Do Beta-Blockers Work for Anxiety — and Are They Safe?

Medications known as beta-blockers are the “chill pill” of the moment, an increasingly popular go-to for people hoping to stave off physical symptoms of anxiety — a racing heart, sweaty palms, trembling — before a stressful event like a speech, audition, big meeting, wedding, or even a first date.

But while beta-blockers are well-studied and considered generally safe, experts have concerns about risks related to side effects or interactions with other drugs. They definitely don’t want people borrowing pills from friends or family or otherwise using beta-blockers without medical oversight.

Beta-blockers have different roles depending on what they are being prescribed for, says Tanuka Datta Piech, MD, a cardiologist at the University of Michigan Health Frankel Cardiovascular Center in Ann Arbor.

They also help slow down certain types of cell activity, managing the surge of adrenaline that drives the nervous system’s fight-or-flight response to an imminent threat. Adrenaline goes directly to receptors located throughout the body, Dr. Piech explains, causing the heart to race, the sweat glands to produce perspiration, and the muscles to move quickly, “which at a standstill manifests as shaking.”

Beta-blockers preempts this reaction by directly binding to adrenaline receptors in different parts of your body, “preoccupying” them so adrenaline has nowhere to go. “If adrenaline can’t bind to the receptors, you no longer feel symptoms of performance anxiety,” says Piech.

Why Do Doctors Prescribe Beta-Blockers for Heart Disease Patients?

“From a cardiac perspective, beta-blockers make your heart more efficient by lowering how much oxygen your heart muscle needs to do its job,” says Piech.

That’s why physicians may prescribe beta-blockers to reduce stress on the heart after a heart attack, to treat heart failure or cardiomyopathy (a progressive disease of the heart muscle), or to slow fast abnormal heart rhythms such as supraventricular tachycardia, atrial fibrillation, or atrial flutter, she says.

Why Do People Use Beta-Blockers ‘Off-Label’ for Anxiety?

Though many people have found beta-blockers helpful for performance anxiety, this is considered an “off-label" use of the medication, which means that there isn’t enough data from clinical trials for the U.S. Food and Drug Administration (FDA) to approve it for that use, says Luke Misquitta, MD, a clinical assistant professor in the department of psychiatry at The Ohio State University Wexner Medical Center in Columbus.

“However, since beta-blockers are relatively safe medications for most people, and there are currently no FDA-approved medications for performance anxiety, beta-blockers are commonly prescribed to improve performance anxiety,” he says.

Beta-blockers may be useful before events where you know you’ll be anxious or nervous like public speaking, interviews, or exams because they work quickly — in as little as 30 to 60 minutes, says Dr. Misquitta.

“Other medications for anxiety, such as SSRIs, can require weeks to take effect,” he adds.

However, even though beta-blockers can temporarily calm physical symptoms of anxiety, they may be inadequate for people experiencing ongoing emotional or cognitive issues, which don’t always improve with beta-blockers, says Misquitta.

For people who experience intense anxiety about future public events, or who are overwhelmed by negative self-talk, self-doubt, or difficulty concentrating, “Psychotherapy can be useful when those symptoms continue,” Misquitta says.

Beta-blockers are not safe for everyone, and the risk depends on the specific medication as well as your unique health history and other medications you may be taking.

Any of the following side effects requires medical attention, according to Geoffrey McLeod, DO, an associate professor in the department of family medicine at the Medical University of South Carolina in Charleston:

• Dizziness, lightheadedness, or feeling like you may lose consciousness could indicate a significant reduction in heart rate (bradycardia) or low blood pressure (hypotension).
• New or worsening shortness of breath, swelling of the legs, or sudden weight gain may indicate significant retention of fluid or worsening of heart failure.
• Wheezing or difficulty breathing may be caused by bronchospasm (a sudden tightening of the muscles lining the airways in the lungs) in people with asthma or bronchospastic lung disease.
• Heart rate consistently below 50 beats per minute is one of the most common serious adverse side effects of beta-blockers. This is most likely to occur within the first two months of treatment.
• Severe fatigue, confusion, or depression could reveal the medication’s effects on the central nervous system; mental depression, hallucinations, as well as disorientation have been reported.
• Signs of poor circulation may include cold, painful, or abnormally colored fingers or toes, indicating poor blood flow to the extremities.

People with difficult-to-control diabetes or frequent low blood sugar should be cautious about using beta-blockers because they can mask symptoms of hypoglycemia (low blood sugar), which can be dangerous if you can’t tell when you need to eat something, says Piech.

Allergic reactions, such as hives or swelling of the lips, tongue, or throat, or wheezing are serious side effects that should prompt people to stop the medication and seek medical care right away, she says.

Piech cautions against taking a beta-blocker that was prescribed for someone else.

“You need to be evaluated first. Everyone’s body is different, everyone metabolizes medications differently, and everyone has a different sensitivity to the effect of drugs,” she says.

Beta-blockers can interact with other medications, so a medication review should happen before starting one, she adds. And if you take a beta-blocker regularly, don’t stop suddenly unless your healthcare provider tells you to.

Beta-blockers may make sense if your anxiety is mostly physical, predictable, and tied to specific events. They may not be the right match if anxiety shows up as constant worry, dread, panic, avoidance, or negative self-talk, Misquitta says.

“Beta-blockers are not recommended for other anxiety disorders, such as generalized anxiety disorder (GAD), due to a lack of evidence — SSRIs and psychotherapy are considered first-line treatments,” he says.

To help your doctor understand your medication needs, track when anxiety happens, what triggers it, which physical symptoms you notice, how long symptoms last, and whether anxiety is affecting your daily life, Misquitta says.

If you’re curious about using a beta-blocker for anxiety, bring these questions to your next appointment:

• Is a beta-blocker appropriate for my specific type of anxiety?
• How should I time this medication before a stressful event?
• Will this drug interact with my other prescriptions, over-the-counter medications, or supplements?
• What alternative therapies, like cognitive behavioral therapy, should I combine with this treatment?