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Beta blockers (eg propranolol) for autistic anxiety

CharlieFreak

I'm looking for experiences anyone has had with beta blockers to subdue the physical symptoms of anxiety - has anyone used it standalone with success, or only in combination with an SSRI?

My 18yo son has been prescribed the immediate release version of propranolol, initially at 40mg once a day, and after first review increased to twice a day, morning and evening.

My concern with this is that I see the half-life of propranolol is a maximum of 6 hours, so drug efficacy after that 6 hours is questionable. Taking a daily dose, or even doses 12 hours apart, means that there will be daily periods where the drug remaining in his system is below 50% and therefore less likely to be effective for him.

I've read here and elsewhere about the immediate release version being used prior (30-60 mins) to an event likely to induce anxiety, which seems like a more sensible application of the drug based on its half-life. But my son's anxiety is mostly triggered by 'surprise' situations and the rest of the time he is ok. It just doesn't seem compatible with his situation, and prescribing it to be taken in the evening seems utterly pointless. (FYI he hasn't reported sleep issues.)

My thought is that the slow release version might be more effective as it's supposed to stay in your system for at least 24 hours, so has the potential to snag any anxiety that pops up, regardless of how long after taking a morning dose that event happens.

I'm actually now considering that we might have to resign ourselves to trying an SSRI instead, as that would build up a constant level of the drug in his system and arguably give him better protection against anxiety surprises. But I'm hesitant due to the potential for more side effects from SSRIs in people with autism due to the lack of research.

Parents

  • Propranolol (and others beta blockers), when used for anxiety are often prescribed on an 'as and when needed' basis. As in, you take it if you think you might be anxious, as opposed to taking it consistently every day. Therefore both the standard (immediate) versions and the slow release versions can be used depending on the patient. I'd suggest asking the doctor about the best way to take it, and whether it matters if it is used consistently or not.

    Its worth noting that Propranolol doesn't tend to fix anxiety - it just helps cut down on things like shaking etc.

    I've used Propranolol various times over the years, and I think it has helped occasionally with physical symptoms, but not much.

    Bare in mind that beta blockers affect blood pressure so this may be an issue if you/he are doing any physical activity - this may be something else to ask the doctor's opinion on.

    SSRIs can be worth a try; they helped me more than the Propranolol did, albeit they never cured my anxiety/depression. I needed a relatively high dose for it to work, but many people on autism forums report needing a lower dose than normal. They can also have very bad withdrawal symptoms, which are worse the longer you take them. Make sure you ask the doctor about how to come off them safely.

Reply

  • Propranolol (and others beta blockers), when used for anxiety are often prescribed on an 'as and when needed' basis. As in, you take it if you think you might be anxious, as opposed to taking it consistently every day. Therefore both the standard (immediate) versions and the slow release versions can be used depending on the patient. I'd suggest asking the doctor about the best way to take it, and whether it matters if it is used consistently or not.

    Its worth noting that Propranolol doesn't tend to fix anxiety - it just helps cut down on things like shaking etc.

    I've used Propranolol various times over the years, and I think it has helped occasionally with physical symptoms, but not much.

    Bare in mind that beta blockers affect blood pressure so this may be an issue if you/he are doing any physical activity - this may be something else to ask the doctor's opinion on.

    SSRIs can be worth a try; they helped me more than the Propranolol did, albeit they never cured my anxiety/depression. I needed a relatively high dose for it to work, but many people on autism forums report needing a lower dose than normal. They can also have very bad withdrawal symptoms, which are worse the longer you take them. Make sure you ask the doctor about how to come off them safely.

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