Resume: Beta blockers, a class of drugs commonly used to treat high blood pressure and cardiovascular disorders, appear to reduce aggressive and violent behavior and may reduce suicidal behavior.
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In a study published on January 31, reductions in violence are seen in people using beta adrenergic blocking agents (beta blockers) compared to periods when they did not take the drug.st in open access journal PLOS Medicine.
If the findings are confirmed by other studies, β-blockers could be considered a way to control aggression and hostility in people with psychiatric conditions.
β-Blockers are used to treat hypertension, angina, and acute cardiovascular events, heart failure, and arrhythmias, as well as migraine headaches, symptoms of hyperthyroidism, and glaucoma.
They are often used for anxiety and have been suggested for clinical depression and aggression, but the evidence is conflicting. They have been linked to an increased risk of suicidal behaviour, although the evidence is inconclusive.
Seena Fazel of the University of Oxford, UK, and colleagues at the Karolinska Institutet in Sweden investigated psychiatric and behavioral outcomes: hospitalizations for psychiatric disorders; suicidal behavior and deaths by suicide; and violent crime charges.
They compared 1.4 million β-blocker users in Sweden during the medicated and non-medicated periods over an eight-year period from 2006-2013.
Periods of beta-blocker treatment were associated with a 13% lower risk of being charged with a violent crime by police, which was consistent across all analyses. In addition, an 8% decreased risk of hospitalization due to a psychiatric disorder was reported, as was an 8% increased association with being treated for suicidal behavior.
However, these associations varied depending on psychiatric diagnosis, previous psychiatric problems, as well as the severity and type of heart condition to treat with β-blockers.
Previous research has linked serious cardiac events to an increased risk of depression and suicide, and these results might suggest that psychological distress and other disabilities associated with serious cardiac problems, rather than treatment with β-blockers, increase the risk of serious psychiatric events. . In secondary analyses, associations with hospitalization were smaller for major depressive disorders, but not for anxiety disorders.
To understand the role of β-blockers in the treatment of aggression and violence, more studies are needed, including randomized controlled trials. If these confirm the results of this study, beta blockers could be considered to control aggression and violence in some people.
Fazel adds: “In a real-world study of 1.4 million people, β-blockers were associated with reduced violent crime charges in people with psychiatric disorders. Repurposing its use to control aggression and violence could improve patient outcomes.”
Money: This study was supported by the Wellcome Trust (No 202836/Z/16/Z): https://wellcome.org/grant-funding (SF), the Swedish Research Council for Health, Working Life and Well-being (2015-0028): https://forte.se/en/ (PL and HL), American Foundation for Suicide Prevention (DIG-1-037-19): https://afsp.org/research-grant-information (BMD) and Karolinska Institute Funds (2016fobi50581): https://staff.ki.se/ki-foundations-funds-list-of-grants (YM). The sponsors had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.
About this research news in psychopharmacology and violence
Author: claire turner
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Contact: Claire Turner–PLOS
Picture: The image is in the public domain.
original research: Open access.
“Associations between β-blockers and psychiatric and behavioral outcomes: a population-based cohort study of 1.4 million people in Sweden” by Seena Fazel et al. PLOS Medicine
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Associations between β-blockers and psychiatric and behavioral outcomes: a population-based cohort study of 1.4 million people in Sweden
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β-Blockers are widely used to treat heart conditions and are suggested for the treatment of anxiety and aggression, although the research is conflicting and limited by methodological problems. In addition, β blockers have been associated with the precipitation of other psychiatric disorders and suicidal behavior, but the findings are mixed. Our aim was to examine the associations between β blockers and psychiatric and behavioral outcomes in a large population cohort in Sweden.
Methods and findings
We conducted a population-based longitudinal cohort study using high-quality Swedish national healthcare, mortality, and crime registries. 1,400,766 people aged 15 years and older who had received beta-blocker prescriptions were included and followed for eight years between 2006 and 2013. We linked registry data on beta-blocker prescriptions dispensed with the main outcomes, hospitalizations for psychiatric disorders (not including self-assessment). harmful behavior or suicide attempts), suicidal behavior (including suicide deaths), and violent crime charges.
We applied Cox within-individual proportional hazards regression to compare treatment versus treatment-free periods within each individual to reduce potential confounding by indication, as this model inherently fits for all stable confounders (p eg, genetics and health history).
We also adjusted for age as a time-varying covariate. In subsequent analyses, we adjusted for established indications, frequent users, cardiac severity, psychiatric and criminal history, individual beta-blockers, beta-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (north = 1,215,247) were 50 years of age and over, and 52.2% (north = 731,322) were women.
During the study period, 6.9% (north = 96,801) of beta-blocker users were hospitalized for a psychiatric disorder, 0.7% (north = 9,960) presented suicidal behavior, and 0.7% (north = 9,405) were charged with a violent crime.
There was heterogeneity in the direction of the results; Intraindividual analyzes showed that periods of beta-blocker treatment were associated with reduced risks of psychiatric hospitalizations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), violent crime charges (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased risks of suicidal behavior (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, the reduced associations with psychiatric hospitalizations during beta-blocker treatment were primarily due to lower rates of hospitalization for depression (HR: 0.92, 95% CI: 0.89 to 0.96 , p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p <0.001).
Low associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalizations and suicidal behavior were inconsistent. Limitations include that the within-individual model does not account for confounding factors that might change during treatment unless they are measured and fitted in the model.
conclusions
In this whole population study, we found no consistent links between β-blockers and psychiatric outcomes. However, β blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β blockers to control aggression and violence could be further investigated.
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