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Beta Blockers For Anxiety Disorders

Beta blockers are drugs that act on “beta receptors” within tissues of the sympathetic nervous system to inhibit stimulatory hormones such as epinephrine and norepinephrine. Medically they are utilized primarily to help manage cardiac arrhythmias, prevent heart attacks, and reduce blood pressure. The first effective beta blockers were documented in the early 1960s as a treatment for chest pain as a result of heart disease.

Many regard the discovery of beta blockers as among the most significant medicinal advances of the 1900s. Although beta blockers are medically approved to help various heart problems, they are often used off-label to help individuals suffering from anxiety disorders.

Beta Blockers for Anxiety Disorders

When a person experiences high levels of stress and/or anxiety, their sympathetic nervous system becomes activated. This leads the individual to experience many physical symptoms of anxiety such as increased heart rate, sweating, pupil contraction, and muscle tension. The physical symptoms are largely influenced by the release of various hormones such as epinephrine (adrenaline) and cortisol.

Over time, significant increases in stress hormones can eventually cause a nervous breakdown in which a person feels as if they have lost control over their thinking and physical functions. In other cases, a person may experience flare-ups of anxiety such as in social phobia and may have a difficult time dealing with their physical responses. Although there are a variety of medications that can be used for anxiety, some people prefer beta blockers.

How beta blockers work…

Beta blockers are antagonists of adrenergic functioning within the body. When a person experiences a high level of stress, epinephrine and other stress hormones bind to various receptors, creating physical symptoms of anxiety like palpitations, sweating, and muscle tension. Beta blockers function by preventing epinephrine and other stimulating hormones from binding to their designated receptors, thereby diminishing the body’s stress response.

Specifics: Beta blockers inhibit both epinephrine (adrenaline) and norepinephrine (noradrenaline) on the “beta receptors” within the sympathetic nervous system. This essentially prevents the “fight or flight” response that people often experience in dangerous or anxiety-inducing situations.

There are three specific types of beta receptors that are scientifically documented: beta-1, beta-2, and beta-3 receptors. The beta-1 receptors tend to affect the functions within the heart and kidneys. The beta-2 receptors affect functions within the lungs, gastrointestinal tract, liver, and skeletal muscles. The beta-3 receptors affect functioning within fat cells throughout the body.

List of Beta Blockers for Anxiety

Below are some common beta blockers, each with different effects. Off all the drugs listed below, the most commonly prescribed beta blocker to help a person cope with anxiety or stress is Propranolol (Inderal).

Propranolol (Inderal LA / InnoPran XL): This is a non-selective beta blocker and is considered a “sympatholytic” drug, meaning it inhibits function within the sympathetic nervous system. It is considered the first effective beta blocker and is used for a variety of conditions. It is prescribed for high blood pressure, heart problems, tremors, migraines, cluster headaches, PTSD, aggression, performance anxiety, generalized anxiety, panic attacks, and blushing. It is sometimes used off-label to help people cope with performance anxiety and stage fright.

Other Beta Blockers include

Other beta blockers are used primarily for various heart conditions and hypertension. These drugs are not commonly prescribed for anxiety. With that said, if you are taking one for a heart condition, you may find that it helps certain physical symptoms of anxiety.

  • Acebutolol (Sectral): This is a selective beta blocker that is primarily used for arrhythmias and high blood pressure. It is also used among people that require a beta blocker to help with asthma or COPD.
  • Atenolol (Tenormin): This is a selective beta-1 receptor antagonist drug that is primarily used for cardiovascular diseases. It was developed as a follow-up drug to propranolol and is considered to have less side effects. Although not as commonly prescribed as in the past, it is still used for various types of tachycardia, hypertension, and alcohol withdrawal.
  • Bisoprolol (Zebeta): This is a drug that acts as a selective beta-1 receptor antagonist and is primarily used for hypertension, heart failure, and to reduce the likelihood of a future heart attack. It reduces activity in of the heart muscle and mostly helps patients that have suffered some sort of heart disease.
  • Metoprolol (Lopressor / Toprol-XL): This is considered an older beta blocker that acts as a selective antagonist of the beta-1 receptor. It is used to treat hypertension, tachycardia, heart failure, for follow-up treatment after a heart attack, and to prevent migraines. It is considered an older beta blocker and has been around since the late 1960s.
  • Nadolol (Corgard): This is a non-selective beta blocker that acts as an antagonist on beta-1 and beta-2 receptors, with greater affinity for beta-1 antagonism. It is prescribed to help treat hypertension and chest pain. Off-label it is sometimes prescribed for migraines, ADHD, tremors, and Parkinson’s disease.

Advantages of beta-blockers for anxiety

Despite the fact that beta-blockers are not FDA approved for anxiety, they may be beneficial for certain individuals. They are commonly used among those with heart problems or hypertension with comorbid anxiety. In general, they do a great job of addressing the physical symptoms and have low dependency ratings, but are not considered clinically effective for anxiety because they fail to adequately address the psychological symptoms.

Additionally, there is research supporting their efficacy for anxiety. They tend to significantly reduce all symptoms associated with the “fight-or-flight” response such as: perspiration, palpitations, body temperature changes, and muscle tension. This allows people with anxiety to focus and not become further anxious over physical symptoms; they lower heart rate and reduce tremors.

  • Augmentation option: Those who haven’t found relief from a typical anxiolytic may be prescribed a beta blocker to determine if it helps. If pursuing a beta blocker as an augmentation option, it is important to be aware of potential contraindications (interactions) with the other drugs that you are on. Work with your doctor to determine whether this is a safe option.
  • Dependence: Unlike other pharmaceutical options such as benzodiazepines, beta blockers don’t carry any dependence. Therefore, they are relatively easy to withdraw from compared to stronger-acting anxiolytics. Some doctors actually prefer to prescribe beta blockers for their lack of dependence over other drugs like Xanax.
  • Effective in some: There is evidence that beta blockers like Inderal can be effective for helping individuals manage their anxiety. In particular if the individual suffers from an overwhelming amount of physical symptoms, beta blockers may be of significant help. Take away the physical symptoms, and it may lead to less psychological worry.
  • Inexpensive: Compared to many other medications, they are considered pretty inexpensive. For a monthly prescription of propranolol, it should cost less than $5 for generic.
  • Inhibition of amygdala: Taking this drug inhibits activity in the brain’s amygdala – a region involved in emotional processing and fear. It is thought that the inhibitory effect could further contribute to the anxiolytic effects of this drug.
  • Performance anxiety: Many professionals use beta blockers in their craft to help cope with performance anxiety. They have been successfully used by actors, dancers, public speakers, and musicians to help avoid stage fright. A survey of various orchestras revealed that approximately 1 in 4 performers have used beta blockers to reduce performance anxiety. It is also thought that they may be used by surgeons and athletes to help reduce the jitters. They have also been suggested to help reduce “stuttering” of speech.
  • Physical symptoms: Those who suffer from somatization disorders and/or physical symptoms from extreme anxiety (e.g. hypochondria) may respond well to a beta blocker. In cases of extreme anxiety, people often panic when they notice physical sensations such as increased heart rate, palpitations, and sweating. This leads to more production of adrenaline and further reinforces the panic cycle. By taking a beta blocker, it will help reduce the physical symptoms, which may help break the “fight-or-flight” cycle.
  • PTSD: This drug has been used to alter memory recall, specifically in the event of traumatic experiences (PTSD). Propranolol inhibits norepinephrine, a neurotransmitter that is thought to be involved in the consolidation of memories. In some cases, administration of this drug immediately following trauma results in reductions of post-traumatic stress symptoms compared to individuals who don’t receive this form of intervention. Some evidence suggests that the drug may also be beneficial for those experiencing PTSD-related nightmares, but the jury is still out on this claim.

Problems with beta-blockers for anxiety

Even though it may sound like beta blockers are great for anxiety, they are not free of problems. In many cases they are ineffective for reducing anxiety and one of the unfortunate long-term effects is development of Type 2 diabetes. Those considering them to manage anxiety should weigh the pros and cons.

  • Cognitive impairment: There is some evidence suggesting that beta blockers may cause a slight degree of cognitive impairment over the long-term. This claim needs to be further investigated, but should be mentioned. In general, short-term beta blocker treatment doesn’t seem to be associated with any impairment, while long term treatment may impair functioning.
  • Efficacy: Beta-blockers are not regarded as “clinically effective” for anxiety disorders, which is why they are not approved.  There is evidence supporting the efficacy of drugs like propranolol, but other beta blockers aren’t thought to be as helpful.  Most people find other classes of drugs more effective for addressing both the physical and mental symptoms of anxiety than beta blockers.
  • Off-label: This class of medications is not considered an approved treatment for anxiety. Therefore all cases of using these drugs to manage anxious symptoms is considered “off-label” and is not medically supported. Therefore if this class happens to work for you, it will likely be difficult to obtain a prescription.
  • Psychological symptoms: Beta blockers fail to adequately address the psychological symptoms associated with anxiety. Therefore one could argue that although the physical anxiety diminishes, a person may still have significant anxiety about other things in his/her environment.
  • Type-2 diabetes: These medications carry the risk of causing type-2 diabetes in certain individuals. In most cases, it is not worth the risk to take this drug and potentially become diabetic. There are other drugs on the market that will not cause diabetes and better manage anxiety.
  • Withdrawal: There can be severe withdrawal symptoms among those who have been on beta blockers for a significant duration. It is common to observe a spike in blood pressure as well as an increased heart rate. The withdrawal symptoms are caused by hypersensitivity of the beta receptors that were stimulated by the medication.

Should you use beta blockers for anxiety?

Prior to using any pharmaceutical treatments, you may want to explore various natural cures for anxiety such as exercise and psychotherapy. Additionally, you may also want to consider trying natural supplements like GABA to determine whether they provide any relief. Assuming you’ve tried natural treatments and haven’t gotten relief, your next step should be to seek professional help.

It is preferred to seek the help of a licensed psychiatrist – treating mental illnesses like anxiety is their specialty. Usually treating anxiety is started with a medication such as an SSRI. If an SSRI fails to do the trick, a psychiatrist may use Clonidine or a Benzodiazepine. Usually something like a beta-blocker would be used as a third or fourth line treatment option, but may be used more frequently by certain psychiatrists.

Beta blockers are usually considered relatively low by doctors on the hierarchy of treatments for anxiety, but should arguably be prescribed ahead of benzodiazepines as they are not habit forming nor are they associated with dementia. In cases of anxiety with comorbid hypertension or heart problems, using a beta blocker for anxiety may prove to be the perfect option. With that said, usually several other classes of medications will be tried before beta blockers.

Understand that not everyone will want to try a beta blocker to treat anxiety and not everyone will respond well to them. In cases of social anxiety, a beta blocker like propranolol may eliminate physical symptoms and blushing, but may not help at all with the psychological symptoms. Have you tried a beta blocker to help your anxiety? If so, feel free to share your experience in the comments section below.

References:

  • http://www.ncbi.nlm.nih.gov/pubmed/1348368

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  • Cathy November 10, 2015, 9:10 pm

    I have always suffered from anxiety and social phobia. It wasn’t noticeable by most people because I kept my feelings stuffer. Tranquilizers helped but I was afraid I’d become addicted. SSRIs did not. I discovered beta blockers after I suffered a heart attack. I never had high blood pressure but apparently beta blockers are part of the cardiac cocktail that one takes after a heart attack.

    I was placed on the lowest dosage of Toprol because a higher dosage dropped my heart rate too low. About 2 weeks after taking Toprol, I noticed that something was different about me. I totally lost my social phobia. Public speaking was not longer a problem for me. I began to enjoy speaking with others. It has been 9 years and all I need is the one 25 milligram pill a day. Toprol changed my life.

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