Beta blockers are medicines generally used for treating cardiac issues reminiscent of hypertension, chest ache, irregular heartbeat and coronary heart failure. Within the US, for instance, one in 5 adults aged 60–79 is prescribed a beta blocker.
In a new examine, we’ve discovered using beta blockers is related to decrease charges of violence. To discover why this is likely to be, let’s begin with some background.
Beta blockers work by blocking the stress hormones and neurotransmitters adrenaline and noradrenaline. These play an vital position in our “battle or flight” response. In a nerve-racking state of affairs, adrenaline and noradrenaline mobilise the mind and physique for motion by growing the quantity of blood the center pumps out.
Beta blockers stop the impact of those hormones. This slows the center price down, lowers blood strain, and likewise decreases pressure. For that reason, beta blockers are generally used as remedy for widespread psychological well being and behavioural issues, like nervousness, despair and aggression.
On the similar time, there have been considerations that individuals who use beta blockers might have the next danger of despair and suicide. However research have contradicted one another. Some have discovered that beta blockers scale back psychological well being and behavioural issues, others have discovered that they improve them, and a few have discovered no relationship.
The conflicting proof leaves docs with troublesome remedy selections. Are beta blockers efficient for treating psychological well being and behavioural issues? Or might they as a substitute improve the chance of significant psychological well being issues?
What we did
To reply this, we studied 1.4 million folks in Sweden who had been handled with beta blockers. We adopted them over eight years, from 2006 to 2013. We wished to know whether or not beta blocker use was related to psychological well being issues, violence, suicide makes an attempt and suicide deaths.
We recognized beta blocker customers by analysing knowledge from Swedish pharmacies and adopted folks via completely different healthcare, crime and loss of life registers. This was an observational examine, which means we noticed patterns of psychological well being and behavioural issues by inspecting these outcomes within the registers.
Sometimes, in an observational examine like this, beta blocker customers could be in comparison with non-users. However the two teams might differ on vital options, like psychiatric historical past. This makes the interpretation of outcomes troublesome. Are any variations seen as a result of beta blockers? Or do the 2 teams simply have completely different background dangers?
So as a substitute, we used a examine design the place we in contrast every particular person to themselves by contrasting intervals after they had been taking beta blockers with intervals after they weren’t. This fashion we might account for the affect of things which are distinctive for every particular person, like household and childhood background or psychiatric historical past.
We discovered that when folks had been taking beta blockers, they’d a 13% decrease danger of being charged with a violent crime by the police. In addition they had an 8% decrease danger of being hospitalised for psychological well being issues. There was nevertheless an 8% increased danger of being handled for suicide makes an attempt or dying from suicide.
We then carried out secondary analyses the place we examined subgroups of beta blocker customers, for instance these with a historical past of violence or psychiatric issues. The decrease danger of being charged with a violent crime when utilizing beta blockers was constant throughout the board.
Once we broke down hospitalisations for psychological well being issues into these for depressive or nervousness problems, we discovered a decrease danger for hospitalisations for main depressive problems, however not for nervousness problems.
We additionally discovered the upper danger of suicide makes an attempt and suicide deaths was particular to folks with severe coronary heart situations or a historical past of psychiatric issues.
We all know from earlier analysis that there’s a higher danger of suicide following severe coronary heart issues. Individuals might have pessimistic ideas, be not sure in regards to the future or involved about their well being. So psychological misery related to coronary heart issues, slightly than the beta blocker remedy, might be the principle rationalization behind the elevated suicide makes an attempt and suicide deaths seen in our examine.
Might we use beta blockers to handle violence?
Our outcomes on violence align with proof from small trials on beta blocker remedy. Nonetheless, we elevated the examine pattern, examined the whole basic inhabitants, and likewise broadened the end result to crime.
A potential rationalization for our outcomes is that beta blockers assist management the physique’s battle or flight response to nerve-racking conditions, so there’s a lower within the agitation and pressure that would result in violent behaviour.
Since that is an observational examine, it can not show that beta blockers trigger reductions in violence, solely that there’s a hyperlink between them. To grasp the position of beta blockers in aggression and violence, research that use different designs (reminiscent of randomised managed trials and experimental laboratory research) are wanted.
If these research verify our outcomes, beta blockers might be used extra extensively to handle violence in sure folks, significantly these with background danger components reminiscent of severe psychiatric issues. Since evidence-based remedies for violence are restricted, that is probably an vital discovering.