Should You Try Taking Beta Blockers to Treat Anxiety?

Beta blockers are medications traditionally used to treat heart conditions like irregular heart rhythms or high blood pressure. Now, they’re increasingly being used to treat anxiety, especially performance anxiety around things like public speaking.

They’re often seen as safe, quick fixes. But is that true? And are they really as effective against anxiety as they’re made out to be?  

How beta blockers affect the body

Beta blocker medications like metoprolol, carvedilol, atenolol and propranolol live up to their name by blocking the effects of your sympathetic nervous system, aka your fight or flight response.  

When you feel threatened — say, by that unavoidable work presentation — your nervous system releases chemical messengers like adrenaline. These chemicals then bind to proteins called beta receptors that are located throughout your body, including in your heart, blood vessels and lungs. This process activates your fight or flight response and causes common anxiety symptoms: a fast heartbeat, faster breathing, restlessness and sweating.

Beta blockers prevent these symptoms by binding to your beta receptors and blocking adrenaline and other adrenaline-like chemicals from having an effect.  

“The typical response to an adrenaline surge is for your heart to beat faster and your airways to dilate so that you can take in more oxygen,” says Dr. Christina Hartje-Dunn, an assistant professor of cardiology at the University of Washington School of Medicine. “Taking a beta blocker makes your body — primarily your heart and lungs — have less response to an adrenaline-inducing stimulus.”

As a result, beta blockers can lower blood pressure and reduce how hard the heart has to work to pump blood through the body, making them helpful for people who have hypertension or have a heart condition. 

Why beta blockers can help with performance anxiety

Beta blockers have also long been used to treat anxiety that is triggered by specific situations, like performance anxiety because they can slow an anxious, racing heartbeat. If you’re prone to nervous jitters, beta blockers can also help keep you from shaking or experiencing muscle tremors.

Despite their regular use to treat anxiety, beta blockers do not actually have Food and Drug Administration (FDA) approval for this type of use. If a doctor prescribes you beta blockers for anxiety, they’re doing what’s called off-label prescribing.

Off-label prescribing in medicine happens all the time and is often supported by excellent data, says Dr. Ryan Kimmel, chief of psychiatry at UW Medical Center. However, in the case of beta blockers, not only do they not have FDA approval for anxiety, but research hasn’t found them to be particularly effective for most anxiety diagnoses.

Why beta blockers aren’t a long-term anxiety treatment

Beta blockers are typically only effective in specific instances of performance anxiety, like during public speaking. They are not considered first-line medications for most other types of anxiety, like panic attacks or generalized anxiety disorder. Research has shown that beta blockers aren’t more effective than a placebo to treat most anxiety disorders, Kimmel says.  

It’s not that beta blockers won’t help some people — they might help slow your racing heart and maybe help you feel a little calmer because of it. But that alone is not going to be enough to treat anxiety in most people. Anxiety often causes many other physical symptoms plus changes the way your brain processes feelings and information. Anxiety’s whole-body impact typically requires a more holistic approach to treatment.  

Cognitive behavioral therapy (CBT) is one of the most effective, evidence-based treatment options for anxiety disorders. It can also be used along with medications like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) that are proven to help reduce anxiety. Some doctors may even prescribe an SSRI along with CBT for anxiety treatment.

Who should and shouldn’t try beta blockers

Still, Kimmel doesn’t rule beta blockers out completely. He has prescribed them before and says they could be helpful for someone who hasn’t found success with multiple other treatment options (like CBT, SSRIs or other interventions with good evidence).  

Always talk with your doctor before trying a new medication. Though beta blockers are safe for most people, they can cause side effects like fatigue, dizziness, cold hands and feet, and an upset stomach. They can also be unsafe for people who have asthma. Beta blockers can make rescue inhalers for asthma attacks ineffective, which could be life-threatening.  

Beta blockers might sound alluring — who doesn’t want to just take a pill and quickly resolve their anxiety symptoms? But while beta blockers may help blunt short-term symptoms of anxiety in certain situations, they will not help resolve anxiety long-term.  

“It’s true that CBT and SSRIs take more time to work, but the benefit and the durability of that benefit certainly seem to be better and last longer,” says Kimmel.