Propranolol is commonly used off-label for anxiety, but high-quality data are sparse regarding its use in panic disorder—especially as an SSRI add-on. In this double-blind, 4-week RCT from Iran, 60 women with DSM-defined panic disorder were randomized to sertraline plus propranolol vs sertraline plus placebo. Sertraline was titrated from 25 to 75 mg/day, while propranolol was titrated from 10 to 20 mg/day. Outcomes were the Panic Disorder Severity Scale (PDSS-SR) for panic severity and the Beck Depression Inventory (BDI-13) for depression.
Baseline panic scores were about 19 in both groups. After 4 weeks, mean PDSS-SR scores fell to 6.6 with sertraline plus propranolol vs 13.1 with sertraline plus placebo, a clinically meaningful between-group difference. Interestingly, depression scores also dropped from 24.8 to 8.9 in the combination group vs 22.4 to 15.5 with sertraline plus placebo. Effect sizes were 1.3 for panic and 1 for depression. There were no adverse events or discontinuations reported.
CARLAT TAKE This was a small, short, single-center RCT, and the remarkably large effect sizes—including that of propranolol for depression, which we wouldn’t expect—should be viewed with caution. That said, panic is excruciating, and any non-benzo that alleviates it relatively rapidly is a welcome option—provided patients don’t have asthma, hypotension, or other contraindications to propranolol.
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