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Beta-Blockers For Anxiety: Which Beta-Blocker To Use?

Beta-Blockers-For-Anxiety-Which-Beta-Blocker-To-Use

World Health Organisation (WHO) defines anxiety disorders as a group of mental conditions characterized by a feeling of fear and anxiety (WHO, 2017).

Common anxiety forms include generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

Pharmacological management of anxiety disorders involves the use of antidepressants, such as a selective serotonin reuptake inhibitor (SSRI) or a serotonin–noradrenaline reuptake inhibitor (SNRI).

antidepressants

NICE guidelines on the management of generalized anxiety disorder and panic disorder in adults do not mention the use of beta-blockers.

Although it is known that beta-blockers may elevate anxiety symptoms.

In this post, I will discuss the use of beta-blockers for anxiety, focusing on the use of Propranolol, a common beta-blocker available in the UK.

What Are Beta-Blockers?


β Adrenergic receptor antagonists (commonly known as beta-blockers) are a group of drugs used in the management of:

  • Angina
  • Myocardial infarction (heart attacks)
  • Arrhythmias
  • Heart failure
  • Hypertension (not recommended as first-line treatment)
  • Migraine prevention and
  • Essential tremor

Beta-blockers can be divided into non-selective beta-blockers (for example, Propranolol) and selective blockers (for example, Bisoprolol, Atenolol). Selectivity relates to the ability of beta-blockers to work in some regions of the body.

Beta-1 receptors are predominantly located in the heart, whereas beta-2 receptors are distributed throughout the body. Non-selective beta-blockers bind to both beta-1 and beta-2 receptors, whereas selective beta-blockers mainly to beta-1 receptors and are commonly known as ‘cardio-selective.’

Why Beta Blocker For Anxiety?

Use of beta=blockers for anxiety, summary.

Non-selective beta-blockers are used for anxiety management.

Beta-blockers can be used in some patients for specific symptoms of anxiety such as:

  • Tremor
  • Shaking
  • Palpitations and
  • Fast heart rate

Beta-blockers do not help with psychological symptoms of anxiety, such as feeling worried, fearful, or tension (NICE, 2020). Beta-blockers block the actions of Norepinephrine and Epinephrine (adrenaline). Both hormones are responsible for the ‘fight or flight’ response characterized by an increase in the heart rate and tremor associated with anxiety symptoms.

Similar to anxiety disorders, beta-blockers can be used to control symptoms of performance anxiety, such as public speaking. People who experience stage fright may comfort similar to panic disorder symptoms such as tremors, increased heartbeats/palpitations, and sweating affecting their performance (Bourgeois, 1991).

By blocking physiological signs of anxiety, beta-blockers create a positive feedback loop, and as a result, patients become less conscious of being anxious (ibid).

Why Is Propranolol Used For Anxiety?

Propranolol is a non-selective beta-blocker and the only beta-blocker used (licensed) to manage anxiety in the UK. Propranolol is a prescription-only medication, which can only be obtained on a prescription written by a qualified prescriber.

In relation to anxiety, Propranolol is licensed in the management of:

  • Anxiety Tachycardia (fast heartbeat due to anxiety)
  • Anxiety with symptoms such as palpitation, sweating, and tremor

Propranolol For The Anxiety: Dosage

The recommended daily dose of propranolol in anxiety management is 40mg once daily.
This dose can be increased up to 40mg 3 times a day if necessary.

Propranolol is available as 10mg, 40mg, and 80mg tablets and 80mg and 160mg, sustained-release capsules. Propranolol sustained-release (also called modified release) is taken daily as compared to standard tablets, which can be taken up to three times a day.

When sustained-release capsules are used for the management of situational and generalized anxiety, a daily dose of 80mg of Propranolol should be adequate to provide short-term relief of acute situational anxiety (EMC, 2020).

Long-term management of generalized anxiety can be managed with the same dose, or if necessary, the dose can be increased to 160mg of sustained-release Propranolol.
For dosage instructions, follow the directions of the prescriber.

Propranolol For Anxiety: Possible Side Effects

Beta-blockers, such as Propranolol, are associated with several possible side effects. Common side effects include:

  • Sleep disturbances, nightmares
  • Slow heart rate
  • Cold extremities (fingers or toes)
  • Fatigue, feeling tired
  • Nausea (feeling sick)
  • Dizziness
  • Erectile dysfunction

Some side effects, such as dizziness, may go away after a few days once the body gets used to the treatment. Please refer to Propranolol’s product information leaflet for less common side effects.

Effectiveness Of Beta-Blockers For Anxiety

Systemic review and meta-analysis (review of all available evidence) do not give definite conclusions in favour or against the use of Propranolol in the treatment of anxiety disorders.

The main reason is the lack of well-designed clinical trials to show the efficacy of Propanol in the management of anxiety (Steenen, et al. 2015). Despite the lack of strong evidence, beta-blockers can provide for symptomatic relief of anxiety, including performance anxiety.

Beta-Blockers For Anxiety: Conclusion

Evidence-based recommendations on the management of anxiety recommend a selective serotonin reuptake inhibitor (SSRI) as a first-line drug treatment of this condition.

In the UK, the only beta-blocker recommended for anxiety management is Propranolol. Patients experiencing physical symptoms of anxiety, such as rapid heart rate and tremor, may benefit from the treatment with a beta-blocker.

Quick FAQ

Which beta-blocker is the best for anxiety?
Propranolol is the beta-blocker that has been most studied for anxiety and perhaps the best one. However, it was found that it lacked benefits for some conditions while effective for others.
Can you take beta-blockers as needed for anxiety?
Beta-blockers are typically taken for the short-term or as needed, unlike antidepressants. Mental health professionals might recommend beta-blockers for various anxiety disorders.
Do beta-blockers shorten your life?
A study in the Journal of American Medical Association found that beta-blockers did not prolonge the lives of patients.
Do you gain weight on propanol?
During the first few months of treatment, you might see some weight gain followed by a plateau.
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