How Do Beta-Blockers Work For Anxiety, And What Else You Should Know

If you experience symptoms of anxiety, your doctor may suggest beta-blockers to alleviate them. Understanding how this medication works and what it can do for you is important for being a good self-advocate.

What are beta-blockers?

Beta-blockers were not created to treat anxiety. Instead, they were developed to treat high blood pressure and heart problems. They slow the heart rate and thus improve circulation.

Beta-blockers also work by stopping the effects of adrenaline, a stress hormone, from getting to the beta receptors in your heart. When adrenaline contacts these receptors, it prepares your heart to run or fight by increasing heart rate.

How do beta-blockers help with anxiety?

Beta-blockers treat the physical symptoms of anxiety, specifically acute symptoms. These might include:

• Increased heart rate

• Shaky voice and/or hands

• Sweating

• Dizziness

Treating these physical symptoms can make you feel less anxious by breaking the cycle of your mind reacting to your body and your body then reacting to your thoughts. However, they do not address the root causes of anxiety.

Beta-blockers are prescribed off label because there is no technical approval. However, they have been demonstrated to be safe and effective over time.

When would you take beta-blockers?

The primary use of beta-blockers is to control the physical symptoms of acute anxiety. Beta-blockers are not a long-term medication for anxiety.

Your doctor will likely prescribe beta-blockers for use before an activity that may trigger your anxiety, such as speaking in public or visiting the dentist. Over time, with a combination of therapy and medication, most people become less anxious about their triggers and may be able to stop taking beta-blockers.

Some people who don't have chronic anxiety may also take beta-blockers to help fight specific situational anxiety or phobias. For example, if you are afraid of flying, you might take one before a flight.

Beta-blockers take an hour or two to reach full effect, so you should time your dose accordingly, although many people notice relief after 30 minutes or so. The effect is fairly short-lived, lasting only a few hours.

Some people might be put on a daily dose of beta-blockers to help deal with recurring or chronic symptoms. This is generally in conjunction with lifestyle changes and counseling.

What are the side effects of beta-blockers?

Beta-blockers can have a number of side effects, some of which require medical attention. Talk to your doctor right away if you experience:

• Allergic reaction

• Breathing problems

• Cold hands and feet (this may indicate that the drug is reducing your blood pressure too far)

• Sleep issues

• Dry skin

• Muscle cramps or weakness

• Hallucinations

• Slow heart rate

• Swelling of legs and ankles

• Vomiting

These side effects may indicate that beta-blockers are not suitable or that you should try a different type. In some cases, however, symptoms will dissipate after you have taken a few doses of the medication. Minor side effects include:

• Change in libido or sexual performance

• Diarrhea

• Dry eyes

• Hair loss

• Nausea

• Weakness

• Fatigue

• Blurred vision

Talk to your doctor about these symptoms if they become bothersome or continue to worsen. Also, some people find their first dose makes them dizzy; because of this, some doctors will suggest taking the first daily dose or a test dose close to bedtime.

Finally, some people may find beta-blockers make their anxiety worse. If this is the case, talk to your doctor. Furthermore, do not drive if your side effects include fatigue, dizziness, or blurred vision.

Who should not take beta-blockers?

Beta-blockers are suitable for adults and children. However, they are not recommended for some groups of people. These include:

• People who are on other medications that lower high blood pressure, as this can result in blood pressure being lowered too much.

• People who are on other medications for an irregular heartbeat.

• People who have naturally low blood pressure (again, it can end up lowering too much).

• People with asthma. The medication can block beta receptors in the lungs, worsening symptoms and interfering with the action of asthma medication. Cardioselective beta-blockers¹ can sometimes be used.

• Many people with diabetes. Beta-blockers can also block the warning signs of low blood sugar, resulting in a potential collapse.

• People who have a very slow heart rate naturally, as the medication can slow it further and cause circulation problems.

Beta-blockers are prescription-only, and your doctor and pharmacist should ensure that you are not taking them with incompatible medications.

What are the common beta-blockers?

Several different beta-blockers are commonly used. Your doctor may start you with one off-label but can switch you to another if the first is not effective or gives you troubling side effects.

The most common beta-blockers are:

Propranolol

Propranolol is also used to treat high blood pressure, irregular heartbeat, angina, overactive thyroid, and migraine. It works by slowing your heart rate, which means it can sometimes cause cold hands and feet, as well as difficulties with sleep. It comes in standard release and sustained release formats; the standard release is more suited to acute situations.

Atenolol

Atenolol is used for similar treatments to propranolol. It is more commonly prescribed, but there are indications propranolol might be more useful. Both medications are available in tablets, capsules, or liquid (which may be more palatable, especially for children).

These are the two most common beta-blockers prescribed for anxiety. Other common beta-blockers that your doctor might suggest are acebutolol, bisoprolol, carvedilol, and metoprolol. Typically, however, doctors prescribe these only if neither propranolol nor atenolol is suitable. It's important to know, though, that if beta-blockers cause side effects, you likely have other options.

The lowdown

Beta-blockers are typically used to provide short-term relief of physical symptoms caused by anxiety. Most people who take beta-blockers for anxiety take the medication as needed before an anxiety-inducing event, such as a plane flight, public speaking engagement, or medical procedure. Some people with acute forms of anxiety may take daily beta-blockers.

They do not treat the underlying cause of anxiety and are often used as part of an overall treatment plan that also includes lifestyle changes and counseling. However, they can help many people function and deal with situations they might otherwise have avoided.