Use of beta-blockers associated with lower rates of violence

Use of beta-blockers associated with lower rates of violence

Summary: Beta-blockers, a class of drugs commonly used to treat hypertension and cardiovascular disorders, appear to reduce aggressive and violent behavior and may reduce suicidal behavior.

Source: OLP

Reductions in violence are seen in people using beta-blocking agents (β-blockers) compared to periods when they do not take the drug, in a study published on January 31st in the open access journal OLP Medicine.

If the results are confirmed by further studies, β-blockers could be considered as a way to manage aggression and hostility in people with psychiatric disorders.

β-blockers are used to treat hypertension, angina pectoris and acute cardiovascular events, heart failure and arrhythmias as well as migraine, symptoms of hyperthyroidism and glaucoma.

They are often used for anxiety and have been suggested for clinical depression and aggression, but the evidence is conflicting. They have been associated with an increased risk of suicidal behavior, although the evidence is inconclusive.

Seena Fazel at the University of Oxford, UK, and her colleagues at the Karolinska Institute in Sweden studied psychiatric and behavioral outcomes: hospitalizations for psychiatric disorders; suicidal behavior and death by suicide; and charges of violent crimes.

They compared 1.4 million users of β-blockers in Sweden to themselves during drug and non-drug periods over an eight-year period from 2006 to 2013.

Periods of β-blocker treatment were associated with a 13% lower risk of being charged with a violent crime by the police, which remained consistent across all analyses. Additionally, an 8% lower risk of hospitalization due to a psychiatric disorder was reported, along with an 8% increased association of being treated for suicidal behavior.

However, these associations varied depending on psychiatric diagnosis, previous psychiatric problems, and the severity and type of heart disease that β-blockers were used to treat.

Previous research has linked serious cardiac events to an increased risk of depression and suicide, and these findings may suggest that the psychological distress and other disabilities associated with serious heart problems, rather than β-blocker treatment , increase the risk of serious psychiatric events. In secondary analyses, associations with hospitalization were weaker for major depression but not for anxiety disorders.

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If these confirm the results of this study, β-blockers could be considered to manage aggression and violence in certain individuals. Image is in public domain

In order to understand the role of β-blockers in the management of aggression and violence, further studies, including randomized controlled trials, are needed. If these confirm the results of this study, β-blockers could be considered to manage aggression and violence in certain individuals.

Fazel adds, “In a real-world study of 1.4 million people, β-blockers were associated with reduced violent criminal charges in people with psychiatric disorders. Redirecting their use to manage aggression and violence could improve patient outcomes.

Funding: This study was supported by the Wellcome Trust (No 202836/Z/16/Z): (SF), the Swedish Research Council for Health Working Life and Welfare (2015-0028) : (PL and HL), American Foundation for Suicide Prevention (DIG-1-037-19) : (BMD ), and Karolinska Institute Fund (2016fobi50581): (YM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

About this news on research in psychopharmacology and violence

Author: Claire Turner
Source: OLP
Contact: Claire Turner – PLOS
Picture: Image is in public domain

Original research: Free access.
“Associations between β-blockers and psychiatric and behavioral outcomes: a population-based cohort study of 1.4 million individuals in Sweden” by Seena Fazel et al. OLP Medicine


Associations between β-blockers and psychiatric and behavioral outcomes: a population-based cohort study of 1.4 million individuals in Sweden

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β-blockers are widely used to treat heart conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological issues. Additionally, β-blockers have been associated with precipitation of other psychiatric disorders and suicidal behaviors, but results are mixed. We sought to examine associations between β-blockers and psychiatric and behavioral outcomes in a large population-based cohort in Sweden.

Methods and results

We conducted a population-based longitudinal cohort study using high-quality Swedish national health care, mortality and crime registers. We included 1,400,766 people aged 15 years or older who collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on β-blocker prescriptions issued with the main outcomes, hospitalizations for psychiatric disorders (excluding harmful self-behavior or suicide attempt), suicidal behavior (including death by suicide) and accusation of violent crime.

We applied intra-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment in each individual to reduce possible confounding by indication, as this model inherently adjusts for all risk factors. stable confusion (eg, genetics and medical history).

We also adjusted for age as a time-varying covariate. In further analyses, we adjusted for reported indications, prevalent users, cardiac severity, psychiatric and criminal history, individual β-blockers, β-blocker selectivity and solubility, and l use of other medications. In the cohort, 86.8% (not = 1,215,247) were aged 50 and over, and 52.2% (not = 731,322) were female.

Over the study period, 6.9% (not = 96,801) of β-blocker users were hospitalized for a psychiatric disorder, 0.7% (not = 9,960) exhibited suicidal behavior and 0.7% (not = 9,405) were charged with a violent crime.

There was heterogeneity in the direction of the results; intra-individual analyzes showed that periods of treatment with β-blockers were associated with reduced risks of psychiatric hospitalizations (relative risk [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), violent crime charges (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001) and increased risks of suicidal behavior (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratification by diagnosis, the reduced associations with psychiatric hospitalizations during beta-blocker treatment were mainly due to lower rates of hospitalization for depression (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001).

Diminished associations with violent accusations remained in most sensitivity analyses, while associations with psychiatric hospitalizations and suicidal behaviors were inconsistent. Limitations include that the within-individual model does not account for confounders that might change during treatment unless they are measured and adjusted for in the model.


In this population-wide study, we found no consistent link between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further.

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