Beta blockers are so called because they prevent the body’s beta adrenergic receptors from binding to the stimulating hormone epinephrine (adrenaline). When that happens, uncomfortable physiological responses are calmed: sweating, shaking, blushing, and other symptoms of performance anxiety. The effect usually lasts for about two hours.
Beta blockers can be helpful to people facing a predictable stressful situation, such as a job interview or a commitment to speak in public. Musicians, actors, and athletes may also use beta blockers to manage stage fright and improve control. This is possible because, unlike the benzodiazepines (e.g., Xanax and Valium), beta blockers do not have a sedating or tranquilizing effect. Instead, they target physical symptoms of anxiety without affecting alertness or mental clarity. Beta blockers do not make the user seem “drugged.”
Commonly Used Beta Blockers
Various beta blocking agents are available, each with slightly different functions and possible side effects. The one most commonly prescribed for performance anxiety is propranolol (Inderal). Others include:
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Carvedilol (Coreg)
- Metoprolol (Lopressor, Toprol XL)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
Potential Benefits of Beta Blockers for Anxiety
While beta blockers help reduce physical signs of stress (like blushing and trembling), they do not affect anxiety directly. However, many people feel less overwhelmed by social phobia or stage fright when they know that their fear is not obvious to observers. Taken for short periods of time, beta blockers can work as a “stepping stone” to help patients gain a sense of control over anxiety-producing situations. The medication may then be stopped, often leaving the person feeling more confident about their ability to perform well.
Potential Side Effects of Beta Blockers
Many people experience no side effects with beta blockers. Among those who do, the commonest side effects are:
- cold hands
Less common side effects include:
- shortness of breath
- trouble sleeping
- loss of sex drive
Some older beta blockers, such as atenolol and metoprolol, can cause weight gain when taken daily.
Because beta blockers lower blood pressure and slow heart rate, people with low blood pressure or heart conditions may not be able to take them. They should be avoided by people with asthma. They may block signs of low blood sugar (such as rapid heart beat), and so should be used with care by diabetics. Beta blockers should never be combined with alcohol.