Everything you need to know about beta-blockers for anxiety

Everything you need to know about beta-blockers for anxiety

Reviewed by:
Austin Lin, MD
Staff Psychiatrist
at Talkiatry
March 29, 2024
In this article

If you experience anxiety, you likely know its physical signs all too well. Symptoms like a racing heart, trembling hands, and excess sweating can make you feel even more anxious, setting a dreadful cycle into motion.  

Beta-blockers are a type of medication that can help counteract these physical symptoms of anxiety. Although beta-blockers are a class of medications originally intended to treat heart-related conditions, one of them is commonly prescribed off-label (for something other than what it was originally approved for, usually based on scientific research) to help people with anxiety.

Read on to learn more about beta-blockers, how they reduce anxiety symptoms, and which one is commonly prescribed by psychiatrists.  


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What are beta-blockers, and how do they work?  

Beta-blockers were first developed in the 1960s for heart-related conditions like angina (chest pain) and irregular heartbeats. Soon after, doctors realized that they could also help relieve symptoms of other conditions like anxiety in addition to hypertension (High blood pressure).h

Put most simply, beta-blockers block adrenaline in certain parts of the body and reduce your body’s physiological stress response. Here’s how: Your body has beta receptors as part of your nervous system. Adrenaline, the hormone associated with your fight-or-flight response, binds to these receptors. When a lot of adrenaline builds up and binds to them, it can trigger physical symptoms like an increased heart rate or shakiness.  

Beta-blockers block these receptors so that adrenaline can’t bind to them. When the adrenaline can’t bind, you won’t experience bothersome symptoms as much. Ultimately, beta blockers will reduce your heart rate and lower your blood pressure, whether you’re taking the medication for a heart condition or anxiety.  

Commonly beta-blockers and their brand names include:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Bisoprolol (Cardicor or Congescor)  
  • Metoprolol (Lopressor or Toprol XL)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Propranolol (Inderal LA or InnoPran XL)

Most of these are prescribed by family doctors and cardiologists for non-anxiety related health issues.

Do beta-blockers help with anxiety?

Even though beta-blockers are not FDA-approved to treat anxiety, many psychiatrists do prescribe them “off-label” to help people cope with symptoms. There is one they prescribe in particular: propranolol. It’s important to note that while  this medication can certainly reduce physical anxiety symptoms, it only does so temporarily and will not directly impact or reduce psychological symptoms of anxiety. The idea behind using propranolol to quell the physical aspects of anxiety is to encourage a patient, who has social anxiety, to have the courage to attend a social event and be able to get through it. This exposure therapy over time helps to reduce their anxiety, also known as extinction learning.

With that in mind, we have decades worth of research showing that beta-blockers can benefit people with anxiety, specifically in the following scenarios:

  • Performance anxiety: Those who struggle with stage fright or performance anxiety can benefit from beta-blockers to calm their nerves before their big moment. Beta-blockers can lessen the physical effects of nervousness of that pre-show adrenaline rush. Performers can take beta-blockers as needed before they go on stage to help with public speaking.
  • Social anxiety: Since people with social anxiety (AKA social phobia) may have a racing heart, tremors, or shaky speech in social situations, beta-blockers can counteract this to help them feel more calm and collected when socializing as needed.
  • Generalized anxiety disorder (GAD): Those with GAD often experience physical anxiety symptoms, especially when their anxiety is flaring up. Beta-blockers can help relieve this and may be prescribed alongside a long-term daily anxiety medication for maintenance treatment.  
  • Phobias: Specific phobias can elicit extreme physiological responses. If someone with a phobia or fear knows they’re about to encounter a trigger, beta-blockers can help. For example, someone afraid of flying can take a beta-blocker before boarding a flight.  

Learn more about different types of anxiety disorders

Precautions and considerations

Although beta-blockers are a great option for many people with anxiety, they aren’t suitable for everyone. It’s crucial to tell your doctor about all of your health conditions, medications, and supplements so they can make sure beta-blockers are a safe option for you.

Here are some situations where your doctor might advise against beta-blockers:

  • Asthma: If you’re asthmatic, you’re at higher risk for severe side effects involving difficulty breathing.  
  • Diabetes: Beta-blockers can potentially cause spikes in blood sugar in people with diabetes. They can also hide signs of low blood sugar, like increased heart rate. Either situation could be dangerous for diabetics.  
  • Pregnancy and breastfeeding: Research is mixed, but there’s some evidence suggesting that certain beta-blockers are safe while others aren’t.. Additionally, some beta-blockers are safer than others during breastfeeding, depending on how much of the drug makes it into the breast milk. Make sure to consult an OB-GYN for more medical advice.
  • Low blood pressure or slow heart rate: If you have low blood pressure or a slow heart rate, beta-blockers can lower these even more.
  • Raynaud’s syndrome: Beta-blockers can worsen symptoms in someone with Raynaud’s.  

How long do beta-blockers take to work for anxiety?

One major benefit of beta-blockers is that they work quickly. After you take a dose, you should feel a reduction in your physical anxiety symptoms within about an hour.  

It should be easy to notice if your prescription is working. You’ll feel your racing heart slow down, stop being so shaky, and stop sweating so much. Basically, you’ll feel physically calmer because your body won’t be in fight-or-flight mode.

When you first start taking a beta-blocker, you might want to keep track of your symptoms before and after your dose so you can see how well it’s working and share this information with your psychiatrist. For example, you can jot down what symptoms you’re feeling, what time you take the dose, and how long it took to experience relief from your symptoms.

If you aren’t feeling symptom relief from a certain beta-blocker dose, you might need a higher dosage. Let your psychiatrist know. Always take your prescription exactly as directed and consult your provider before making any changes.  

What are the common side effects of beta blockers?

Because of the way beta blockers work, two of the most common potential side effects are bradycardia, which means slow heart rate, and hypotension, which means low blood pressure.  

Other potential side effects include:

  • Changes to sleep
  • Constipation
  • Dizziness
  • Fatigue
  • Nausea
  • Sexual dysfunction  
  • Weight gain  

People who are taking beta-blockers, namely propranolol, for anxiety may not experience all of these side effects since they’re taking it as needed, rather than on a daily basis.  

In rare cases, beta-blockers can cause the muscles in your airways to tighten, leading to shortness of breath, coughing, and wheezing. This is most likely to happen in people with asthma. The most serious side effects include heart block, which is more common in those with a pre-existing cardiovascular condition. If you have heart problems, doctor will let you know if beta-blockers are safe for you when prescribing them.

Remember, if your doctor prescribes you beta blockers (for any reason), they’ll help you minimize the risks and make sure it’s safe for you to take by going over your health history and asking about any underlying medical conditions.  

Alternatives to beta-blockers for anxiety

There are many other medications to treat anxiety. There’s no one-size-fits-all approach to anxiety treatment, and everyone responds to medications differently. Your provider will assess your history and symptoms before deciding what type of medication or mix of medications will help you the most.  

Examples of other types of anxiety medications are:

Antidepressants

On top of relieving depression, antidepressants can help reduce anxiety, too. Unlike beta-blockers, which you typically take as needed, you have to take your antidepressant every day for it to be effective. The most commonly used antidepressants for anxiety are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors). Less commonly prescribed antidepressants are tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). There are also atypical antidepressants like mirtazapine (Remeron) which don’t fall into these categories. All of these meds work by affecting neurotransmitters in the brain related to anxiety and depression.  

Benzodiazepines

These drugs are fast-acting sedatives that help you calm down when you’re experiencing high anxiety or panic attacks by slowing down your central nervous system and brain activity. Benzodiazepines are meant for short-term, as-needed use since they have a high risk for dependence and abuse.  

Gabapentin

This medication is originally intended for nerve pain and seizures, but similar to beta-blockers, it’s sometimes prescribed off-label for anxiety. Gabapentin isn’t a first-line treatment option for anxiety, but it may help people who aren’t experiencing relief from more traditional anxiety meds.  

Buspirone

Buspirone (brand name BuSpAr) is also FDA-approved to help with anxiety. It’s thought to work by affecting neurotransmitters serotonin and dopamine. Psychiatrists might prescribe it as an add-on to an antidepressant to reduce its side effects or enhance depression treatment.  

Hydroxyzine

This antihistamine was initially used to treat allergies, but it’s now FDA-approved for anxiety. Depending on your provider's recommendation, you can take hydroxyzine daily or as needed. In addition to blocking histamine, it also acts on serotonin in the brain and slows down the nervous system.  

On top of medication, therapy plays a big role in anxiety recovery, especially for people who do not want to take medications long-term. A licensed therapist can help uncover the root causes of anxiety, identify unhealthy thought patterns, teach you coping skills and relaxation techniques, and more.  

A diagnosis from a qualified mental healthcare provider is the first step to feeling better. For many people with anxiety, a combination of medication and therapy is the most effective treatment. Talkiatry offers both. We’re a national psychiatry practice that treats mental health conditions like anxiety, depression, ADHD, and more.

To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

Here are more questions about beta-blockers for treatment of anxiety.

What’s the best beta blocker for anxiety?

There isn’t a one-size-fits-all “best” beta blocker. Everyone is different and responds differently to medications. However, we have the largest body of research surrounding the effectiveness of propranolol for physical anxiety symptoms surrounding stage fright, generalized anxiety, social anxiety, and phobias. It is also generally the only beta-blocker that is prescribed by psychiatrists.

What’s the difference between a beta-blocker and Xanax?

Beta-blockers are in a different drug class than Xanax, which is a benzodiazepine. Beta-blockers work by blocking receptors that adrenaline binds to, while benzodiazepines like Xanax slow down brain and nervous system activity. Xanax comes with a much higher risk of dependence or addiction than beta-blockers do.  

What are natural beta-blockers?

Some naturally occurring nutrients may have beta-blocker-like effects, but they are less effective than prescription beta-blockers and research is mixed. Examples are antioxidants, garlic, saffron, and potassium. Natural products are not without side effects and are not FDA approved to address physical symptoms of anxiety. Consult your doctor before taking any supplements.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.

Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.

Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.

Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.



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