BRIEF
Oxprenolol
in the
BY W. P. MCMILLIN,
Treatment MB.,
of Anxiety
Due
HAVE SHOWN that the a-blocking drugs may have anxiety-inhibiting properties (1, 2). Further studies (3,4) have shown that successful treatment of anxiety with the fl-blocking agent is due to the control of the somatic concomitants, which is the most useful application of the drugs. Other trials have shown the benefits of oxprenolol on the cardiovascular system under psychological stress (5, 6). It would be reasonable therefore to assess oxprenolol in the treatment of patients who are afraid and whose symptoms are related to a recognizable stress. The emotional response to recognized sources of dangen is fear, which can range from mild apprehension and uneasiness to intense dread. Since somatic and physiological concomitants are mediated by the autonomic nervous system and endocrine glands, there is an immediate rise in circulating catecholamines that prepares the individual for fight or flight. Ideally, therefore, management should consist oftreatment ofthe somatic aspect by a a-blocking drug and treatment of the psychic aspect by psychotherapy. There is considerable fear in Belfast, where the political situation has given rise to civil unrest resulting from bombing, hijacking, and assassination (7, 8). I therefore decided to evaluate oxprenolol in patients attending their general practitioner with symptoms of anxiety related to the local stress. TRIALS
I
Following preliminary dose-finding studies, a controlled double-blind crossover study was set up in 12 patients who had reported to their general practitioner
Dr. McMillin is a general Lower Castlereagh, Belfast,
Stress
B.CH.
The author conducted two trial studies to evaluate the use ofoxprenolol in the treatment ofsymptoms resulting f rom environmental stress. Results indicated that on a three-times-a-day regimen, 80 mg ofoxprenolol was superior to 20 mg ofoxprenolol and equally as effective as 5 mg ofdiazepam. The author discusses the benefit of fl-blocking drugs andpoints to the need forfurt her studies.
TRIAL
to Environmental
COMMUNICATIONS
practitioner, 2 Cohn Ireland BT5 6QD.
View,
220
Knock
Rd.,
and whose symptoms were attributable to stress. Ten women and 2 men entered the study; their average age was 38.9 years. Based on the Hollingshead and Redlich (9) scale for social class, 1 man was in social class I and the remainder were in either social class II on III. They were assessed at the start of the trial, after one week, and finally after the second week. The patients measured their anxiety, tension, sleep, concentration, depnession, and well-being using a visual analogue scale. At the end of two weeks the patients stated their treatment preference. Of the I 2 patients who entered the trial, 2 dropped out: 1 was involved in a bomb incident and had to be hospitalized, and the other, a 22-year-old girl, took 10 chlondiazepoxide (Libnium) capsules in a panic state and was hospitalized for gastric lavage. The remaining 10 patients divided themselves into two groups of 5: one group took 80 mg the first week and 20 mg the second week; the othen group reversed the weekly dosage. The 20-mg and 80mg capsules looked identical. The preliminary dose-finding study showed that 20 mg of oxprenolol was equivalent to placebo. It was therefore used in place of placebo because it slowed the pulse rate, thus helping preserve blindness. Since 80 mg of oxprenolol three times a day was a useful drug in the treatment of stress, this dose was compared with 5 mg of diazepam (Valium) three times a day in a trial of similar design.
TRIAL
2
Twelve patients who attended the surgery with symptoms attributable to emotional stress entered the trial; they were all women with an average age of 33.9 years. One woman was in social class I, and the rest were in eithen social class II on III. One patient dropped out after she was involved in a bombing incident and had to be given sedatives intravenously. The design was similar to the previous trial, but on this occasion one group of 6 patients took 80 mg of oxprenolol three times a day for the first week followed by 5 mg of diazepam three times a day for the second week, while the other group of 5 patients reversed the procedure. Patients again assessed anxiety, tension, concentration, sleep, depression, and well-being on a 10-cm visual analogue scale at the start of the trial, after one week, and aften the second week. At the end of the trial the patients stated their treatment preference. Spontaneously reported side effects were recorded.
Am J Psychiatry
132:9, September
1975
965
BRIEF
COMMUNICATIONS
RESULTS The results from trial 1 showed a significant improvement with 80 mg of oxprenolol in tension (p
Oxprenolol
in the
BY W. P. MCMILLIN,
Treatment MB.,
of Anxiety
Due
HAVE SHOWN that the a-blocking drugs may have anxiety-inhibiting properties (1, 2). Further studies (3,4) have shown that successful treatment of anxiety with the fl-blocking agent is due to the control of the somatic concomitants, which is the most useful application of the drugs. Other trials have shown the benefits of oxprenolol on the cardiovascular system under psychological stress (5, 6). It would be reasonable therefore to assess oxprenolol in the treatment of patients who are afraid and whose symptoms are related to a recognizable stress. The emotional response to recognized sources of dangen is fear, which can range from mild apprehension and uneasiness to intense dread. Since somatic and physiological concomitants are mediated by the autonomic nervous system and endocrine glands, there is an immediate rise in circulating catecholamines that prepares the individual for fight or flight. Ideally, therefore, management should consist oftreatment ofthe somatic aspect by a a-blocking drug and treatment of the psychic aspect by psychotherapy. There is considerable fear in Belfast, where the political situation has given rise to civil unrest resulting from bombing, hijacking, and assassination (7, 8). I therefore decided to evaluate oxprenolol in patients attending their general practitioner with symptoms of anxiety related to the local stress. TRIALS
I
Following preliminary dose-finding studies, a controlled double-blind crossover study was set up in 12 patients who had reported to their general practitioner
Dr. McMillin is a general Lower Castlereagh, Belfast,
Stress
B.CH.
The author conducted two trial studies to evaluate the use ofoxprenolol in the treatment ofsymptoms resulting f rom environmental stress. Results indicated that on a three-times-a-day regimen, 80 mg ofoxprenolol was superior to 20 mg ofoxprenolol and equally as effective as 5 mg ofdiazepam. The author discusses the benefit of fl-blocking drugs andpoints to the need forfurt her studies.
TRIAL
to Environmental
COMMUNICATIONS
practitioner, 2 Cohn Ireland BT5 6QD.
View,
220
Knock
Rd.,
and whose symptoms were attributable to stress. Ten women and 2 men entered the study; their average age was 38.9 years. Based on the Hollingshead and Redlich (9) scale for social class, 1 man was in social class I and the remainder were in either social class II on III. They were assessed at the start of the trial, after one week, and finally after the second week. The patients measured their anxiety, tension, sleep, concentration, depnession, and well-being using a visual analogue scale. At the end of two weeks the patients stated their treatment preference. Of the I 2 patients who entered the trial, 2 dropped out: 1 was involved in a bomb incident and had to be hospitalized, and the other, a 22-year-old girl, took 10 chlondiazepoxide (Libnium) capsules in a panic state and was hospitalized for gastric lavage. The remaining 10 patients divided themselves into two groups of 5: one group took 80 mg the first week and 20 mg the second week; the othen group reversed the weekly dosage. The 20-mg and 80mg capsules looked identical. The preliminary dose-finding study showed that 20 mg of oxprenolol was equivalent to placebo. It was therefore used in place of placebo because it slowed the pulse rate, thus helping preserve blindness. Since 80 mg of oxprenolol three times a day was a useful drug in the treatment of stress, this dose was compared with 5 mg of diazepam (Valium) three times a day in a trial of similar design.
TRIAL
2
Twelve patients who attended the surgery with symptoms attributable to emotional stress entered the trial; they were all women with an average age of 33.9 years. One woman was in social class I, and the rest were in eithen social class II on III. One patient dropped out after she was involved in a bombing incident and had to be given sedatives intravenously. The design was similar to the previous trial, but on this occasion one group of 6 patients took 80 mg of oxprenolol three times a day for the first week followed by 5 mg of diazepam three times a day for the second week, while the other group of 5 patients reversed the procedure. Patients again assessed anxiety, tension, concentration, sleep, depression, and well-being on a 10-cm visual analogue scale at the start of the trial, after one week, and aften the second week. At the end of the trial the patients stated their treatment preference. Spontaneously reported side effects were recorded.
Am J Psychiatry
132:9, September
1975
965
BRIEF
COMMUNICATIONS
RESULTS The results from trial 1 showed a significant improvement with 80 mg of oxprenolol in tension (p
