Clinical and humoral effects of beta-blockade with ICI 118,551 in the general neurotic syndrome

Abstract

Fifty-six patients satisfying the diagnostic criteria for the general neurotic syndrome, a mixed anxiety-depressive disorder, were randomly allocated to treatment with a selective β ₂-blocking drug, ICI 118,551, in a dose of 50 mg tds, or placebo for 4 weeks after a 2-week placebo run-in period. Ratings of anxiety using the Hamilton anxiety rating scale and patient self-assessments in 46 evaluable patients showed no significant difference in the outcome of active drug and placebo groups, and also no significant improvement over time during the study. This unusual finding supports the impression of the general neurotic syndrome as a severe form of neurotic disorder which shows little evidence of placebo response. Diastolic blood pressure was increased and heart rate reduced after 2 weeks on ICI 118,551, and plasma levels of noradrenaline and adrenaline showed no evidence of an expected decrease with active drug; on the contrary the data showed some evidence of increased catecholamine levels. The results suggest that selective β-blockade has little part to play in the treatment of anxiety and that on repeated dosage the effects of selective blockade are attenuated or reversed.