Do Beta-Blockers Work for Anxiety?
Medically reviewed by Lindsay Cook, PharmD
Beta-blockers (also referred to as β-blockers) are a type of medication commonly used to manage heart-related health conditions like chest pain and high blood pressure. However, there's also another way they are being used that's getting attention in the field of mental health.
Beta-blockers, such as Inderal (propranolol) and Tenormin (atenolol), are also sometimes used to treat certain types of anxiety. Beta-blockers are used off-label for anxiety. This means that the Food and Drug Administration (FDA) has not approved them for use in people with this condition, but they have proven effective against symptoms of anxiety.
This article will discuss the use of beta-blockers for anxiety, including how well they work and what types of anxiety they can help manage.
Beta-Blockers for Anxiety
Beta-blockers work by calming down the effects of adrenaline, which is a hormone that makes your body get ready for action, as in a fight-or-flight situation.
When a person feels anxious, their body releases high amounts of the hormone called epinephrine, which is also known as adrenaline. This hormone can cause physical responses to anxiety, such as a fast heartbeat or tremors. Beta-blockers stop adrenaline from having these effects, which can help reduce these symptoms of anxiety.
Healthcare providers may consider prescribing beta-blockers to help with the following four kinds of anxiety disorders:
Social anxiety disorder: Social anxiety disorder is characterized by anxiety in social situations due to the fear of being criticized or judged. Beta-blockers can help with the physical symptoms of anxiety that might be experienced in these situations.
Performance anxiety (stage fright): Performance anxiety manifests as anxiety or panic attacks in response to a public event, such as giving a speech in front of others or performing on a stage. Beta-blockers can be useful in controlling these immediate physical reactions.
Panic disorder: Panic disorder is a form of anxiety that causes sudden and unexplained panic attacks, which include physical symptoms that can feel like a heart attack.
Post-traumatic stress disorder (PTSD): PTSD occurs in response to a scary or traumatic event. It can cause recurring symptoms such as nightmares, anxiety, and trouble sleeping.
It's important to understand that beta-blockers can help with the physical symptoms of anxiety, but they don't make anxiety go away completely or fix what's causing it. To effectively tackle anxiety, beta-blockers should be used as part of a broader treatment plan that includes talk therapy and other forms of therapy.
How Effective Are Beta-Blockers for Anxiety?
The effect of beta-blockers on anxiety disorders has been a topic of several studies. The findings are mixed due to differing scenarios and types of anxiety symptoms.
Social Anxiety Disorder
While beta-blockers like propanolol are helpful due to their ability to lessen the physical symptoms of anxiety, it's not entirely clear if they can combat broader social anxiety symptoms such as fear of criticism or avoidant behaviors.
For this reason, beta-blockers are largely considered more helpful for the physical symptoms of anxiety disorders rather than cognitive or psychological symptoms.
One eight-week study determined no significant differences between the beta-blocker Tenormin (atenolol) and a placebo (an inactive substance given to control groups) for treating generalized social phobia.
Performance Anxiety
Performers like musicians, actors, and public speakers may sometimes use beta-blockers to manage their performance anxiety. These medications help reduce physical symptoms such as a fast heart rate and tremors that can occur when on stage. Given the short-term nature of such anxiety, beta-blockers appear suitable for these scenarios.
One double-blind study of 29 people showed that beta-blockers helped eliminate physical responses to performance anxiety, including dry mouth. As a result, performance quality improved for those who took the beta-blockers.
Panic Disorder
Some experts suggest beta-blockers can help lessen physical symptoms, such as heart palpitations, during a panic attack. In terms of preventing or managing the sudden and intense panic attacks associated with this disorder, their utility is less certain.
Studies investigating beta-blocker use in panic disorder have been small and of low quality. Guidelines typically recommend beta-blockers as a third-line therapy option for panic disorder.
Beta-blockers seem more suitable for managing situational anxiety than spontaneous panic attacks.
Post-Traumatic Stress Disorder
Based on a larger analysis that looked at many different studies (meta-analysis), propranolol may help with anxiety disorders linked to distressing memories, especially in cases like PTSD.
Also, propranolol can be effective at calming down strong emotions, reducing performance anxiety, and improving the ability to think clearly during anxiety.
Generalized Anxiety Disorder (GAD)
Beta-blockers generally don't work as well for GAD.
GAD involves frequent, consistent anxiety or worry that interferes with daily life. Beta-blockers work best when managing physical symptoms of anxiety, but they are not as effective at controlling the psychological symptoms of anxiety.
For this reason, healthcare providers usually suggest other treatments like antidepressants, benzodiazepines, and cognitive behavioral therapy (CBT). These treatments can help manage both the physical and mental aspects of GAD.
Beta-Blockers vs. Other Anxiety Medications
When it comes to treating anxiety, there are many options. what works for you will depend on your unique situation.
Beta-blockers are most helpful for those who need short-term relief from the physical symptoms that arise from anxiety, such as feeling your heart race before giving a speech in public. They work fast by blocking the effects of adrenaline, which slows down your heart rate and reduces anxiety-induced reactions like shaking and sweating.
On the other hand, traditional anxiety medications, like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRI), are usually used for the long term because they take weeks to months to make a noticeable difference in anxiety symptoms.
Benzodiazepines are also another alternative for fast anxiety relief. However, benzodiazepines are associated with physical dependence. Therefore healthcare providers are often more cautious when it comes to prescribing them for anxiety.
So, whether you go for beta-blockers or traditional anxiety medicines depends on your specific symptoms, needs, and possible risks. Beta-blockers are a good choice for fast relief in certain situations, whereas traditional anxiety medications are better for managing anxiety in the long run.
Related: Comparing Ativan (Lorazepam) vs. Xanax (Alprazolam)
Types of Beta-Blockers
There are many different beta-blocker medications. Examples of beta-blockers include:
Bisoprolol
Coreg (carvedilol)
Immediate-release propranolol and extended-release propranolol (Inderal LA)
Tenormin (atenolol)
Lopressor (metoprolol)
When healthcare providers prescribe beta-blockers for anxiety, they are prescribing the drugs for a treatment not officially approved by the FDA. Two beta-blockers that providers often prescribe to help with anxiety off-label are propranolol and atenolol.
Side Effects of Beta-Blockers
As with most medications, beta-blockers come with side effects. However, they are generally considered safe when used as directed.
Common side effects of beta-blockers may are:
Slowed heart rate
Fatigue
Light-headedness
Low blood pressure
Trouble sleeping
Loose or watery stools
Hard or difficult to pass stools
Cold hands and feet
Stomach pain or cramping
Vivid or strange dreams
Who Should Not Take Beta-Blockers?
Beta-blockers are sometimes given to people with anxiety because they can make the physical symptoms of the disorder feel better. However, they might not be right for everyone.
Before prescribing beta-blockers, healthcare providers will consider different factors that would prevent them from prescribing a certain drug to you. For example, propranolol is contraindicated (meaning it should not be used) in those with:
Atenolol should not be used in people with:
Slowed heart rate (bradycardia)
Cardiac shock
When considering treatment options, share your medical history with your healthcare provider, including any preexisting health conditions and prescription or over-the-counter (OTC) medications you are taking.
Summary
Beta-blockers can be a viable treatment option for certain types of short-term anxiety, such as performance anxiety. However, it may not be as effective for other types of anxiety disorders, such as panic disorder or GAD, that require longer-term treatment. This is because beta-blockers target the physical manifestations of anxiety and do not treat the underlying cause.
There's much more to learn about using beta-blockers for anxiety, and it's a topic that needs more study. Successful use of drugs approved to work on the heart, such as beta-blockers, for conditions such as anxiety points to the interconnection between body and mind and how drugs for one can benefit the other.
Frequently Asked Questions
How long do beta-blockers take to work for anxiety?
Beta-blockers are fast-acting medications. After taking propranolol, for example, you should expect to notice improvements in your physical symptoms within one to two hours. Taking 40 milligrams (mg) of propranolol one hour before an event causing performance anxiety has proven beneficial
What other methods can be used to manage performance anxiety?
Other methods to help with anxiety include talking to a therapist, using relaxation techniques such as deep breathing or yoga, staying active, eating well, getting enough sleep, focusing on the present moment, joining support groups, and avoiding triggers that make you anxious. What works for one person may not help another, though.
The author would like to recognize and thank Norma Ponce, PharmD, MHA for contributing to this article.
Read the original article on Verywell Health.
