Propranolol vs Selective BB for anxiety d/o

[SCPA]

Can anyone elaborate why a non-selective BB, classically propranolol, is the beta blocker of choice in performance anxiety and other anxiety disorders?

If the mechanism is via reduction of adrenergic activity resulting in slowing HR, reducing tremor, etc.. Shouldn't beta-1 selective BB's be just as effective? Where might blocking B2 receptors be helpful in this?

Has anyone had success using b1 selective drugs for generalized anxiety and performance anxiety? Also if you have some experience I'd be curious where you've found the dosing sweet spot to be..

Thanks!

---

Members don't see this ad.

 

[Ironspy]

Can anyone elaborate why a non-selective BB, classically propranolol, is the beta blocker of choice in performance anxiety and other anxiety disorders?

If the mechanism is via reduction of adrenergic activity resulting in slowing HR, reducing tremor, etc.. Shouldn't beta-1 selective BB's be just as effective? Where might blocking B2 receptors be helpful in this?

Has anyone had success using b1 selective drugs for generalized anxiety and performance anxiety? Also if you have some experience I'd be curious where you've found the dosing sweet spot to be..

Thanks!

Propranolol is lipophilic and crosses the blood brain barrier readily is my understanding

 

[hamstergang]

If the mechanism is via reduction of adrenergic activity

This sounds perfectly reasonable but isn't so clearly true. Or so I believe, at least.

 

[SCPA]

Error -- see next post below!

 

[SCPA]

Propranolol is lipophilic and crosses the blood brain barrier readily is my understanding

Good point, I've heard this before -- but what then is the proposed mechanism of action in reducing anxiety by crossing BBB?

Also are any b1 selective drugs lipophilic like propranolol?

 

[clausewitz2]

Propranolol is lipophilic and crosses the blood brain barrier readily is my understanding

The mechanism is definitely central; older literature on this point compared propanolol (which crosses the BBB readily) and atenolol (which is far less lipophilic). Lo and behold you can have anxiety reduction with atenolol but it requires much higher equivalent doses than propanolol.

 

[Stagg737]

Good point, I've heard this before -- but what then is the proposed mechanism of action in reducing anxiety by crossing BBB?

Also are any b1 selective drugs lipophilic like propranolol?

Metoprolol is B1 selective and lipophilic, propranolol hits b1 and b2.