Your grandpa takes beta-blockers for his heart, but could they help treat anxiety? When Heather, 33, started experiencing paralyaing anxiety triggered by public speaking at her job, she knew she needed something different than the Xanax she was already taking. While she had been able to count on the prescription drug for other situations, it was no match for speaking in front of crowds.
“It only calmed me down a little,” says Heather, who lives in New York. “I really felt like I needed a massive tranquiliser to not want to jump out of the window during a presentation.”
But she was surprised when her doctor prescribed propranolol – a beta-blocker, typically used to reduce blood pressure – for her anxiety.
“It truly is a magic pill,” Heather says, adding that she even uses it for conference calls that tend to instigate her anxiety. “It doesnt necessarily alleviate your nerves, but any symptom you may experience – for example, your heart pounding out of your chest – is totally eliminated. Its the best kept secret.”
Uh, wait, what are beta-blockers?
Beta-blockers are typically used to manage abnormal heart rhythms, reduce high blood pressure or treat angina (chest pain). They work by blocking the bodys beta receptors, which are stimulated by epinephrine (a.k.a. adrenaline), explains Dr Sanjiv Patel, cardiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.
Basically, beta-blockers help your heart beat slower and with less force, according to the U.S. National Library of Medicine (NLM).
But, while theyre typically used to treat heart and blood pressure issues, beta-blockers can also be used to treat glaucoma, hyperthyroidism, tremors, migraines and – you guessed it – anxiety, says Dr Patel.
Beta-blockers also come in different formulations – non-selective and selective – which dictate what theyre used for.
Selective beta-blockers, like atenolol, work specifically on the heart, according to the NLM, while non-selective beta-blockers (like propranolol, which Heather takes) work on a variety of receptors, opening them up to more general uses like anxiety.
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So, beta-blockers can really help with my anxiety?
Well, it depends on what type of anxiety youre experiencing.
“One of the more common off-label uses for beta-blockers is in the treatment of performance anxiety,” says Dr Wilnise Jasmin, a board-certified family medicine doctor and a current preventive medicine trainee at Johns Hopkins Bloomberg School of Public Health. “Beta-blockers act on the sympathetic portion of the nervous system, which is responsible for your fight reaction in the fight or flight response.”
That “fight” response, is what makes you feel the more physical symptoms of anxiety – the pounding heart, the shakiness, the profuse sweating – which beta-blockers, well, block.
“Since beta-blockers work by blocking the effects of epinephrine – also known as adrenaline – this slows down the heart, reducing the feeling of ones heart pounding, tremors, or sweating,” says Dr Ashwini Nadkarni, an associate psychiatrist at Brigham and Womens Hospital and instructor at Harvard Medical School.
Thats how they worked for Heather, who says her symptoms were so severe she struggled to hide them in public.
“It didnt matter if the presentation required me to speak for 15 seconds or 15 minutes, I wanted to die before and during,” she says, adding that alternative relaxation methods, like deep breathing, were never an option.
Thats because even if she did achieve a level of calm before a presentation, the symptoms would reappear the moment she was in front of people. “Once youre up, your body just panics and there is nothing that deep breathing or meditation can do for you.”
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Should I consider beta-blockers for my anxiety?
If you experience the occasional bout of performance anxiety, you might want to consider talking to your doctor about beta-blockers to help manage the physical symptoms. But, for other types of anxiety – generalised, social, etc. – beta-blockers may not be enough.
Thats because beta-blockers dont treat the more mental aspects related to anxiety, like persistent and excessive worrying, suggests Dr Nadkarni
Another thing to consider about beta-blockers: Theyre a legitimate medication (they are used for heart conditions, after all), so theyre not something to be taken lightly. They also come with some very real side effects, including dizziness, tiredness and difficulty breathing, per the U.S. National Library of Medicine.
Theyre also only available via prescription, so, you kind of have to talk to your doctor about them, anyway.
As for Heather, she says her now-and-then use of beta-blockers has been a lifesaver. “Propranolol taught me that I can say three sentences out loud in front of an audience without dropping dead and Im much better now,” she says.
And, while she doesnt use them quite as often anymore, she still keeps them on hand, in case of emergencies. “I still carry them in my purse just in case,” she says.