Paradoxical new-onset intrusive thoughts with beta blocker

[stilllooking]

Patient is female, mid-30s, pmh of single MDE treated to remission with SSRI, seen in a PCMHI context. Was prescribed the lowest possible dose of a beta blocker (propranolol) for borderline HTN and reported experiencing sudden, new-onset intrusive thoughts after starting it. I know BBs are often used to treat anxiety but have you ever heard of a paradoxical reaction where they cause it?

Thanks!

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[ObsequiousAplomb]

Paradoxical reactions can happen with anything, that's why they're paradoxical.

The information provided isn't completely convincing evidence that the propranolol caused the intrusive thoughts - who's to say it wasn't the diagnosis of borderline hypertension or some other acute change / stressor that coincided?

Did the nature of the thoughts indicate anything in particular? (Fear of death, fear of contamination - especially prominent with so many blood pressure medications in the news for having toxic contaminants, etc)

Did the thoughts go away shortly after stopping the propranolol? (still wouldn't prove anything, but at least the thoughts would be gone)

Also, why was propranolol started for borderline hypertension? Isn't that not the normal first-line treatment? Hasn't it not been first-line for a rather long time? Don't PCPs generally try to avoid giving propranolol to people with history of MDE? (whether or not that is indicated)

There wasn't some other indication at the time (like intrusive thoughts / anxiety that started before the propranolol and the provided history is off) and propranolol was being given to address two concerns?

 

[Desired Member]

Also, why was propranolol started for borderline hypertension? Isn't that not the normal first-line treatment? Hasn't it not been first-line for a rather long time? Don't PCPs generally try to avoid giving propranolol to people with history of MDE?

Maybe she is having intrusive thoughts that her PCP is not too bright lol

 

[aim-agm]

Any history of asthma, reactive airway disease, COPD, etc.? She might be experiencing a bit of bronchoconstriction that subtly makes it harder to breathe, leading to feelings of anxiety.

 

[whopper]

I've seen this happen and have a theory that turned out to likely be correct in the few times I've seen this happen.

Adrenergic blockade causes increased activity in the system that's not blocked. E.g. alpha blockade increases Beta activity. Beta blockade increasea Alpha activity.

Alpha Blockade reduces ADHD. In some people I've noticed B-blockage worsens ADHD.

The problem being is I see this in real life but haven't seen studies backing it up. It's the same reason why B-blockers can increase nightmares. Alpha blockade and decrease them and B-blockade causes an increase in Alpha activity.

How do I know my theory is correct? I don't but when this happens I have screened these people for ADHD, then treated them for it and all of them told me it helps. Then further checking out their backgrounds turned out they likely had ADHD and wasn't even aware of it until a B-blocker worsened their concentration and memory without hypotension.