Beta-blockers for anxiety: What to know
The Food and Drug Administration (FDA) have not approved beta-blockers for the treatment of anxiety. However, these drugs change how the body responds to epinephrine, which may help relieve some of the symptoms of anxiety.
Some doctors prescribe beta-blockers on an off-label basis to help people for whom other anxiety medications are unsafe or ineffective. Self-medication with beta-blockers is also increasingly popular, but it is not safe.
Post-traumatic stress disorder (PTSD), phobias, and panic disorder are serious medical conditions that require competent medical treatment. While beta-blockers might be appropriate for some cases of anxiety, self-medication is a dangerous strategy that may cause serious side effects.
Read on to learn more about how beta-blockers help treat anxiety, their effectiveness, and whether they have any risks.
How they work
A doctor may prescribe beta-blockers to treat high blood pressure, abnormal heart rhythms, and chest pain.
Some doctors refer to beta-blockers as beta-adrenoceptor antagonists because these drugs block the effects of epinephrine, or adrenaline, on beta receptors.
Epinephrine is a hormone and neurotransmitter that plays a vital role in the body’s fight-or-flight response, which can lead to anxiety. Reducing the effects of epinephrine on the body may also reduce the intensity of anxiety.
Beta-blockers treat heart conditions by dilating the blood vessels and lowering blood pressure. They can also help regulate and slow the heart rate.
Many people who experience anxiety report a racing heart or higher blood pressure. By changing the way in which the body responds to anxiety, beta-blockers may reduce the intensity of the symptoms and lessen the physical effects.
Emerging research suggests that some beta-blockers may also change how the body recalls and responds to fearful memories. This finding suggests that the drug could treat PTSD and phobias, but more research is necessary to confirm this use.
Benefits
Beta-blockers work differently than traditional anti-anxiety medications, making them a viable alternative for people who need rapid relief.
These medications may be beneficial because they:
- are fast acting, making them an ideal choice for people who need rapid relief
- work well for acute short term anxiety
- can help lower blood pressure and heart rate, relieving physical symptoms
- may be an alternative for people who experience intolerable side effects when they take other anti-anxiety medications
- may be an effective option for people with anxiety disorders who also have high blood pressure or other heart health problems
- may reduce tremors, boosting the confidence of people anxious about public speaking and other performances
A range of other drugs can treat anxiety. Doctors frequently prescribe a group of drugs called benzodiazepines, which include alprazolam (Xanax).
These medicines work well for some people, but they are potentially addictive and can be unsafe when a person takes them alongside certain other drugs. Some people also find that benzodiazepines make them feel sleepy or sluggish.
Some antidepressants, including a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs), can also help ease the chronic anxiety of generalized anxiety disorder and PTSD.
However, these medications can take several weeks to work. They may also not work as well for acute short term anxiety, which phobias and public speaking can trigger in some people.
Effectiveness
Beta-blockers are particularly effective at treating the physical symptoms of anxiety.
Research generally finds that although the FDA have not approved beta-blockers for treating anxiety, these drugs are effective in reducing many of its physical effects.
The authors of a 2015 analysis emphasized that beta-blockers are less effective in treating psychological symptoms of anxiety and primarily work by treating physical symptoms, such as rapid heart rate and tremor.
A 2016 meta-analysis compared a beta-blocker called propranolol with benzodiazepines, a popular first-line treatment for anxiety.
The authors found that both types of drug could treat panic disorder and agoraphobia, but propranolol did not perform better than benzodiazepines. This finding suggests that there is no reason to try beta-blockers before benzodiazepines in most people.
The same analysis found that propranolol did not improve PTSD symptoms. In contrast with some earlier research, the analysis did not find that the drug changed how the brain manages traumatic memories.
The authors of a 2015 study concluded that a single dose of propranolol following exposure to a tarantula could relieve symptoms of spider phobia for at least a year after this treatment.
The authors suggest that this may be because propranolol changes the way in which the brain manages fearful memories. While the results are promising, the study sample was small.
Types
Many types of beta-blocker are available in the United States. All beta-blockers work by changing the response of beta receptors to epinephrine, but there are two distinct types:
- Nonselective beta-blockers. These drugs block epinephrine from binding to beta receptors throughout the body (beta-1 and beta-2 adrenoceptors).
- Selective beta-blockers. These drugs primarily prevent epinephrine from binding to beta receptors in the heart. They selectively target beta-1 receptors. At higher doses, they may become less selective and also target beta-2 receptors.
Side effects
Possible side effects of beta-blockers include:
- rashes and other skin reactions
- bradycardia (slow heart rate) after a person stops taking the drug
- increased risk of anesthesia complications
- low blood pressure
- gastrointestinal problems, such as diarrhea and nausea
- impotence
As with any medication, it is possible to have a dangerous allergic reaction to beta-blockers. A person should go to the emergency room if they experience difficulty breathing, loss of consciousness, or other sudden severe symptoms.
It is important to note that not everyone experiences all or any of the possible side effects.
Risks
Taking a beta-blocker without a prescription increases a person’s risk of taking the wrong dosage or using the drug for a condition that it cannot treat.
Some other risks of self-medication include:
- making other medical conditions worse
- interactions with other drugs
- not getting relief from treatment
Beta-blockers are not safe for people with cardiogenic shock, bronchial asthma, certain types of heart blockage, and sinus bradycardia. They may also reduce the symptoms of hypoglycemia in people with diabetes, making it difficult to determine the right insulin dosage.
Beta-blockers may also cause dangerously low blood pressure in people who already have hypotension.
What to ask a doctor
A person can talk to a doctor about the best treatment options for their anxiety.
Some people feel embarrassed about their anxiety and are reluctant to seek help. It is important to remember that anxiety is a medical condition, not a personal failing.
A knowledgeable doctor will ask about a person’s symptoms, diagnose the anxiety, and offer a range of treatment options.
People who do not get relief from benzodiazepines or other drugs should ask for alternatives. They may need to change the dosage, switch medications, or try a beta-blocker.
Some questions to consider asking the doctor include:
- What side effects can I expect with each medication?
- Are there any medical conditions that make beta-blockers or other anxiety medications unsafe?
- Do I need to make any lifestyle changes or avoid other drugs?
- What should I do if I experience side effects?
A person will need to tell a doctor about any drugs that they take, including supplements, alcohol, and illicit or recreational drugs.
It is also important to discuss all medical issues because certain conditions — such as very low blood pressure — may make beta-blockers unsafe.
Summary
Beta-blockers may offer hope to people who have found other medications ineffective in relieving their anxiety.
These medications can also improve performance in people who feel overwhelmed by short term anxiety, such as when speaking in public. For people with phobias, beta-blockers may make it possible to do things that were once terrifying.
The promise of life with less anxiety is compelling. However, no drug is free of risks. It is never safe to use a prescription drug without first consulting a doctor.
People who experience anxiety need a medical diagnosis that rules out other causes, such as other mental health conditions or a heart defect. They should talk to a doctor about treatment options and ask specifically about beta-blockers if these are of interest.
