Propranolol as a Novel Therapeutic Approach for Post-Stroke Anxiety: A Clinical Review and Future Directions

Stroke remains a leading cause of death globally, with survivors facing both physical and psychological challenges. While acute stroke treatment has improved, many patients develop post-stroke anxiety (PSA), particularly generalized anxiety disorder. PSA represents a significant clinical challenge as most stroke survivors suffer from it. Current management includes lifestyle changes, behavioral therapy, and medications like selective serotonin reuptake inhibitors (SSRIs). Propranolol, a non-selective beta-blocker, has shown promise in treating anxiety disorders by targeting physical symptoms through its effects on the sympathetic nervous system. Its dual benefits in managing both cardiovascular and psychiatric symptoms make it particularly relevant for stroke patients. We aim to evaluate the therapeutic potential of propranolol in managing PSA and to establish a framework for future clinical studies comparing its effectiveness with SSRIs in stroke patients. Propranolol presents a potentially advantageous therapeutic option for post-stroke patients due to its multifaceted clinical benefits. Its dual mechanism of action addresses both neuropsychiatric symptoms and cardiovascular complications, offering simultaneous management of anxiety, cardiac arrhythmias, and hypertension, conditions that frequently coexist in stroke patients. We recommend high-quality randomized trials to estimate the efficiency of propranolol in comparison to other interventions and to estimate the cost-effectiveness while taking into consideration the associated risk.