Psychosis with propranolol: still not recognized?

A 21 year old male developed hallucinations, personality change and severe depression following an increase in oral propranolol administration at recommended dosage levels. The symptoms improved markedly on stopping the drug. Without provocation, the patient developed further symptoms, mainly depressive, with marked suicidal impulses. Again, this quickly settled. The case identifies the need for careful observation of patients with psychiatric side effects from propranolol, following discontinuation of the drug.