Beta-blockers are a class of drugs used to treat heart-related conditions such as hypertension and heart failure.
Beta-blockers have anxiolytic effects and have been prescribed off-label to treat anxiety-related conditions.
Beta-blockers may be a good option for short-term use in treating anxiety, and can be used to ease its physical symptoms.
Beta-blockers are a class of drugs used chiefly to treat cardiovascular diseases. These drugs work by blocking beta receptors that exist in three forms: beta-1, beta-2, and beta-3.
The FDA has approved beta-blockers for the treatment of hypertension, tachycardia, myocardial infarction, coronary artery disease, aortic dissection, congestive heart failure, cardiac arrhythmias, and portal hypertension.
While beta-blockers are not approved for treatment of anxiety-related disorders, they can be helpful as anxiolytics and have been prescribed off-label for this purpose.
More about beta-blockers
Epinephrine (also known as adrenaline) and norepinephrine are catecholamines that bind to B1 receptors leading to an increase in cardiac automaticity and conduction velocity.
The B1 receptors aso increase blood pressure by inducing renin release. On the other hand, binding to B2 receptors induces smooth muscle relaxation in addition to increasing metabolic effects.
Beta-blockers, also known as beta-adrenergic blocking agents, prevent adrenaline from binding to the heart’s beta receptors. Once beta-blockers bind to B1 and B2 receptors, they have an inhibitory effect on the heart, slowing down heart rate and decreasing blood pressure.
Beta-blockers reduce angina by decreasing the body’s oxygen demand. These drugs also have a strong antiarrhythmic effect and increase the atrial refractory period.
While there are a myriad of beta-blockers available on the market, commonly prescribed ones include:
Atenolol and propranolol are most commonly prescribed to treat anxiety-related disorders.
Beta-blockers and anxiety
Shortly after propranolol was discovered in the early 1960s, its anxiolytic effects were recognized, prompting increasing interest in its off-label use. There have been numerous studies exploring its use to treat substance use and withdrawal, high trait anxiety, autism, aggression, and schizophrenia.
In addition, propranolol has been shown to help individuals suffering from exam nerves, stage fright, performance anxiety, or those who are anxious about undergoing surgery.
A 2016 systematic review and meta-analysis published in the Journal of Psychopharmacology explored the efficacy of oral propranolol compared with placebo or other medications as a treatment option for patients suffering from anxiety disorders.
The authors determined there was no statistically significant difference between propranolol and benzodiazepine in the short-term treatment of panic disorders, with or without agoraphobia.
While beta-blockers may not treat the psychological symptoms of anxiety, they may be a good option for short-term use.
"For many people, beta-blockers do a really good job of blocking the physical symptoms of anxiety like a racing heart, sweating, or tremors," said psychiatrist Sarah Gupta, MD, in an article published by VeryWell Mind. "And a lot of the time, just dialing down the physical symptoms can be enough to get anxiety under control."
Beta-blockers versus anxiety medications
Serotonin serotonin reuptake inhibitors (SSRIs) and benzodiazepines are two commonly prescribed medications for the treatment of anxiety disorders.
SSRIs typically require a long period of time—potentially up to 12 weeks—to take effect. Therefore, adjuvant treatment with propranolol may be considered early on.
Benzodiazepines, on the other hand, carry a risk of tolerance, cognitive impairment, dependence, and undesired sedative effects. Compared with benzodiazepines, SSRI side effects are often temporary, reversible, and relatively mild, although tend to occur more frequently.
Treatment with beta-blockers also comes with some risks such as reduced heart rate and low blood pressure. Furthermore, they have been shown to exacerbate asthma symptoms.
Other common side effects of beta blockers include cold extremities, weight gain, and fatigue. Less common side effects include insomnia, shortness of breath, and depression.
When determining which medication offers the most advantages for his patients, psychiatrist Alex Dimitriu, MD, said in the VeryWell Mind article, "I always ask my patients if they feel anxiety more in the mind—rumination, catastrophic thoughts, worry—or the body—racing heart, tight chest, shortness of breath, tremor.”
"More globally, it should be recognized that either beta-blockers or other medication such as Xanax or Klonopin are patches."
— Alex Dimitriu, MD
"If someone needs a patch too often, it might be better to take something that works all the time, usually SSRIs," Dimitriu concluded.
What this means for you
While beta-blockers are approved for the treatment of heart failure and other cardiovascular-related conditions, there has been a long-standing interest in using them for the treatment of anxiety. Clinicians can consider prescribing beta-blockers to ease the physical—but not psychological—symptoms of anxiety. Clinicians should also weigh the risks and benefits of prescribing a beta-blocker, SSRI, or benzodiazepine to patients suffering from anxiety-related conditions.