Beta Blockers for Anxiety: Benefits & Risks

Beta adrenergic blocking agents, also called beta blockers, are a group of drugs commonly prescribed to treat high blood pressure, chest pain, coronary artery disease, irregular heart rates, heart failure, and other cardiovascular conditions. In addition, these drugs are prescribed for medical conditions such as migraine prevention, essential tremor, hyperthyroidism (overactive thyroid), and glaucoma. Sometimes, beta blockers are used off-label to relieve the symptoms of anxiety to treat anxiety disorders such as generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD). Please continue reading to learn more about beta blockers for anxiety.

How do beta blockers work for anxiety disorders?

Beta blockers work for anxiety disorders by relieving physical symptoms and reducing the body’s physiological response to anxiety.

As you may know, in addition to psychological symptoms, anxiety disorders can cause a number of physical symptoms such as dizziness, heart palpitations or a rapid heartbeat, excessive sweating, trembling, shaky voice, and the sensation of “feeling sick to your stomach.” In addition to that, more serious symptoms such as headache and insomnia are also commonly reported by people with anxiety disorders.

In some people, anxiety disorders can be a vicious cycle in that anxiety and stress feed off each other and worsen the anxiety symptoms. In other words, focusing on the physical symptoms of anxiety and worrying about them can cause these symptoms to intensify.

Beta blockers work by blocking beta receptors in the heart and blood vessels. By blocking the heart’s beta receptors, these drugs block epinephrine (also called adrenaline— the body’s stress-related hormone and a natural chemical involved in the fight or flight response). Taking beta blockers can decrease the force with which the heart can pump blood, decrease heart rate, relax the blood vessels, ease blood flow, and reduce blood pressure — all of which contribute to the relief of anxiety symptoms such as:

Increased sweating
Shaky voice, hand tremors
Fast, pounding heart rate
Dizziness

Which anxiety symptoms can beta blockers treat?

Beta blockers can treat physical symptoms of anxiety such as heart palpitations (fast or irregular heart rate or racing heart), high blood pressure, dizziness, sweating, and trembling. Medical professionals may prescribe beta blockers, especially propranolol, for off-label use to treat symptoms and conditions such as:

Chronic stress — propranolol has the potential to be used as a preventative treatment for people who are chronically stressed
Anxiety
Post-traumatic stress disorder (PTSD)
Panic disorder
Stage fright or fear of public speaking
Performance anxiety
Social anxiety disorder
Phobias, such as fear of dental extractions or fear of spiders

Which beta blocker is best for anxiety?

Propranolol and atenolol are the two most commonly prescribed beta blockers for anxiety.

What are the pros and cons of beta blockers for anxiety?

Pros

Even though beta blockers do not provide acute relief like certain sedative anti-anxiety medications such as benzodiazepine, they are pretty effective and can offer rapid relief from the physical symptoms of anxiety that are situational, such as performance anxiety that happens prior to an important exam, stage fright, or interviews. Therefore, they are especially useful in treating short-term anxiety.
Beta blockers have been in use for decades and are well understood and studied and less likely to cause unexpected side effects for most people.
Using beta blockers for treating anxiety can benefit other health conditions. For example, they can treat anxiety and lower blood pressure in people who have both anxiety disorders and high blood pressure.
Beta blockers are affordable. Most are available in lower-cost generic versions.
They may be useful for people who did not benefit from or had intolerable adverse effects on other anti-anxiety medications.

Cons

Beta blockers do not treat the underlying psychological causes of anxiety.
These drugs can cause adverse effects such as slow heart rate, low blood pressure, irregular heart rhythms, fatigue, lightheadedness, dry mouth, dry eyes, nausea, insomnia, and sexual dysfunction.
They can interact with other drugs such as antihypertensives, angina (chest pain) medications, inotropic agents such as epinephrine and digoxin, and anti-arrhythmic drugs. For example, if you are already taking medication for high blood pressure, adding a beta blocker may further reduce your blood pressure and heart rate to dangerously low levels. It is important to talk to your healthcare provider before starting a new medication.

Is it safe to take beta blockers for anxiety?

Beta blockers have been around for decades and are well-studied, well-understood, and generally safe. They may be helpful in treating anxiety symptoms in some people, especially in managing short-term anxiety before stressful events. For example, people who have anxiety with public speaking take a beta blocker before giving a speech or a presentation to a large group of people. However, beta blockers may not be the best choice for chronic anxiety. In addition, beta blockers may not be safe for people with certain medical conditions, such as moderate to severe asthma, hypoglycemia (low blood sugar), certain types of heart rhythm abnormalities, Raynaud’s phenomenon (cold hands and feet), low blood sugar, slow heart rate, or low blood pressure.

Is there a downside to beta blockers?

Downsides to beta blockers include the fact that these drugs are prescribed off- label for anxiety and they are not the first-choice drugs to treat anxiety. In addition, suddenly stopping beta blockers after taking them for a long time can result in withdrawal symptoms. Moreover, some of the side effects of beta blockers can make anxiety symptoms worse.

Other anxiety medications, such as selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, are typically used, along with psychotherapy modalities like cognitive behavioral therapy (CBT), to treat anxiety.

Your mental health professional will discuss treatment options with you. They will take various factors into account, including your medical history, while choosing either beta blockers or other anti-anxiety medications. They may prescribe beta blockers along with other drugs, psychotherapy, and lifestyle changes to relieve symptoms of anxiety.

If your healthcare professional prescribes a beta blocker for anxiety, make sure you take it at the prescribed dose and also take other medications and go to psychotherapy as advised. This will give you the best chance of effectively treating symptoms of anxiety.

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