Propranolol + Sertraline: New Evidence in Treating Panic Disorder in Women
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Published: July 2025 in BMC Psychiatry
Study: The effect of sertraline with or without propranolol on panic attacks in women: a controlled clinical trial
📌 Context Within Existing Research:
- This study addresses a significant gap in the literature as the first to investigate the combination of sertraline with propranolol specifically for treating panic attacks in women.
📌 Study Summary
This double-blind, randomized, controlled clinical trial explored whether adding propranolol to sertraline improves treatment outcomes in women with panic disorder, compared to sertraline alone.
Study Design:
- Participants: 60 women aged 18–45 with DSM-5–defined panic disorder
Groups:
- Sertraline + Propranolol (20 mg/day)
- Sertraline + Placebo
Primary Outcomes:
- Number of panic attacks (weekly)
- Hamilton Anxiety Rating Scale (HAM-A)
- Panic Disorder Severity Scale (PDSS)
Key Results:
- Both groups showed significant reductions in panic attacks and anxiety scores from baseline.
- Propranolol augmentation group had greater reduction in number of weekly panic attacks compared to the placebo group (p < 0.05).
- No significant differences were observed between groups for HAM-A or PDSS scores at week 8.
- Tolerability: No major adverse effects; propranolol was well tolerated.
💬 Clinical Commentary
This trial contributes meaningful insight into the role of beta-blockers as augmentation agents in panic disorder, particularly in female patients. While SSRIs remain first-line, propranolol may offer added benefit in reducing frequency of panic attacks, possibly by blunting the physiological “fear response” driven by adrenergic overactivation.
Key Clinical Implications:
- Targeted symptom relief: Propranolol may specifically reduce somatic symptoms of panic (e.g., palpitations, tremors) rather than overall anxiety severity.
- Augmentation strategy: Consider propranolol (10–20 mg/day) in patients with partial response to SSRIs—especially when autonomic hyperactivity dominates.
- Gender relevance: All participants were women; extrapolation to male patients requires caution.
✅ Key Conclusions
- Anxiety Relief: Combining propranolol with sertraline significantly reduces panic attack severity compared to sertraline alone
- Depression Relief: The combination therapy also provides greater improvement in depression symptoms
- Augmentation strategy: Consider propranolol (10–20 mg/day) in patients with partial response to SSRIs—especially when autonomic hyperactivity dominates.
- Safety: No adverse effects were reported, suggesting good tolerability
- Gender relevance: All participants were women; extrapolation to male patients requires caution.
📚 References
Rouhzendeh S, Mousavi Z, Mashayekh-Amiri S, Shaseb E, Mirmolaei ST, Mirghafourvand M. The effect of sertraline with or without propranolol on panic attacks in women: a controlled clinical trial. J Pharm Health Care Sci. 2025 Jul 4;11(1):57. doi: 10.1186/s40780-025-00466-x. PMID: 40615929; PMCID: PMC12228203. (Pubmed)
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