Beta blockers like propranolol can swiftly reduce anxiety symptoms, as experienced by Lauren Sawyer, who felt the calming effects within 30 minutes of taking a pill.
Experts warn the tablets that slow your heart rate are a double-edged sword.
Lauren Sawyer was on a train heading into London for work when she had a sudden and overwhelming sense of fear and anxiety. Arriving at Liverpool Street Station she sought medical help from staff at the platform, who advised her to go home and see her GP.
The 29-year-old PR manager had suffered her first panic attack. It wasn’t due to anything extraordinary that was happening in her life, but stemmed from “putting pressure on myself to always be on it”. The effort to always be one step ahead and in control had taken its toll.
“The minute I didn’t feel like I was on top of things, I got easily overwhelmed,” she admits.
To treat her overwhelming anxiety, her GP gave her a prescription for propranolol, a beta blocker. Four months later she is taking a pill every day.
“It’s very fast-acting, as soon as I take it, within 30 minutes I begin to feel the full effect. I’ve even noticed on my Fitbit that since taking it my resting heart rate has decreased noticeably, which does make me feel calmer and more level-headed.”
Popping a beta blocker has become the norm for office workers under pressure, stressed students and Oscar winners alike. In a new book, 50 Oscar Nights by Dave Karger, the actress Olivia Colman revealed she was so nervous the night she won an Oscar in 2019 for her role as Queen Anne in The Favourite, she took a beta blocker to “calm down”. So much for the old trick of imagining the audience naked.
Beta blockers, or beta-adrenergic blocking agents, are a class of medications primarily designed to manage abnormal heart rhythms, protect the heart from a second heart attack, and treat hypertension. They work by blocking the effects of adrenaline on your body’s beta receptors, which helps reduce heart rate, lower blood pressure and diminish the force of heart muscle contractions.
Licensed to be prescribed as a blood pressure medication or to support irregular heartbeats, beta blockers act on the beta adrenergic system, thus blocking the release of adrenalin and noradrenalin so are very effective at reducing the symptoms of anxiety, explains Dr Sabine Donnai, the co-founder of Viavi, a clinic that specialises in health and longevity assessments. “The effect of the beta blocker results in slowing the heart rate and reduces the ‘fight and flight’ response.”
Although beta blockers are not indicated as a prescription for anxiety, the “off-label” use for this purpose is increasing as levels of anxiety, especially among young adults, has increased over the past decade. “Better detection of the symptoms, better acceptance of the diagnosis and acceptability of medication as a support, together with an increase of social pressures and society and social media expectations have led to an increase of prescriptions issued,” says Dr Donnai.
In 2022, researchers from the University of Bristol found there have been increases in incident prescribing of most anti-anxiety medications (called anxiolytics) in recent years, which have been substantial in young adults (aged under 25).
With the social media pressure on young people, she adds: “They are often put in a situation where they feel the need to ‘perform’ outside their comfort zone and then experience anxiety.”
Stage fright, like Colman’s, and performance anxiety are the reasons Dr Donnai prescribes beta blockers. “To suppress the unpleasant symptoms in situational anxiety such as in public speaking events,” she explains. “In those circumstances, you would take a beta blocker about 30 minutes prior to the event.” However, beta blockers are not her drug of choice for people with chronic anxiety disorders “as they do not tackle the emotional or chemical drivers for the anxiety”.
In the short time Sawyer has been taking them every day, she admits to feeling a lot calmer: “My heart doesn’t feel like it’s beating out of my chest and since being on it I haven’t had another panic attack.”
Beta blockers can also help with migraines, which Sawyer has suffered from frequently since age 13. “That has been a really helpful side effect,” she adds.
Despite the benefits, Sawyer is concerned about becoming reliant on medication to control her anxiety. “I’m not afraid to admit that sometimes I need a little extra help to get back on track, so this is why I’m happy to take beta blockers for the short term, to get me over any hurdles in life and then hopefully rely on it less as time goes on.”
Masking the symptoms of anxiety is not the same as dealing with anxiety. And while they are helpful when someone has first been diagnosed and would like to calm their palpitations, Jaspreet Randhawa, a clinical prescribing pharmacist, says: “I would not view beta blockers as a standalone anxiety treatment, as they essentially mask symptoms of anxiety, in which there are signs of palpitations.”
Any other symptoms such as agitation, hyperventilation, excessive sweating and flashbacks are often not effectively treated by beta blockers: “And the emotional cause is not attended to at all when simply prescribing beta blockers for anxiety.”
Examples of beta blockers include: atenolol (Tenormin), propranolol (Inderal), bisoprolol (Emcor), metoprolol (Lopresor). The kind most commonly prescribed for anxiety is propranolol and while they are non-addictive and can be stopped relatively easily without any withdrawal symptoms, Randhawa says: “Many of my patients who start on beta blockers prescribed by their GP eventually have to increase their dose, or add in other medicines such as antidepressants or hypnotics which are often more addictive. I believe this is because the actual root cause is not dealt with when we simply prescribe medicine, with no form of therapy, guidance or mentorship.”
Beta blockers are different from antidepressants. The latter, such as Prozac, which is an SSRI (selective serotonin reuptake inhibitor), have a direct effect on the hormone release in the brain, whereas a beta blocker is a medication to reduce blood pressure and treat irregular heartbeats. “Beta blockers do not alter a person’s mood as antidepressant aims to do. They are a short-term fix while antidepressants deal with the underlying imbalance,” explains Dr Donnai.
However, where they do share a similarity is in how commonly they are now prescribed for anxiety. Dr Donnai says beta blockers are not yet quite as popular as Prozac for treating depression, “but they could become popular quite easily as they are very effective, not addictive, are inexpensive and well-tolerated”.
The primary action of beta blockers on the cardiovascular system – reducing heart rate and blood pressure – can be a double-edged sword. For patients with certain heart conditions, these effects are lifesaving. “However, in the context of anxiety treatment, the implications for heart and lung function necessitate careful consideration,” says Randhawa.
Side effects may include tiredness, dizziness and lightheadedness, which can be signs of a slow heart rate. “It may affect the blood supply to the hands and feet causing cold fingers or toes” says Abbas Kanani MRPharmS, a superintendent pharmacist at Chemist Click.
“People may also feel nauseous, have difficulties sleeping, experience nightmares or struggle to have an erection and other sexual dysfunction issues.”
Serious side effects are rare but they can cause shortness of breath and a cough that gets worse when you exercise, which includes movements like walking up stairs. “Another serious side effect, which can be a sign of heart problems, is swollen ankles or legs or an irregular heartbeat. Some may also notice wheezing or that they have a shortness of breath or tightening of the chest which could be signs of lung problems,” says Kanani.
Dampening your body’s stress response is another drawback of long-term beta blocker. “Obscuring the vital signals that our bodies send us in moments of distress,” says Randhawa.
“The very essence of healing from anxiety involves re-establishing a harmonious connection between mind and body, understanding the roots of our fears, and addressing the underlying issues that perpetuate them.”
By muting the body’s alarm signals, beta blockers may inadvertently encourage individuals to further disconnect from their internal experiences, potentially stalling the journey toward genuine healing.
If you are looking for a non-medical solution for addressing anxiety, she recommends somatic therapy. “With its emphasis on body awareness and the physical sensations tied to emotional states, it invites a reconnection to the bodily signals encouraging compassionate inquiry into the origins of your anxiety. This therapeutic journey aims to transform the experience of anxiety from one of fear and avoidance to one of understanding and growth.”
It poses the essential questions: why does fear take hold? What narratives and experiences have shaped our response to perceived threats?
“By exploring these questions, individuals can begin to reconstruct a sense of safety within themselves, ultimately paving the way for lasting healing beyond the temporary respite offered by medications.”
After taking beta blockers for two months, Victoria Gibson, a marketing director from Hertfordshire, decided they weren’t for her.
“After a few days, I started to feel quite spaced out, not quite with it. They slowed my palpitations but I just felt numb and still had anxiety,” says the 42-year-old mum of two.
She now thinks being prescribed beta blockers was a rushed solution to her problem. “It was a very typical ‘See how you get on’ with no real explanation as to how they may make you feel,” she says. “Yes they regulate your heartbeat but it never stopped the anxiety, and they made you feel a bit dopey.”
Today, she uses breathing exercises learnt from yoga to help control and regulate her anxiety. “Controlling and regulating my breathing definitely relieved my anxiety and helped to calm and that’s what I’ve done ever since.”
Any strategy that helps to stimulate the parasympathetic arm of our autonomic nervous system is part of building a drug-free approach to anxiety. Deep diaphragmatic breathing, meditation, mindfulness or yoga are all good tools to start addressing underlying anxiety.
Controlling the pace of his breathing is a strategy employed to great effect by Dr Rahul Jandial, one of the world’s leading neurosurgeons. “Pacing your breathing during stressful times and several times a day is your built-in anxiolytic,” says Dr Jandial, who uses paced breathing as his go-to strategy to keep his poise during stressful moments in the complex cancer surgeries he specialises in.
“During paced breathing, the vagus nerves that connect the brain to your lungs, heart and abdomen work in reverse and help dampen the frenetic energy in the mind associated with anxiety. We know this to be true based on real-time measurements of the brain while people participated in breathing exercises while having their brain electricity monitored for epilepsy.”
Learning how to breathe through periods of stress and anxiety can make us feel calmer and more relaxed, slowing our heart rate and reducing the stress hormones cortisol and adrenaline without having to pop a pill.
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