Wirkung des Beta-Rezeptoren-Blockers Propranolol auf Manien

Abstract

Six patients with the diagnosis of acute mania were treated with high doses of the beta-adrenergic blocking agent propranolol. One of these patients was treated during two manic phases. Psychopathologic change during treatment was rated daily by a psychiatrist not informed on the patients medication. The IMPS (Inpatient Multidimensional Psychiatric Scale) was used. Three cases were placebo-controlled under double blind conditions. Four times we had a second medication period, twice with propranolol and once with oxprenolol and dexpropranolol respectively. Propranolol was administered every 4 h (six times per day), starting with single doses of 20–40 mg. Doses were increased individually under control of pulse rate, blood pressure, and ECG. Augmentation of doses was continued until an effect on manic symptomatology was undoubtedly seen or unitl therapy had to be discontinued because of side-effects. In four patients definite improvement of manic symptomatology could be achieved during altogether five manic phases within usually two treatment periods of 5–15 days. Manic behavior disappeared completely in two of these patients. The effective dosage of propranolol varied between 280 and 2320 mg per day. All of the improved patients relapsed after discontinuation of the drug. In the only case on dexpropranolol (5 days up to 900 mg daily) the effect was questionable. No extrapyramidal side-effects were observed. In one patient treatment was discontinued because of lack of cooperation, in another because of extrasystoles. Gastrointestinal bleeding occurred in the patient who received dexpropranolol. This complication was possibly due to other medication. Other side-effects were insomnia, hypertension, precordial pain, abdominal pain as well as the expected hypotension and bradycardia. The significance of these results regarding the catecholamine hypothesis of manic-depressive illness is discussed. Sechs Patienten mit der Diagnose einer akuten Manie wurden mit hohen Dosen des Beta-Rezeptoren-Blockers Propranolol behandelt. Bei zwei patienten mußte die Behandlung abgebrochen werden, in einem Fall wegen einsetzender Extrasystolie, im zweiten Fall wegen mangelnder Kooperation des Patienten. Bei den überigen vier Patienten, dabei in einem Fall bei zwei getrennten manischen Phasen, zeigte sich klinisch und anhand mehrerer Faktoren der IMPS nach Lorr et al. eine deutliche Besserung der manischen Symptomatik. Extrapyramidale Symptome, Sedierung oder andere für Neuroleptika charakteristische Nebenwirkungen wurden nicht beobachtet. Ein erster Behandlungsversuch mit Dexpropranolol in einem Fall mußte nach wenigen Tagen abgebrochen werden; zu diesem Zeitpunkt war die Wirksamkeit nicht sicher zu beurteilen.