. This article reviews the published clinical trials of the efficacy of propranolol in schizophrenia to characterize those patients in whom it might be helpful and for whom future clinical trials should be designed. Despite a large number of inconsistent reports, the evidence to date favors its potential value as an adjunct to neuroleptic therapy in neuroleptic-resistant chronic schizophrenic patients. Several recommendations are made to improve the methodology of future clinical trials with this agent for the treatment of schizophrenia.

Ventral Striatal Noradrenergic Mechanisms Contribute to Sensorimotor Gating Deficits Induced by Amphetamine

“…There is some evidence for enhancement of antipsychotic function by compounds that reduce central NE transmission or block postsynaptic NE receptors, suggesting the possibility of NE-based therapeutics as adjunct treatments for schizophrenia, but there are also examples of no clinical improvement with these compounds in schizophrenia (Berlant, 1987; Freedman, et al 1982; Friedman, et al 2001; Maas, et al 1995; Wahlbeck, et al 2000). …”

Do Central Antiadrenergic Actions Contribute to the Atypical Properties of Clozapine?

“…Several therapeutic interventions in psychotic or manic patients with centrally active anti-NA agents other than clozapine have led to less convincing results. These include putative additional benefits from adding reserpine (a non-specific monoaminedepleting agent) to neuroleptic treatment regimens, especially in affective psychoses (Berlant, 1986), as well as long-standing but still inconclusive reports that high doses of the centrally active {3-adrenergic antagonist propranolol may have benefit when added to standard neuroleptic treatments (Berlant, 1987;van Kammen & Gelernter, 1987;Lader, 1988). The centrally active direct al antagonist prazosin was found to be ineffectivein treating schizophrenia in one small study (Hommer et ai, 1984), but it has not been combined with neuroleptics to seek additional benefit or reduction of neurological side-effects.…”

Adjunctive Medication in the Maintenance Treatment of Schizophrenia and its Conceptual Implications

“…Propranolol may also be a useful adjunct to neuroleptic agents, separate from the issue of akathisia in terms of enhancing or augmenting antipsychotic action in patients otherwise considered to be refractory or hyporesponsive, although this issue remains controversial (Donaldson et ai, 1983;Ananth & Lin, 1986;Berlant, 1987;Lader, 1988;Lipinski et ai, 1988;Christison et ai, 1991). In this case, as in the case of treatment of akathisia, the strategy of propranolol dosing may be important in the avoidance of autonomic and toxic side-effects (Ananth & Lin, 1986).…”