A reduction in violence was observed in individuals using beta-adrenergic-blockers (β-blockers) compared to periods when they did not take the drug, in a study published on January 31.st in the open access journal PLOS Medicine. If the findings are confirmed by other studies, β-blockers could be considered as a way to manage 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 migraines, 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 are associated with an increased risk of suicidal behavior although the evidence is inconclusive.
Senna Fazel from the University of Oxford, UK and colleagues from the Karolinska Institute in Sweden investigated psychiatric and behavioral outcomes: hospitalization for psychiatric disorders; suicidal behavior and deaths by suicide; and violent crime reports. They compared 1.4 million β-blocker users in Sweden to themselves during medication and medication-free periods over an eight-year period from 2006-2013.
Periods of β-blocker treatment were associated with a 13% lower risk of being charged with violent crime by the police, which remained consistent across analyses. Additionally, an 8% lower risk of hospitalization for a psychiatric disorder was reported, as well as an 8% increased association with treatment for suicidal behavior. However, these associations varied by psychiatric diagnosis, past psychiatric problems, and the severity and type of heart condition for which β-blockers were used.
Previous research has linked severe cardiac events to an increased risk of depression and suicide, and these results may suggest that psychological stress and other disabilities associated with severe cardiac problems, rather than β-blocker treatment, increase the risk of serious psychiatric events. In secondary analyses, the association with hospitalization was lower for major depressive but not for anxiety disorders.
In order to understand the role of β-blockers in the management of aggression and violence, further studies, including randomized controlled trials, are needed. If these confirm the results of this study, β-blockers could be considered to manage aggression and violence in some individuals.
Fazel adds, “In a real-world study of 1.4 million people, β-blockers were associated with reduced violent crime in people with psychiatric disorders. “Repurposing their use to manage aggression and violence may improve patient outcomes.”
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine:
Quote: Molero Y, Kaddoura S, Kuja-Halkola R, Larsson H, Lichtenstein P, D’Onofrio BM, et al. (2023) Associations between β-blockers and psychiatric and behavioral outcomes: A population-based cohort study of 1.4 million individuals in Sweden. PLoS Med 20(1): e1004164. https://doi.org/10.1371/journal.pmed.1004164
Countries of Authors: Sweden, United Kingdom, United States of America
Funding: 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 Funds of the Karolinska Institute (2016fobi50581): https://staff.ki.se/ki-foundations-funds-list-of-grants (YM). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
An observational study
Subject of research
Competing interests: I have read the journal policy and the authors of this manuscript have the following competing interests: HL reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals, and Evolan Pharma AB; and sponsorship of a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside of the submitted work. All other authors declared no competing interests.
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