Beta Blocker Use Tied to Reductions in Violence

The use of beta blockers was associated with a reduction in violence, according to a population-based, longitudinal cohort study published in PLoS Medicine.

Beta blockers are used to treat multiple cardiovascular disorders, as well as other conditions such as migraine and glaucoma. Though evidence is unclear, the drug class has been associated with an increased risk of suicidal behavior.

To better understand the link between beta blocker use and psychiatric and behavioral outcomes, Seena Fazel of the University of Oxford, UK, and colleagues at the Karolinska Institute in Sweden compared the medicated and non-medicated periods of over 1.4 million beta blocker users. In this study, metoprolol was the most commonly prescribed beta blocker (60%), followed by atenolol (24.8%) and bisoprolol (16.6%). Over the 8-year study period, 6.9% of patients were hospitalized for a psychiatric disorder, 0.7% presented with suicidal behavior, and 0.7% were charged with a violent crime.

Compared with periods off treatment, findings showed a 13% lower risk of being charged with a violent crime during periods on beta blockers (hazard ratio [HR], 0.87; 95% CI, 0.81-0.93; P <.001). Additionally, during the medicated periods, an 8% lower risk of hospitalization due to psychiatric disorders (HR, 0.92; 95% CI, 0.91-0.93; P <.001), as well as an 8% increase in the hazards of suicidal behavior (HR, 1.08; 95% CI, 1.02-1.15; P =.013), were observed.

“Reduced associations with violent charges were consistent across sensitivity analyses, while associations with suicidal behavior and psychiatric hospitalizations varied by specific psychiatric diagnoses, past psychiatric problems, and cardiac severity,” the study authors noted.

Though beta blockers are known to be widely used off-label to manage anxiety, a secondary analysis showed no association between beta blocker use and hospitalization for anxiety disorders. A reduction in hospitalization for major depressive disorder was reported.

The study authors concluded that if confirmed in larger studies using other designs, beta blockers could potentially be considered for the management of aggression and violence in some individuals.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Molero Y, Kaddoura S, Kuja-Halkola R, Larsson H, Lichtenstein P, D’Onofrio BM, et al. Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden. Published online January 31, 2023. PLoS Med.