Beta-blockers

Beta-blockers are a group of medications that have several physical and mental health uses. Although they are considered a heart medication, beta-blockers can also help reduce anxiety symptoms. Several alternative anxiety treatments are available, including other medications, therapy, and self-help techniques.

What are beta-blockers?

Beta-blockers are a group of medications often used to treat heart conditions and neurological conditions. They are also sometimes prescribed to treat mental health conditions, such as anxiety disorders, although the FDA has not approved them for this purpose ^[1].

Beta-blockers reduce heart rate and blood pressure, so they are effective at managing various cardiac conditions. These effects also help reduce the physical symptoms of anxiety, which is why they are commonly prescribed to treat anxiety disorders such as panic disorder and performance anxiety ^[2].

What are beta-blockers used to treat?

There are several beta-blockers available, which have various uses and indications. Many beta-blockers are FDA-approved to use in treating a range of heart conditions, including ^[1][3]:

• Hypertension (high blood pressure)
• Myocardial infarction (heart attack)
• Cardiac arrhythmias (irregular heartbeat)
• Coronary artery disease

Additionally, some beta-blockers are FDA-approved to treat migraines, glaucoma, and neurological conditions such as restless leg syndrome and essential tremor ^[1][4].

Off-label uses

Beta-blockers are often used off-label, for conditions not approved by the FDA. Some beta-blockers are prescribed off-label for anxiety disorders, such as ^[5]:

• Social phobia, specifically relating to performance anxiety or stage fright
• Panic disorder, to treat panic attack symptoms

Beta-blockers have been found to be somewhat effective at managing symptoms of other conditions, although research results have been conflicting, so they are less commonly prescribed for these uses. This includes ^[6][7]:

• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Specific phobias

Beta-blockers are not FDA-approved for treating mental health conditions but are commonly used for these purposes as they can help manage the physical symptoms of anxiety. The FDA has not approved these uses as there is insufficient conclusive evidence for their safety and effectiveness in these treatments ^[2][5].

Despite not being FDA-approved, beta-blockers tend to work quicker than SSRIs, so they can be a more effective treatment for acute anxiety symptoms. Similarly, while benzodiazepines and beta-blockers are both effective for acute anxiety and panic symptoms, beta-blockers may carry less risk of side effects and potential for abuse ^[2][6].

As such, beta-blockers are regularly prescribed for anxiety symptoms and generally are considered safe for short-term use, although side effects can occur. Appropriate medication will vary depending on the individual, their condition and symptom severity, and their medication response ^[1][5].   

How do beta-blockers work?

Beta-blockers are also referred to as beta-adrenergic blocking agents. They impact the activation of the beta receptors around the body. There are three beta-receptors, beta-1, beta-2, and beta-3, although beta-3 is not targeted by these medications ^[1].

Some beta-blockers are beta-1 selective and mainly impact the heart, while others are non-selective, so they impact various bodily functions and the sympathetic nervous system ^[1][8].

Beta receptors are activated by epinephrine (adrenaline) and norepinephrine (noradrenaline), which are released during the stress response. When they are activated, it results in an increase in heart rate and blood pressure, along with other symptoms around the body ^[4].

Beta-blockers bind to these receptors, preventing them from activating, thus reducing the effect of epinephrine and norepinephrine in the body. This produces an effect on cardiac functions, such as reducing heart rate, blood pressure, and oxygen requirements of the heart ^[9].

As such, they can be effective at managing physical symptoms experienced during panic attacks and acute anxiety, such as a racing heart, sweating, shaking, hyperventilation, and muscle tension. By reducing the physical symptoms of anxiety, beta-blockers can help to improve daily, professional, and social functioning ^[5][6].

This contributes to their use in performance anxiety. For example, people might use beta-blockers if they experience debilitating physical effects of anxiety that prevent them from performing their professional roles. This could include performers such as musicians and people in high-stress jobs such as surgeons ^[5][7].

However, although beta-blockers can improve acute symptoms and professional functioning, they are ineffective at managing ongoing anxiety symptoms and the emotional causes of anxiety disorders ^[7].

Recent research suggests that beta-blockers may be able to alter how memories relating to fear and trauma are stored in the brain. This indicates a potentially effective use of beta-blockers in the treatment of trauma-related disorders such as PTSD, as they may be able to prevent or reduce the long-term psychological effects of trauma. This research is ongoing and requires further investigation ^[10].

Types of beta-blockers

Many beta-blockers are available in the US. Some of these medications are prescribed for specific uses only, while others may be prescribed for several uses. Different types of beta-blockers include ^[3][7][11]:

• Propranolol: Propranolol is a regularly prescribed beta-blocker for anxiety symptoms. It is available in various forms, including an immediate-release tablet, an extended-release capsule, and an oral liquid. Brand names for propranolol include Inderal, Inderal LA, and InnoPran XL.
• Atenolol: Atenolol is also sometimes prescribed for anxiety disorders as well as physical health conditions such as hypertension. Brand names for atenolol include Tenormin.
• Metoprolol: Metoprolol is occasionally prescribed to treat anxiety symptoms. It is available in various forms, including an immediate-release tablet, an extended-release tablet, and an extended-release capsule. Brand names for metoprolol include Toprol XL, Lopressor, and Kapspargo Sprinkle.

Several other beta-blockers are available that are less commonly prescribed for anxiety but regularly used for physical health conditions, including ^[3]:

• Acebutolol:There is no brand version of this medication.
• Carvedilol:Brand names include Coreg.
• Labetalol:Brand names include Trandate.
• Nadolol:Brand names include Corgard.
• Timolol:There is no brand version of this medication.

Side effects of beta-blockers

When starting a new medication, it is common to experience some side effects. These will likely alleviate as your body gets used to the medication, but you should inform your doctor or healthcare provider if you experience any persistent or concerning effects.

Common short-term side effects of beta-blockers include ^[1][12]:

• Feeling dizzy and lightheaded
• Tiredness
• Insomnia
• Nightmares
• Nausea
• Diarrhea
• Constipation
• Stomach pain
• Cold hands and feet
• Sexual dysfunction

Sometimes, serious side effects of beta-blockers can occur. If you experience any of the following, contact your doctor immediately ^[3][12]:

• Shortness of breath
• Tightness or pain in the chest
• Coughing or wheezing
• Irregular heartbeat
• Swollenankles or legs
• Yellowing of the skin or whites of the eyes

Abruptly stopping beta-blocker medication after prolonged use can result in withdrawal symptoms. This can include ^[13][14]:

• Shaking
• Increased blood pressure
• Increased heart rate
• Heartpalpitations
• Fatigue
• Headaches
• Sweating

Individuals who have used beta-blockers regularly for an extended time will likely be prescribed a gradually reducing dosage when treatment is no longer needed, which will help prevent withdrawal symptoms.

Cautions and interactions

Health conditions

Before starting treatment with a beta-blocker, you should inform your doctor of any past or present medical conditions you have experienced.

People with liver or kidney conditions may not be able to take this medication or may require a reduced dose to prevent adverse effects. Due to the potential for serious side effects, beta-blockers may be unsafe for individuals with a low heart rate or blood pressure or those with lung or breathing problems, such as asthma or COPD ^[12].

The effects of beta-blockers can be similar to the indications of hypoglycemia, so it may be unsafe for individuals with diabetes to take this medication ^[13].

Pregnancy and breastfeeding

Before commencing beta-blocker treatment, inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding. This medication may cause harm to the fetus and could be excreted in breast milk, which could affect a breastfeeding infant.

It is important to be aware of the potential risks to your baby so that you can make an informed decision about your treatment and discuss alternatives with your doctor if required. If beta-blockers are used during breastfeeding, it may be necessary to closely monitor your baby for any unusual changes in their physical or mental state ^[13][15].

Drug interactions

Some medications can interact with beta-blockers, which can reduce the benefits of your medications or increase the risk of severe side effects.

This includes medications for high blood pressure, arrhythmias, lung and breathing conditions, migraines, Parkinson’s disease, and allergies, as well as cold and flu, anti-inflammatory, anti-anxiety, and antidepressant medications, and blood thinners ^[12].

Inform your doctor of your medications before starting a new treatment.

Additionally, alcohol and illicit drug use while taking beta-blockers can increase the risk of severe and potentially fatal effects, so this should be avoided ^[13][15].

Alternative treatment

There are other medications and treatments that have been FDA-approved to treat anxiety disorders, PTSD, and other mental health conditions. For example, alternative medications for anxiety include ^[2][16]:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), including sertraline and citalopram
• Antihistamines, such as hydroxyzine
• Benzodiazepines, such as lorazepam and diazepam

Anxiety symptoms can also be treated and managed with therapy, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) ^[16].

Additionally, self-care techniques can help in managing these symptoms, such as ^[16]:

• Improving physical health with a healthy diet, exercise, and sleep routine
• Talking to friends and family
• Utilizing relaxation exercises
• Mindfulness, meditation, and yoga
• Avoiding alcohol and caffeine