Why Is Everyone Suddenly Obsessed With Beta Blockers?

There are two categories of beta blockers: selective, which affect your heart rate; and nonselective, which affect blood vessels throughout the body. When it comes to treating anxiety, you’ll likely be prescribed a non-selective beta blocker like propranolol.

How do beta blockers work?

Jayne Morgan, MD, a cardiologist specializing in women’s health and cardiovascular research, and vice president of medical affairs at Hello Heart, an app for monitoring cardiovascular health, explains that beta blockers work by blocking the effects of adrenaline (also called epinephrine) on the body—specifically on the beta receptors. “There are beta 1 receptors on the heart and beta 2 receptors on the lungs,” she says. “When it comes to the receptors on the heart, when beta blockers bind to these receptors, they’re blocking the effects of the adrenaline, slowing the heart rate. It decreases the strength of the contractions of the heart. In doing so, it lowers your blood pressure because it reduces the oxygen demand of the heart.”

Epinephrine is the hormone that’s responsible for triggering that fight-or-flight feeling in the body, which can often manifest as the heart beating faster, sweating, and shaking. Beta blockers can help lessen those effects.

Can beta blockers be used for anxiety?

The FDA has only approved beta blockers for the treatment of heart-related conditions, so using them for anxiety is considered off-label. Before we dive in, I just want to make it clear that the research on beta blockers for anxiety is a bit all over the place. There have been a few studies where the sample sizes were small, and the evidence of beta blocker’s effectiveness or noneffectiveness either way isn’t robust.

That said, many psychiatrists prescribe it to their patients for situational performance-anxiety issues (think public speaking, presentations, job interviews, etc.). The main thing to be aware of is that beta blockers do not treat the psychological symptoms or underlying causes of anxiety. They can help manage the physical symptoms like heart palpitations, which may then be effective in getting an anxiety attack under control.

“Many people who have generalized anxiety disorder describe not just the psychological dread, but also a physiological or bodily dread,” says Judith Joseph, MD, MBA, a board-certified psychiatrist, researcher, and author. “The reason that happens is because the mind-body connection is real.” Beta blockers can dampen the response your body is having when presented with an anxiety-inducing situation. “It can become this vicious loop where feeling physiologically anxious then triggers you to have more psychological dread, and then you’re in a full-on state of panic,” she says.

Beta blockers can be an attractive alternative to SSRIs or benzodiazepines like Xanax for a couple of reasons. For one thing, they’re not addictive or considered a controlled substance in the way that Xanax is, and they’re fast-acting—within 30 minutes or so—whereas SSRIs can take anywhere from a week to a month to kick in. Dr. Joseph makes an interesting point that it’s great for people who like to drink alcohol. “I don’t have to worry about putting them on a benzo like Xanax or Klonopin, which can be sedating [and dangerous] when taken with alcohol,” she says. “A lot of people with performance anxiety or social anxiety tend to self-medicate with alcohol, so it’s a way to keep them from having a full-on pass-out.”