Beta-blockers are a class of drugs that can be used to treat excessive blood pressure, irregular heartbeats, chest discomfort, and a variety of other heart-related disorders. (1) The use of beta blockers for anxiety treatment is also widely studied.
The stress hormones norepinephrine and epinephrine are greatly affected by beta-blockers. These hormones are responsible for the physical symptoms of anxiety, and inhibiting them lessens their effects, so assisting to regulate some of the physical symptoms of anxiety. (2)
Beta-blockers have not been authorized by the Food and Drug Administration for the treatment of anxiety. These medications, however, alter how the body reacts to epinephrine, which may help alleviate some of the symptoms of anxiety.
Some clinicians use beta-blockers off-label to aid patients for whom other anxiety drugs are either harmful or inefficient. Off-label usage refers to when a drug has been approved by the FDA for one use but is being used for another that has not been recognized. Since the FDA oversees drug testing and approval, not how doctors use them to treat their patients, a doctor can still administer it for this purpose. If your doctor believes it is in your best interests, he or she can prescribe an off-label prescription. Self-medication with beta-blockers is also becoming more widespread, but it can be really dangerous. (3)
Even though beta-blockers are not intended to be used as an anti-anxiety medicine, they can help you feel more relaxed when you take them. Beta-blockers can help to lower heart rate. Our heart rate rises when we are stressed. This rise signals to the brain that our bodies are panicking as they should. This only adds to the worry. If you take away your capacity to swiftly boost your heart rate, your heart can signal to your brain that it is not frightening, at least not as much as might be expected. When our heart and body are quiet, the brain receives calming input. This helps to alleviate anxiousness. (4)
Beta-blockers may be beneficial in some cases of anxiety, such as postpartum anxiety or performance anxiety, etc. but self-medication is a risky method with substantial negative effects. It is crucial to look at how it works to fully comprehend its involvement in anxiety.
How do beta-blockers work?
Beta-blockers are frequently referred to as beta-adrenergic blockers. They keep adrenaline, a stress hormone, from interacting with the beta receptors in your heart. This keeps your heart from pumping stronger or quicker as a result of adrenaline.
Beta-blockers activate receptors on the surface of cells. Receptors are molecular switches that change the shape when a certain chemical attaches to them, signaling the cell to execute a specified function. Beta-blockers work by blocking beta receptors, which are activated by the stress hormones adrenalin and noradrenalin. (5)
There are two types of beta-receptors in humans: beta-1, which is mostly found in the heart (6), and beta-2, which is found in a variety of places, including smooth muscle cells in the bronchial tubes and veins. (7) The heart is commanded to beat faster and pump harder when adrenalin and noradrenalin connect to beta-1 receptors. Smooth muscle relaxation is caused by binding to beta-2 receptors, notably in the airways.
Beta-blockers link to both types of receptors, but they do not cause the cellular response to be activated. This prevents the hormones adrenaline and noradrenalin from accessing their target and triggering the reaction. Beta-blockers reduce blood pressure by slowing the heart and causing it to pump less strongly by inhibiting the usual hormone-receptor interaction. (8)
According to the latest analysis, certain beta-blockers may alter how the body recalls and reacts to unpleasant experiences. This study shows that the drug may be useful in the treatment of PTSD and phobias, but additional research is needed to validate this. (9)
Types of beta-blockers
Beta-blockers come in a variety of forms. Beta-blockers all function by modifying how beta receptors respond to epinephrine, however, there are two main types:
I. Non-selective beta-blockers
Nonselective beta-blockers inhibit both beta1 and beta2 receptors, affecting a variety of organs throughout the body. Propranolol and other first-generation beta-blockers are non-selective or nonspecific. Nadolol, timolol maleate, penbutolol sulfate, sotalol hydrochloride, and pindolol are some other common examples.
II. Selective beta-blockers
The primary action of selective beta-blockers is to hinder epinephrine from binding to beta receptors in the heart. They target beta-1 receptors alone. They may become less selective and target beta-2 receptors at greater concentrations.
Second-generation beta-blockers such as Metoprolol and Bisoprolol, Atenolol, acebutolol, esmolol, and betaxolol are examples of selective beta-blockers that primarily affect the heart and produce a decrease in cardiac output. (10)
Benefits of beta blockers for anxiety
Since beta-blockers act differently than typical anti-anxiety drugs, they are a feasible option for patients who want immediate relief. The following are some of the primary advantages of beta-blockers:
- They are quick functioning, making them an excellent alternative for individuals who want immediate relief.
- They might be a helpful choice for patients who have unbearable side effects from existing anti-anxiety drugs.
- Beta-blockers can also help lessen tremors, giving those who are nervous about public speaking and other performances more courage and confidence. (11)
- People with anxiety disorders who simultaneously have high blood pressure or other heart health issues benefit tremendously from beta-blockers.
- Beta-blockers are effective for treating acute short-term anxiety.
- They can help reduce blood pressure and heart rate, as well as alleviate physical discomfort.
Effectiveness of beta-blockers
A meta-analysis published in 2016 compared propranolol, a beta-blocker, to benzodiazepines, a common first-line therapy for anxiety. (12) The researchers discovered that both types of drugs were effective in treating panic disorder and agoraphobia, although propranolol did not outperform benzodiazepines. This study implies that, for the vast majority of patients, there is no factor to consider beta-blockers prior to benzodiazepines. (13)
According to the researchers of a 2015 study, a single dosage of propranolol given after being exposed to a tarantula might cure symptoms of spider phobia for at least a year. This might be because propranolol alters how the brain maintains frightening memories. The research sample was limited, although the results are encouraging. (14)
According to Japanese research, the beta-blocker atenolol had favorable benefits on 81% of persons with anxiety disorders and 87% of those with post-traumatic stress disorder (PTSD). Nonetheless, the authors concluded that these intriguing outcomes needed to be followed up with a more thorough study. (15)
Another research discovered that an atenolol-combination drug had considerable relaxing effects on individuals prior to medical procedures. In certain high-anxiety conditions, replacing benzodiazepines with something else might mean minimal side effects and a lower chance of dependence. (16)
Interaction of different drugs with beta-blockers
A variety of commonly prescribed drugs interact with various kinds of beta-blockers, either enhancing or hindering their effectiveness. The following are some of the most prevalent interactions:
Beta-blockers with Clonidine
High blood pressure is often medicated with metoprolol and clonidine. Clonidine and metoprolol belong to separate drug classes. Clonidine is an alpha-2 adrenergic agonist (central alpha agonist). and metoprolol is a beta-blocker (beta-adrenergic blocking agent). When clonidine (Catapres) is used with a beta-blocker, or when clonidine or a beta-blocker is withdrawn after their simultaneous usage, dangerous blood pressure rises can occur. When clonidine or a beta-blocker are used together, blood pressure should be regularly monitored once they are started or stopped. (17)
Beta-blockers with antipsychotic drugs
Antipsychotics are a kind of psychotropic drug used to treat psychosis, most notably in schizophrenia but also in a variety of other mental disorders. Utilizing propranolol or pindolol with antipsychotics such as thioridazine or chlorpromazine potentially leads to low blood pressure and irregular heart rhythms because both the drugs conflict with each other’s clearance and result in elevated levels of the substances. (18)
Beta-blockers with Anticonvulsants
Anticonvulsants are a class of pharmacological medicines used to treat epileptic seizures. This class of medicines includes phenobarbital. Phenobarbital is a prescription drug that can be used alone or in combination with other medicines. Certain beta-blockers, such as propranolol or metoprolol, may be broken down and blood levels reduced by phenobarbital and related drugs. As a result, the beta blocker’s efficacy may be diminished. (19)
Beta-blockers with nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs are a type of medication that relieves pain, lowers fever, prevents blood clots, and, at higher dosages, reduces inflammation. Aspirin and other nonsteroidal anti-inflammatory medicines (NSAIDs) may negate the blood-pressure-lowering effects of beta-blockers by decreasing the actions of prostaglandins, which play a major part in blood pressure regulation. (20)
Beta-blockers with Insulin
Insulin release from pancreatic cells can also be hampered by beta-blocker treatment. beta-blockers may reduce the initial phase of insulin production, potentially by impairing beta2-mediated insulin release. Beta-blockers can prolong, aggravate, or change the symptoms of hypoglycemia in insulin-dependent diabetics, although hyperglycemia appears to be the predominant concern in noninsulin-dependent diabetics. Beta-blockers can boost blood glucose levels and interfere with the effect of oral hypoglycemic medications. (21)
Side effects of beta-blockers
The majority of people who take beta-blockers experience no or extremely moderate adverse effects that fade with time. People who use beta-blockers frequently experience the following side effects: tiredness, dizziness, or lightheadedness (which can be indicators of a sluggish heart rate), chilly fingers, or toes since because beta-blockers might impair blood flow to your hands and feet (22), difficulty sleeping (insomnia), or hallucinations. Beta-blockers can cause shortness of breath, chest tightness, and even full-blown asthma episodes in certain people. (23)
Although it occurs infrequently, some people may have major adverse effects when taking beta-blockers. If you experience shortness of breath with a cough that worsens when you exercise, swelling ankles or legs, chest discomfort, or an erratic heartbeat, see a doctor right once. These are all symptoms of heart issues.
Shortness of breath, coughing, and chest tightness can all be symptoms of lung difficulties, while yellow skin or the whites of your eyes might be symptoms of liver problems.
Are beta-blockers safe?
Beta-blockers are typically safe, although there is a minor possibility of severe adverse effects, as with other pharmacological medicines. Propranolol and other drugs rapidly penetrate the blood-brain barrier, raising the risk of major side effects such as acute stress disorder, depression, or psychosis. (24) However, the chances are still minimal.
People are urged to avoid immediately discontinuing beta-blockers, which can cause significant chest discomfort or even a heart attack on extreme occasions.
However, unlike other anti-anxiety medications such as benzodiazepines, beta-blockers are not addictive, thus you are unlikely to get dependent on them. This is an obvious advantage of beta-blocker use that should be considered, especially if you have a history of substance abuse.
How long do beta-blockers for anxiety last?
Theoretically, the duration of the effectiveness of commonly used beta-blockers ranges from three to six hours, but in regards to how you feel, count on a couple of hours of relaxation. Beta-blockers are typically administered as pills that are taken orally.
The medicine acts swiftly, reaching peak levels in as little as an hour. The soothing effects of a low dosage of a beta-blocker remain for a few hours after it enters your system.
A beta blocker’s normal dose varies depending on your symptoms, diagnosis, and other health complications. Propranolol is normally started at a low dose for anxiety alone, and then gradually increased if necessary. There is an extended-release form of propranolol available, although, for anxiety, the non-extended version is commonly utilized.
Propranolol can assist reduce the bodily response to performance anxiety that reacts to a crowded room, in the same manner, it does to a grave threat. This means you can make your important presentation at the meeting scheduled or address a recruiter’s queries during a hiring process without your anxiety taking over your body. A 10-20mg dosage of this beta-blocker medicine taken an hour before a stressful event will keep your heart rate stable, your breath steady, and your shaking and sweaty palms under control for many hours making you feel confident.
How do beta-blockers make you feel?
Beta-blockers can help anxious people feel more comfortable and in control of their emotions without making them feel like they are being dominated by their emotions. The goal of anxiety treatment is to allow you to go about your everyday activities without being hampered by symptoms. By decreasing your body’s adrenaline response to everyday stimuli, beta-blockers can let you focus on more important things.
SSRIs are used to treat anxiety and depression over a lengthy period and take several weeks to function but unlike them, beta-blockers are efficient right away and may be used on an as-needed basis with no adverse effects. They help with anxiety symptoms for a short time, but they do not cure it. If you are having anxiety symptoms all the time, you may need to try a new prescription or augment another prescription with a beta-blocker after speaking to your doctor.
Beta-blockers can help with stage fright before performances or public speaking engagements, as well as sleep anxiety. They have traditionally been administered to persons with performance anxiety before public speaking or acting. Just make sure to test it out first at leisure to see how it impacts you before utilizing it for a high-stress situation. They are a safe alternative for whenever anxiety arises and may be beneficial for social anxiety if taken a few hours before the event.
To alleviate pre-sleep anxiety, beta-blockers can be taken instead of or in addition to sleep aids. This beta-blocker prevents interference of anxieties about the previous day or fears about the upcoming day from increasing heart rate and hindering a gradual progression into sleep.
Who should not take beta-blockers?
If you have persistent, uncontrollable anxiety, you may require more regular treatment, such as a regular drug, rather than an occasional beta-blocker. In addition to an SSRI, some individuals take a beta-blocker. Beta-blockers are generally well-tolerated, and symptomatic medication interactions are uncommon. However, if you have any of the following conditions, beta-blockers may not be the best option for you:
Blocking Beta-2 receptors can raise the risk of asthma episodes and other respiratory issues. People with asthma can continue to utilize Beta-1 selective blockers, but their risk level will be carefully considered by their doctor. (25)
Beta-blockers may cause persons with hypotension (low blood pressure) to have significantly lower blood pressure.
Medical conditions that necessitate medicine
Beta-blockers have the potential to interact with a wide range of frequently prescribed medications. Antihypertensive and antianginal pharmaceuticals, anti-arrhythmic drugs, anti-inflammatory drugs, psychotropic drugs, anesthetics, cholesterol-lowering agents, warfarin, diabetic medications, and certain TB therapies are among them.
Beta-blockers are quite quick-acting and do not significantly impair consumers; it is useful for someone with an anxiety disorder to keep in their bag for the potential of an unanticipated anxiety attack; even knowing it is there can lessen the onset of anxiety symptoms.
Medication affects everyone differently, especially when it comes to addressing mental health disorders such as anxiety. To recover from anxiety or to help someone else with anxiety, keep in mind that what works for one person may not work at all for another. To address the more psychological components of anxiety while taking beta-blockers, you may require to consider additional therapy alternatives.
People who have tried and failed to relieve their anxiety with other drugs may find hope in beta-blockers. The prospect of a life free of anxiety is enticing. However, no medicine is completely risk-free. Using a prescription medicine without first visiting a doctor is never a good idea.