Beta Blockers for Anxiety Are Becoming More Popular, but Are They the Right Treatment?

People in the public eye can feel anxious just like anyone else — even when performing or speaking — the very things that make them famous. Some celebrities have talked about their experiences with stage fright and panic attacks. They say taking a beta blocker before an event helps with symptoms like a pounding heart, dry mouth, or shaky voice. 

But are beta blockers safe to take for anxiety? And do they work?

What are beta blockers?

Beta blockers have been around for a long time. They’re mainly used to treat high blood pressure and heart disease. Some types are also prescribed to calm tremors or to prevent migraines. 

Beta blockers work by binding to cell receptors for stress hormones like epinephrine and norepinephrine. This helps keep your blood pressure and heart rate from going too high when you’re stressed or afraid. 

That’s why beta blockers treat high blood pressure (hypertension) and heart conditions. But by blocking the effects of stress hormones, they can also decrease some of the physical symptoms of fear and anxiety. 

Can beta blockers treat anxiety?

Anxiety is complex. It can develop for many different reasons and affect people’s bodies and minds in different ways. So, it’s not surprising that using beta blockers to treat only the physical symptoms of anxiety has shown mixed results. 

For most kinds of anxiety, beta blockers aren’t a complete form of treatment. Many anxious conditions are best treated with: 

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) 

• Benzodiazepines (usually used short-term while other medications start working)

• Different forms of therapy, like cognitive behavioral therapy (CBT) or exposure therapy

Beta blockers are sometimes added to these other forms of anxiety treatment. In some cases, they’re used as a stand-alone medication. Let’s look at the evidence for and against using beta blockers to help treat different types of anxiety disorders.

EXPERT PICKS: WHAT TO READ NEXT

• Natural remedies for anxiety: Interested in alternative ways to treat anxiety without prescription medication? We review the research for the most popular supplements.

• What does an anxiety attack feel like? Panic attacks can be scary and feel very different from person to person. Three people share their experience.

• Beta blocker side effects: If you’re thinking about starting a beta blocker, learn more about how they work and what to expect — including side effects.

Performance anxiety

For some people, taking a beta blocker an hour or two before an event helps calm the physical symptoms of performance anxiety. 

You’ve likely experienced the pounding heart, sweaty palms, or shaky voice that come with performance anxiety. Performance anxiety includes fears of: 

• Public speaking

• Taking exams

• Performing on stage

• Performing in front of a crowd or a judge, like in athletic performances

It’s common to feel nervous in situations like these. In fact, feeling a little stress may even help with focus, memory, and performance. But overwhelming feelings of fear can make things worse. This is a big problem for people like performers, musicians, and public figures. Their professions may depend on being able to speak or perform in public on a regular basis. 

Post-traumatic stress disorder (PTSD)

For people with post-traumatic stress disorder (PTSD), situations or memories may trigger a stress response. Beta blockers aren’t used alone to treat this type of anxiety. 

But some studies have shown that beta blockers may help decrease the body’s stress response to triggers. This may help reduce PTSD symptoms when used in combination with other forms of therapy, like memory reactivation. That’s when a therapist helps someone recall traumatic memories in a controlled environment.

Beta blockers can help with some symptoms of PTSD, like feeling vigilant or having intrusive thoughts. They may also help decrease the physical symptoms that can occur with flashbacks. 

But beta blockers don’t seem to work for other symptoms, like avoidance or mood swings. So, if they’re used for PTSD, beta blockers are combined with therapy and medications like SSRIs.

Social anxiety

Social anxiety disorder is an intense fear of judgment. It can happen often, in many different social situations (called pervasive social anxiety). Or it can occur only in certain settings, as in performance anxiety.

Beta blockers may help to relieve short-term symptoms of social anxiety. That’s what makes them useful for performance anxiety. But for pervasive social anxiety, they don’t work as well as SSRIs and therapy. 

Still, beta blockers might help with anxiety that happens in specific situations — especially if physical symptoms are your main concern. They may also ease symptoms until other treatments like SSRIs or therapies take effect. 

Other anxiety disorders

Beta blockers may be helpful for some people with other types of anxiety disorders. But there’s not much evidence available to support this use. These include:

• Panic attacks and panic disorder: SSRIs, SNRIs, and therapy are the first-line treatments for panic disorder. But beta blockers may be useful if you have strong physical symptoms with your panic attacks. 

• Generalized anxiety disorder: There aren’t a lot of studies on the use of beta blockers for persistent worrying or fear. One small study found that beta blockers may decrease symptoms. But most studies show other treatments work better for generalized anxiety disorder. 

• Specific phobias: A few small studies have found beta blockers to be helpful for phobias like going to the dentist or flying. But there isn’t a lot of research on this.

Which beta blockers are best for anxiety?

The best-studied beta blocker for performance anxiety is propranolol. This is still considered an off-label use. 

Proprandolol is a short-acting medication, meaning it doesn’t stay in your body long. A typical dose is 10 mg to 40 mg, taken about an hour before a performance or event. It’s a good idea to try it out beforehand — just to make sure there are no significant side effects. 

However, propranolol isn’t good for people with asthma or chronic obstructive pulmonary disease (COPD). It can make wheezing worse. 

Other beta blockers, like metoprolol and atenolol, may also help with anxiety and usually have fewer effects on the lungs. But people with lung conditions should still use caution with any beta blocker.

What are the side effects of beta blockers for anxiety?

Even if you only take beta blockers occasionally, they can still have side effects. Some common ones include:

• Dizziness

• Low blood pressure

• Slow heart rate

• Feeling tired

• Nausea

If you take beta blockers daily, depression is a possibility. But some studies of people taking them for cardiovascular conditions showed no increase in depression. In fact, one large study even showed that people taking beta blockers had less depression than those who didn’t. 

Use caution — or avoid beta blockers — if you have:

• Asthma

• COPD

• A slow heart rate

• Low blood pressure

• Certain types of heart failure or heart rhythm problems

• Diabetes, especially if you have episodes of low blood sugar

Beta blockers are sometimes used with antidepressants or antianxiety drugs. Some of these medications are broken down by your liver in the same way. So, your dose of beta blocker may need to be lower to avoid side effects. 

Frequently asked questions

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified physician since 1999. She was a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts