What to Know About Beta-Blockers for Anxiety

Beta-blockers are also known as beta-adrenergic blocking agents. Medical professionals most often use them to treat heart-related problems like:

• hypertension
• congestive heart failure
• hyperthyroidism
• cardiac arrhythmias

Our hearts have three different types of beta receptors that receive messages from stress-related chemicals, like norepinephrine and epinephrine (adrenaline). Beta-blockers do as their name suggests — they block the adrenaline from binding to those receptors.

By reducing the amount of adrenaline rushing into the heart, beta-blockers slow the rate and intensity of the heartbeat.

So what does this have to do with anxiety?

Generally speaking, beta-blockers are thought to work by reducing the physical symptoms of anxiety, not by impacting the underlying causes of your anxious feelings.

The physical or physiological symptoms of anxiety can be extensive and include:

• increased heart rate
• heart palpitations
• shortness of breath or rapid breathing
• chest pain
• trembling
• sweating

Decreasing these physical reactions to acute stress can actually alleviate the mental anxiety, creating a chain reaction of symptom reduction.

Unlike an antidepressant, beta-blockers are typically taken on a short term or as-needed basis, like before a medical procedure or public speaking event.

Your mental health professional might recommend beta-blockers for various anxiety disorders. Types of anxiety disorders include:

• generalized anxiety disorder (GAD)
• panic disorder
• specific phobia
• social anxiety disorder
• separation anxiety disorder

As we mentioned earlier, beta-blockers work by slowing the heart rate and relieving the physical symptoms of anxiety.

But the research on the efficacy of beta-blockers as a treatment for anxiety is mixed.

Despite some studies and anecdotal evidence to support the use of beta-blockers for treating anxiety, the Food and Drug Administration (FDA) hasn’t yet approved them for this purpose.

For example, one study from Japan found that the beta-blocker atenolol had positive effects for 81% of people with anxiety disorders, and 87% of those with post traumatic stress disorder (PTSD) reported positive effects. That being said, the authors agreed that these promising findings still required further, more robust research.

Another study found that the calming effects of an atenolol-combination drug on patients prior to medical procedures were significant. Replacing benzodiazepines in these types of high-anxiety situations could mean fewer side effects and reduced risk of addiction.

On the other hand, one meta-analyses indicated some promising results for the use of beta-blocker propranolol in panic disorder, but still found insufficient evidence to support its use for anxiety disorders overall.

If you’re interested in learning more about the efficacy of beta-blockers or think they might help you manage anxiety, consult with your doctor for personalized medical advice.

Beta-blockers are generally divided into two categories:

• Selective. These drugs block epinephrine from binding to beta receptors (Beta-1) that affect the heart almost exclusively. Atenolol (Tenormin) is a selective Beta-1 blocker.
• Nonselective. These drugs are more generalized, blocking beta receptors (Beta-1 and -2) in the heart, lungs, smooth muscle, kidneys, and other organs from receiving epinephrine. Propranolol (Inderal) is a nonselective beta-blocker.

Propranolol is often prescribed off-label for panic disorder, performance anxiety, and prevention of PTSD. But some people do experience disruptive side effects, which we’ll talk about in depth below.

Most people tolerate beta-blockers relatively well, experiencing few if any adverse effects.

Still, some possible side effects of beta-blockers include:

• Insomnia. Beta-blockers reduce your body’s natural production of melatonin, which can lead to insomnia or other changes in your sleep patterns.
• Fatigue or dizziness. Reduction in your heart rate can trigger symptoms like these that are related to lowered blood pressure.
• Nausea or constipation. Be sure to take medication with food to avoid gastrointestinal side effects.
• Sexual/erectile dysfunction. As with other drugs that lower blood pressure, beta-blockers can lead to sexual difficulties.

Beta blockers are generally safe, but as with most pharmaceutical drugs, there’s a slight risk of some severe side effects.

Drugs such as propranolol easily cross the blood-brain barrier, increasing the risk of serious adverse effects like depression or psychosis. But the likelihood is still slim.

In some people, beta-blockers can lead to shortness of breath, chest tightness, or even full asthma attacks.

People are advised to avoid abruptly stopping usage of beta-blockers, which in rare cases can lead to severe chest pain or even heart attack.

But unlike other anti-anxiety drugs like benzodiazepines, beta-blockers are not habit-forming, so you’re unlikely to become dependent on them. This is a clear benefit of beta-blocker usage that should be taken into consideration, particularly if you’ve experienced substance dependance in the past.

There are some people for whom beta-blockers are largely off-limits, due to significantly increased risks of complications. This includes people who:

• Have asthma. Blockage of the Beta-2 receptors can increase the risk of asthmatic attacks and other respiratory problems. People with asthma may still use Beta-1 selective blockers, but your doctor will consider the risk level carefully.
• Have hypotension. Beta-blockers could bring the blood pressure of people with hypotension to a dangerously low level.
• Take other interacting drugs. Some medications, including anti-arrhythmics, antipsychotics, antihypertensives, and others, may interact with beta-blockers.

Always remember to share your full medical history with your doctor so that they can provide you with the best and safest treatment.

Managing anxiety can seem like a daunting task. The symptoms can be frustrating and overwhelming.

The good news is that anxiety disorders are highly treatable. Along with go-to treatments like cognitive behavioral therapy (CBT) and antidepressants, beta-blockers may help you manage your anxiety symptoms.

If you are interested in trying beta-blockers, you can speak with your doctor to figure out the right path for you.

Here are some useful resources to help you learn about and manage anxiety and any other mental health difficulties:

• National Alliance on Mental Illness (NAMI)
• Anxiety & Depression Association of America (ADAA) – support groups
• Psych Central’s Find a Therapist resource