An unlikely byproduct of the Oscars red-carpet coverage last Sunday? The mention of beta blockers by actor Rachel Sennott, who told a host that her pre-event routine is to “take that beta blocker, girl.” And she isn’t the only one. During the last few months, it seems talk of beta blockers being used to treat everyday anxiety is suddenly everywhere. It’s in my queued Giggly Squad podcast episodes and being popped by characters on my favorite HBO show (see Rob on Industry). Targeted ads for the pills are showing up on my Instagram promising to make me feel “confidently cool—no appointment or insurance needed!”
You might have had a vague awareness of people quietly using beta blockers for things like public speaking, but you may not have understood how they work. Beta blockers are a heart medication—their main function, in simple terms, is to slow down the heart rate and lower blood pressure while treating heart conditions. It seems there’s a growing realization that anxiety and panic attacks often present with the same physical symptoms. Meaning, rapid heart rate and shortness of breath can, in some cases, be eased by a beta blocker.
When I told friends I was writing a story on the medication’s recent rise, I was flooded with messages. My friend Emmie said they help soothe her “hangxiety” after a night of one too many martinis. My friend Rachel, who has bipolar disorder and hasn’t had good results with traditional anti-anxiety medications like selective serotonin reuptake inhibitors (SSRIs), told me that propranolol has been a “genius everyday solution” and helps her avoid getting to the point where she has to take a Xanax. My friend Travis sent me a five-paragraph essay about how beta blockers were the only thing that helped him get over his anxiety going into an interview for his dream job. “Of course I still needed to prepare and focus,” he said, “but the distraction of my body was gone and I was clear. My body doesn’t go into fight-or-flight mode.”
Not everyone had the same experience, however. When my cousin, Ariel (who is on an SSRI) was having panic attacks before having to present over Zoom, her doctor recommended trying beta blockers. “I found that because I am already so body aware, it was just really uncomfortable,” she says. “I could feel my entire body revving up for a panic attack but my heart was beating very slowly. It was like having a foreign heart in my chest.”
As a Zoloft devotee myself, I am acutely aware that anxiety has many faces and many deep roots for most of us—so I was particularly curious about how beta blockers fit into this framework.
What are beta blockers?
Beta blockers are a class of medication intended to treat a range of disorders involving the heart and the circulatory system. “They can improve heart muscle function in patients who have had heart attacks, they can improve survival in patients with heart failure, and we use them to effectively control dangerous cardiac arrhythmias such as atrial fibrillation [Afib] or ventricular tachycardia, and can even lower blood pressure,” explains Ali Haider, MD, a board-certified interventional cardiologist at New York-Presbyterian Medical Group Queens and an assistant professor of medicine. They’re also often used to treat people with essential tremor, and certain medications can treat migraines and glaucoma.
There are two categories of beta blockers: selective, which affect your heart rate; and nonselective, which affect blood vessels throughout the body. When it comes to treating anxiety, you’ll likely be prescribed a non-selective beta blocker like propranolol.
How do beta blockers work?
Jayne Morgan, MD, a cardiologist specializing in women’s health and cardiovascular research, and vice president of medical affairs at Hello Heart, an app for monitoring cardiovascular health, explains that beta blockers work by blocking the effects of adrenaline (also called epinephrine) on the body—specifically on the beta receptors. “There are beta 1 receptors on the heart and beta 2 receptors on the lungs,” she says. “When it comes to the receptors on the heart, when beta blockers bind to these receptors, they’re blocking the effects of the adrenaline, slowing the heart rate. It decreases the strength of the contractions of the heart. In doing so, it lowers your blood pressure because it reduces the oxygen demand of the heart.”
Epinephrine is the hormone that’s responsible for triggering that fight-or-flight feeling in the body, which can often manifest as the heart beating faster, sweating, and shaking. Beta blockers can help lessen those effects.
Can beta blockers be used for anxiety?
The FDA has only approved beta blockers for the treatment of heart-related conditions, so using them for anxiety is considered off-label. Before we dive in, I just want to make it clear that the research on beta blockers for anxiety is a bit all over the place. There have been a few studies where the sample sizes were small, and the evidence of beta blocker’s effectiveness or noneffectiveness either way isn’t robust.
That said, many psychiatrists prescribe it to their patients for situational performance-anxiety issues (think public speaking, presentations, job interviews, etc.). The main thing to be aware of is that beta blockers do not treat the psychological symptoms or underlying causes of anxiety. They can help manage the physical symptoms like heart palpitations, which may then be effective in getting an anxiety attack under control.
“Many people who have generalized anxiety disorder describe not just the psychological dread, but also a physiological or bodily dread,” says Judith Joseph, MD, MBA, a board-certified psychiatrist, researcher, and author. “The reason that happens is because the mind-body connection is real.” Beta blockers can dampen the response your body is having when presented with an anxiety-inducing situation. “It can become this vicious loop where feeling physiologically anxious then triggers you to have more psychological dread, and then you’re in a full-on state of panic,” she says.
Beta blockers can be an attractive alternative to SSRIs or benzodiazepines like Xanax for a couple of reasons. For one thing, they’re not addictive or considered a controlled substance in the way that Xanax is, and they’re fast-acting—within 30 minutes or so—whereas SSRIs can take anywhere from a week to a month to kick in. Dr. Joseph makes an interesting point that it’s great for people who like to drink alcohol. “I don’t have to worry about putting them on a benzo like Xanax or Klonopin, which can be sedating [and dangerous] when taken with alcohol,” she says. “A lot of people with performance anxiety or social anxiety tend to self-medicate with alcohol, so it’s a way to keep them from having a full-on pass-out.”
This is definitely not to say that beta blockers are a substitute for SSRIs or benzos (or therapy, for that matter). “With beta blockers, you’re trying to aid and support a person with something situational,” says Dr. Joseph. “If you’re anxious all the time or have generalized anxiety, beta blockers don’t support that.” However, beta blockers can be taken in conjunction with other antianxiety medications. In that case, Dr. Joseph says, “You’re trying to support the mind connection with the serotonin (SSRI) and the body connection with the beta blocker. So you’re getting dual support, but you can’t swap one out for the other.”
What are the risks of using beta blockers for anxiety?
It’s important to remember that the main function of beta blockers is to slow down your heart rate and decrease your blood pressure, which can be dangerous in some cases. All the doctors I spoke with emphasize the importance of using beta blockers only under your doctor’s supervision—it’s not a good idea to share your prescription beta blocker with your friend who hasn’t been evaluated by a medical professional. “Make sure you are being very transparent with your physician about your medical history,” says Dr. Morgan. “Medication isn’t innocuous.”
According to Dr. Morgan, beta blockers can mask the symptoms of hypoglycemia—meaning your blood sugar has dropped too low—so it can cause a problem for people with diabetes. She also notes that your blood pressure could bottom out and get too low, causing you to get dizzy and lightheaded or even pass out. It’s also important to consider the interaction a beta blocker may have with another drug you’re taking; for example, if you’re taking beta blockers for anxiety alongside another blood pressure medication, your heart rate could get dangerously low. Other side effects can include erectile dysfunction, worsening symptoms in people with asthma, cold hands or feet, insomnia, and nightmares.
While none of the doctors have specific problems with people taking beta blockers for anxiety when under a doctor’s supervision, each says it wouldn’t be their first line of defense against anxiety. “I think sometimes people are looking for quick fixes,” says Dr. Morgan. “That would not be my first choice for managing [anxiety]. That’s not really a long-term strategy in my book.” Dr. Haider echoes the sentiment about beta blockers as a long-term solution. “We’re not targeting the brain, which is where the anxiety is coming from,” he says. “We are just blunting some of the symptoms of the anxiety.”
Likewise, Dr. Joseph says that before one reaches for a beta blocker, there are many other ways to regulate the parasympathetic and sympathetic system (the flight-or-flight response). She emphasizes the importance of using breath to manage that panic response. “Breathing is the only physiological function that we can control, and that’s not by mistake,” Dr. Joseph says. “We can’t tell our heart to stop beating, we can’t tell our liver to stop processing or our brain to stop thinking, but we can tell our lungs to stop breathing. The reason that we have that function is for survival. Our bodies have the potential to calm ourselves naturally by using breathing.”
After digging in and talking to these doctors, it seems to me that the consensus is that beta blockers can be a really effective tool to manage situational anxiety. But (and this is a big but), if you don’t deal with the underlying cause of your anxiety, just tamping down the physical symptoms isn’t likely to be great for your mental health in the long run. I’d like to formally disagree with Miss Sennott: Numb is very much not in.
Aviel Kanter is a Los Angeles–based writer and editor. Follow her on Instagram @avielpk.
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