ß-Blockers; admirably versatile or pitifully overused?

We know so little about the brain. And despite the fantastic efforts of many to raise awareness for mental health conditions, effective treatments for anxiety, depression, paranoia, and OCD – just a few of the major mental illnesses – are both woefully misunderstood and/or non-existent.  

developing effective therapeutics against mental illness is tricky; symptoms are both concealable and subjective

Although mental disorders seem more common now, it is likely they have been ever-present but simply undiagnosed. And here is precisely the first reason why developing effective therapeutics against mental illness is tricky; symptoms are both concealable and subjective. Whilst being ill with more ‘traditional’ ailments follow common identifiable symptoms like a runny nose and high blood temperature – both targets to combat in drug development – mental illnesses present so dependently on an individual’s brain makeup, leading to a chasm of symptom ‘outputs’ presented per patient. How can you treat something if you can’t recognise it? This issue is adjoined with the difficulty of dynamic symptom presentation, leading to a lack of common symptoms that can be combatted by a single medicine. How can you tailor every drug to each individual presentation? There are, however, exceptions. Often those with anxiety, paranoia and frequent panic attacks suffer from an elevated heart rate prompted by our ‘fight-or-flight’ response. Although other factors are involved, returning the heart rate to its resting beat can significantly relax the patient and return them to an autonomous state. This rationale inspired many scientists and clinicians to develop a drug that could do precisely this, leading to the development of one of the most influential, yet controversial, mental health treatments of the 21st century: the Beta-Blocker.  

Following the early death of his father, medical student James Black fell into a crater of grief. In that grief he made a promise:; to quench the detrimental effects adrenaline can have on the heart. By doing this he hoped to, firstly, alleviate pain for those with heart disease, but more importantly reduce the incidence of myocardial infarction. He hoped few would have to feel the pain of losing a loved one to a heart attack. The following display of ingenuity not only earned Sir James Black his knighthood but also provided the world with an aperture through which to view the therapeutic potential of receptor-ligand drug discovery. The biology was clear: if you could inhibit the release of stress-hormones adrenaline and noradrenaline, you would reduce the heart’s oxygen demand – thus individuals with functional damage affecting the heart’s capacity to take up oxygen would undergo fewer angina attacks resulting from a lack of blood flow to the heart muscles. Following a sound rationale and a clear plan, James Black got to work, and in 1958, the world had its first beta-adrenergic blocking agent, or ‘Beta-blocker’.  

Beta-receptors are common on the outside of cardiac cells in the heart. They serve as a receptor for ‘adrenaline’, a hormone integral in the ‘fight– or– flight’ response that cause the heart to beat faster, thereby pumping oxygen around the body at a faster rate and providing your muscles with recourses to work at a higher intensity and for longer. Beta-blockers, as described in the name, block these beta-receptors, preventing adrenaline from reaching the receptors and thus lowering the heart rate. As many forms of heart disease stem from a lack of oxygen flowing to the heart, reducing the heart rate subsequently reduces the oxygen required in the heart, and thereby makes many forms of heart disease rarer. 

these drugs don’t combat the source of the issue – leading to common over-reliance

Beta-blockers were initially formulated as a treatment against heart disease. However, modern application has extrapolated their mechanism to treat mental conditions, anxiety and paranoia. This is due to an overlap in symptoms between the two diseases where many who suffer from mental disorders present with an elevated heart rate and a ‘fight-or-flight’-like response. The good thing is that we have a ‘tried and tested’ drug at our disposal, which has been shown to work on many levels; but on the other hand these drugs don’t combat the source of the issue – leading to common over-reliance. Furthermore, as an elevated heart rate is so common among a cacophony of mental disorders, they are prescribed by GPs without further investigation into the nuances of a specific issue. It’s all too common that people with vastly different issues get treated with beta-blockers without more specific and effective approaches even considered.  

 Yet despite this, Beta-Blockers are helping an extraordinary number of patients deal with both heart disease and mental illness, leading to questions such as: is the rise in ß-Blocker prescription commended by their all-round efficacy? Or is it quickly becoming a ‘throw-away’ treatment used to usher patients out of clinics, mistreating those with, particularly mental, complex disorders? The answer to these? You decide.