Beta Blockers To Treat Anxiety

Beta blockers (also known as beta-adrenergic blocking agents) are typically prescribed off label to help people manage the physical side effects that anxiety can bring. Sometimes, they are used to treat anxiety symptoms alone, but much more frequently, they are used in combination with other treatments.

Before talking to your doctor about beta blockers, it is important to understand all you can about these special medications. While beta-blockers do not alleviate the psychological symptoms, they can help you cope with your anxiety so that it doesn't stop you from functioning.

There are many different types of anxiety, and beta blockers are not appropriate for all of them. However, even with generalized anxiety disorder, or GAD, it is possible to use beta blockers in combination with other medications and treatments to manage physical symptoms.

Understanding what type of anxiety you are experiencing, how beta blockers work, and what options you have can help you be prepared for well-informed conversations with your doctor. Arming yourself with information may be the first logical step in addressing the treatment of your anxiety.

Types of anxiety

Social anxiety is another type that doctors sometimes prescribe beta blockers for. Many people do not have anxiety at any time other than when they are faced with certain social situations. Beta blockers are a good treatment option when it is situational.

There are also additional anxiety disorders. The most common are panic disorder and general anxiety disorder (GAD). Panic disorder is not effectively treated by beta blockers because the anxiety comes on so quickly and unexpectedly that there is no time for them to work. Some patients might benefit from beta blockers for GAD, but frequently they are paired with other types of treatment.

Physical symptoms

It is important to understand that beta-blockers do not treat the emotional effects of anxiety. If you take beta-blockers, you may still feel apprehensive, worry excessively, or feel fearful, for example. They only treat the physical symptoms.

There are many different physical symptoms that may present themselves, such as a racing heart, shortness of breath, dizziness, nausea, numbness, tingling in the hands and feet, trembling or shaking, and, in some severe cases, even diarrhea or frequent urination. These physical symptoms are the result of increases in adrenaline and noradrenaline. This is what beta blockers prevent.

How do beta blockers work?

Beta-blockers work by blocking the release of adrenaline (epinephrine) and noradrenaline. These drugs block epinephrine and cause your heart to pump blood with less force through your blood vessels (which is why they are often used for high blood pressure), which can reduce the physical symptoms. In other words, they slow things down and may give you a general sense of well-being.

They do not work right away. Beta-blockers are usually in pill form and can take one to two hours before you start feeling the physical effects. Sometimes, they are taken on a schedule to consistently prevent adrenaline production, maintain a low heart rate, and keep that calm physical feeling, while other times, they are taken shortly before a provoking situation.

Evidence supporting beta blockers

There have been a lot of studies conducted as to the effectiveness of beta-blockers to treat anxiety symptoms. Studies (such as this meta-analysis) have found that beta-blockers are effective in the treatment of anxiety when compared to placebo and anti-anxiety medications. The studies found that they are most helpful when physical symptoms predominate.

Other studies (including this systematic review) have sought to understand what types of anxiety and situations for which beta-blockers are most effective. They have found that they are most effective for anxiety characterized by moderate physical symptoms and anxiety that has had a recent onset and is not characterized by a recognized anxiety disorder.

Potential side effects

One of the biggest advantages of beta-blockers is that they do not have as many side effects, and they are not addictive. While the potential side effects are much less severe than the side effects of most anti-anxiety medications, there are still some side effects about which to be aware of. 

Some of the common side effects of beta-blockers are:

• Fatigue
• Cold hands or feet
• Headache
• Dizziness or lightheadedness
• Shortness of breath
• Vomiting, diarrhea, stomach pain, or constipation

These side effects could be mild, or you may not have them at all. However, these mild side effects are not cause for concern, and you do not need to worry or stop taking the medication if you have them. However, there are a few rare side effects that could be more problematic.

If you have any of these side effects, you should contact a doctor immediately.

• Very slow or irregular heart rhythms
• Chest pain
• Low blood sugar
• Swelling or fluid retention

Also, some people with asthma may experience more frequent asthma attacks when on beta blockers. If you have asthma, you should be aware of this and report to your doctor immediately if it happens.

Another thing that you need to be aware of is that beta blockers have been known to cause depression in people who have a predisposition to it. If you have both depression and anxiety, beta-blockers may not be right for you. If you have a history of depression, it is important to discuss this with your doctor before deciding to take them.

Also, anyone who already has low blood sugar levels or low blood pressure should probably avoid taking beta blockers. If you have one of these conditions, then talk to your doctor about other drugs that can help with the physical and psychological aspects. You should also discuss your medical history with them in case other medications cause side effects or an allergic reaction. Everybody responds differently, so a thorough discussion with a doctor with relevant experience is essential before deciding on a treatment for your symptoms. If a medicine affects you negatively, you can mention it immediately to your doctor, and they may prescribe something different. 

Who should avoid them?

Some people should not take beta blockers for treating anxiety. If you have a history of depression or asthma, it is important for you to discuss this with your doctor before taking them. You should also make your doctor aware if you have low blood sugar or a slow heartbeat. Beta-blockers used for symptom treatment can make these conditions worse and may be dangerous. A doctor may monitor your condition to make sure that you don’t have dangerously low blood pressure. 

List of common types

There are many beta-blockers available, but only a few are regularly prescribed for anxiety. Not all have been tested or have shown promise in the treatment of anxiety. The most common are:

• Propranolol
• Sotalol
• Oxprenolol
• Atenolol

All of these come in a generic form, which can save you money at the pharmacy. Only a healthcare provider can prescribe propranolol and other beta blockers. Stopping propranolol suddenly may lead to serious side effects. Also, if you’re breastfeeding, propranolol may not be the best option. It’s recommended that you speak with a doctor if you breastfeed. Also, drinking alcohol while taking propranolol may lead to even lower blood pressure, so it’s recommended that you not drink alcohol while taking propranolol. If you are afraid to stop drinking alcohol abruptly, a healthcare provider may be able to prescribe medication to help you safely stop.*

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Getting help with anxiety disorders

If you have anxiety that is severe or situational and you need help addressing your symptoms, it may be beneficial to contact a therapist. The sooner you get help, the better you will feel. There are a lot of treatments available, including cognitive behavioral therapy, which is often used in conjunction with other treatments. A therapist provides an invaluable service and can help you examine your feelings and determine the best course of action. They can refer you to a doctor if they feel that either beta blockers or another medication may help you in the treatment of your anxiety.

Having anxiety can make seeking professional help difficult, though. Symptoms like fatigue and social withdrawal may cause you to avoid going out in public, even for therapy appointments. If this sounds familiar, then you may find online therapy more feasible. This type of internet-based treatment for anxiety can be reached from the comfort of your home. And you can make appointments at a time that’s convenient for you. 

Researchers have found that online therapy is associated with positive outcomes for individuals with anxiety. In a recent study, college students experiencing symptoms of anxiety were separated into two groups: one received traditional therapy and one underwent an online intervention. Both experienced positive outcomes, and there were no significant differences in results.