People who are diagnosed with an anxiety disorder often suffer from unpleasant physical symptoms, including rapid heart beat and breathing, tremors and blushing when they encounter anxiety-producing situations.
Beta blockers, a class of medications that block beta receptor sites in the nervous system, may provide relief to those who suffer from the physical symptoms of anxiety.
Anxiety disorders are believed to result from chemical imbalances of serotonin, epinephrine, norepinephrine and gamma aminobutyric acid, or GABA.
Because beta blockers prevent epinephrine and norepinephrine from binding to the receptor sites, they can be an effective method for reducing physiological anxiety symptoms.
Beta blockers have been shown to be especially helpful to people who have a diagnosis of social anxiety disorder, but are also useful for treatment of generalized anxiety disorder and panic disorder.
There are seven things you should know if you are considering talking to your physician about prescribing beta blockers for your anxiety disorder.
1. What Are Beta Blockers?
Prescribed for more than 30 years for the treatment of high blood pressure, migraines and other conditions, beta blockers are a class of beta-adrenergic blocking agents that prevent the neurotransmitters epinephrine and norepinephrine from binding to receptor sites on the nerves.
While the FDA does not list anxiety disorders as one of its approved uses, doctors are able to prescribe these medications for this off-label use.
The neurotransmitters epinephrine and norepinephrine are produced in the adrenal gland as well as by nerves, and are chemicals that nerves use to pass information during neural transmission throughout the body.
They are normally released in high concentrations when people experience fear.
2. What Are the Different Types of Beta Blockers?
How beta blockers work depends largely on the location and function of the individual kinds of beta receptors found in the body. There are three main types of beta receptors that function differently from one another:
β1, or beta-1 receptors, are found in the heart, eyes and kidneys
β2, or beta-2 receptors, are located in the gastrointestinal tract, lungs, liver, uterus, skeletal muscles and blood vessels
β3, or beta-3 receptors, are found in fat cells located throughout the body
Beta blockers primarily work by blocking epinephrine and norepinephrine binding of beta-1 and beta-2 receptors, thus affecting such things as heart rate, breathing rate and muscle relaxation.
They also can help relieve other symptoms, including shaking and blushing for many hours after taking a prescribed dose.
Here are the most popular types of beta blockers used for anxiety treatment:
• Propanolol, also known as Inderal, is normally prescribed in order to help alleviate the physical symptoms of social anxiety disorder on a short-term basis. People may have them prescribed on a PRN, or take as needed, basis, taking a dose approximately 30 minutes to one hour prior to attending an anxiety-producing event. Other people may be prescribed a daily dose of the medication.
• Atenolol, also known as Tenormin, has effects that last longer than those of propanolol. The medication also has fewer reported side effects. People who are prescribed altenolol should not stop taking it suddenly, but should instead gradually titrate their dosages down. Abruptly stopping an altenolol prescription can cause a serious increase in blood pressure.
3. How Are Beta Blockers Used and What is the Common Dosage?
Doctors most commonly prescribe beta blockers in order to lessen physical symptoms of social anxiety disorder, such as shyness, sweaty palms, racing heart and shaking.
They are available in pill form and are taken orally. The usual dose depends on the person's severity of symptoms and the particular medication prescribed.
Propanolol, when used for performance anxiety, is prescribed on an as-needed basis in dosages ranging from 10 to 40 mg.
Atenolol is available in dosages of 50 mg or 100 mg. People normally begin at a 50 mg daily dose, and after taking the medication for several weeks, it may be increased to 100 mg if the person does not experience improvement in their physical anxiety symptoms.
4. Are Beta Blockers Effective for Public Speaking and Performance Anxiety?
Performance anxiety can affect people of all stripes, and a 2001 Gallup poll found that almost 40 percent of Americans find public speaking very frightening.
People who experience performance anxiety experience physical symptoms, such as gastrointestinal distress, tachycardia, sweating, shaking and blushing, due to the effects of epinephrine triggering the body's fight or flight reaction.
The fear is so intense for people who suffer from performance anxiety that some react by self-medicating with drugs or alcohol, while others may choose to leave promising careers due to the intensity of the reaction.
A number of studies have been conducted regarding the effectiveness of beta blockers in the treatment of performance anxiety for different performance types:
• Studies with the use of beta blockers for musical performances
In this study, music students took either a beta blocker or a placebo one and one-half hours before a performance. Those who were given a dose of propanolol showed performance improvements and a reduction of some physical anxiety symptoms, including dry mouth. String performers who were given nadolol showed reduced shaking and a better ability to control their bows, while singers showed mild benefits when given nadolol at lower, rather than higher, doses.
• Study with the use of beta blockers for opthalmology surgeries
Medical residents who suffered from performance anxiety were prescribed either propanolol or a placebo pill an hour prior to performing eye surgeries. The surgeons who took propanolol reported a reduction in experienced anxiety and hand tremors while performing the delicate surgeries.
• Studies regarding taking exams
In one study, students who had taken the Scholastic Aptitude Test, or SAT, and who reported having experienced performance anxiety while taking the exam were given propanolol before retaking it. Those who were administered the drug demonstrated greater improvements in scores versus students who retook the test without the benefit of beta blockers. In another study of medical students, those who reported experiencing performance anxiety and who were given propanolol showed demonstrated increases in their verbal reasoning and arithmetic versus students who were provided with a placebo.
• Studies of sports performance anxiety and beta blockers
Because beta blockers have been demonstrated to reduce tremors and thus improve performance for athletes whose sports require precision, the World Anti-Doping Agency prohibits their use by athletes in certain sports, such as archery, golf or billards.
• Studies of performance anxiety and public speaking
Propanolol or a placebo were administered to people who had self-reported experiencing performance anxiety related to public speaking. The two groups then gave speeches that were videotaped and reviewed by observers. The test group reported experiencing decreased anxiety levels, and observers who reviewed the videos also reported that this group showed significant reduction in outward symptoms of anxiety as well. People with higher anxiety levels also improved in their ability to remember words, while those with lower anxiety levels who were given propanolol actually showed a decrease in word recall.
5. Can You Use Beta Blockers for Anxiety and Panic Attacks?
Panic disorder is characterized by repeated and sudden attacks of fright lasting for multiple minutes.
Those who have these panic attacks experience feelings of lost control and impending disaster even when no danger exists.
Some people also experience physical symptoms that lead them to feel as if they are having a heart attack.
These attacks can occur unexpectedly and at any time, leaving many people with the disorder in constant fear that they will have another such attack.
Although other medications, including selective-serotonin reuptake inhibitors, or SSRIs, and benzodiazepines are generally the preferred medications prescribed by doctors for anxiety disorder and panic attacks, physicians do prescribe beta blockers for anxiety and panic attacks to a lesser extent.
Beta blockers can be prescribed for those who have panic disorder in order to decrease some of the physical symptoms associated with a panic attack, thus providing some relief to those who are diagnosed with it.
6. Are There Any Natural Beta Blockers for Anxiety?
Natural beta blockers for the treatment of anxiety are available and derive from a variety of sources.
These substances occur naturally in some foods and herbs, including all of the following:
• Meat, dairy and fish
These foods are rich in potassium, tryptophan and L-arganine, two amino acids that have been demonstrated to increase the body's production of serotonin. Serotonin acts as one of the body's naturally occurring beta blockers. Thus, a diet rich in meat, dairy and fish can help alleviate some anxiety symptoms.
• Magnesium-rich foods
Thought to be one of the best-performing natural beta blockers, magnesium can help to reduce anxiety, lower the heart rate and lower blood pressure. Eating a diet that is full of magnesium-rich foods can help people who suffer from anxiety disorders.
• Certain fruits and vegetables
Many fruits and vegetables are rich in antioxidants and nutrients that function as important beta blockers for anxiety, hypertension and related issues. People who want to try to control some anxiety symptoms may want to include fruits that are rich in amino acids and potassium, such as bananas, beans, potatoes, raw spinach, citrus fruits, almonds, oranges and raisins.
Highly effective, passionflower's properties include helping to reduce stress, insomnia, tension and other symptoms associated with anxiety disorders. This flower has natural substances that aid in relaxation. The effectiveness of this natural remedy has led to its being included in a number of other medications, and it is available in tincture or pill form.
• Pomegranates and pomegranate juice
Recent studies conducted in California showed that pomegranate juice has a greater concentration of antioxidants than does red wine. Because of this, pomegranates have become quite popular as a source of natural beta blockers for people who suffer from anxiety.
• Yoga and breathing techniques
According to Harvard Medical School, yoga and associated breathing techniques have been demonstrated to help practitioners regulate their stress response systems, thus reducing anxiety symptoms by easing breathing, lowering the heart rate and reducing blood pressure.
In one study conducted by researchers at the University of Utah in 2008, the study's authors noted that people who have problems with regulating their stress response also have a correlative greater pain sensitivity.
The study participants included three groups: one that was comprised of 12 yoga practitioners, one that included 14 people who were diagnosed with fibromyalgia, and one that was made up of 16 volunteers who did not have any health conditions.
Fibromyalgia, interestingly, is believed to be a medical condition that is caused by stress and anxiety.
Participants in all three groups were subjected to different levels of pressure to their thumb nails. Participants in all three groups were given MRIs while receiving the pressure.
Those who were in the experienced yoga practitioner group showed the lowest amount of activity in the pain centers of their brains, pointing to how the practice of yoga can help the body produce more of its own beta blockers in order to reduce the effects of stress-related neurotransmitters.
Participants in the group that were diagnosed with fibromyalgia showed the highest activation levels of their brains' pain centers, while those in the no-diagnosis group showed levels in between the other two groups.
• Herbal remedies and chamomile tea
Many herbs, such as St. John's Wort, are effective in helping to reduce the physical symptoms of anxiety.
Regularly drinking chamomile tea provides many health benefits due to the high concentration of antioxidants contained in it.
Antioxidants work in the body to fight free radicals, aid in relaxation, encourage sleep and relax the muscles.
Chamomile tea thus has positive affects on people who have anxiety disorders because the antioxidants work as natural beta blockers.
7. What Are the Side Effects of Beta Blockers?
Because of the effects beta blockers have on the ability of different organs to accept epinephrine and norepinephrine, people may experience several side effects:
• Blurry vision
The fight or flight response usually works to increase visual sharpness with a flood of adrenaline into the system. Adrenaline is what is commonly known as epinephrine. When the receptor sites in the eyes are blocked, people may experience reductions in visual clarity as a result.
• Weight increases
Some people who are prescribed beta blockers will experience gains in weight due to the reduction of epinephrine and norepinephrine uptake. Blocking these neurotransmitters is thought to lead to a body system in which the person is more sluggish, leading to weight gains.
• Sexual side effects
In some men and women, beta blocker use is associated with sexual side effects. Men may have difficulty with impotence, while women may lose interest in sex.
• Dizziness and faintness
Common side effects of beta blockers include feelings of faintness and dizziness due to a reduction in blood pressure and a slowed heart rate. For this reason, people who have low blood pressure generally should not take beta blockers for anxiety treatment, as the medication can cause significant drops in blood pressure.
People may feel tired as a side effect of taking beta blockers due to having less epinephrine and norepinephrine available throughout their systems.
• Gastrointestinal side effects
Some people experience gastrointestinal disturbances, including nausea and diarrhea, associated with beta blocker prescriptions.
• Sleep disturbances
People who take beta blockers may experience sleep disturbances, including insomnia or nightmares.
Beta blockers are contraindicated in pregnant women, as women who have been prescribed beta blockers in the second trimester of pregnancy have been demonstrated to have babies with lower birth weights.
Women who take beta blockers and who plan to become pregnant may thus want to discuss alternatives with their doctors.
People who have low blood pressure should also not take beta blockers due to the reduction in blood pressure that results from their use.
Those with diabetes who are prescribed beta blockers will need to carefully monitor their blood sugar, as the medications can lessen their ability to experience symptoms involved with low blood sugar levels.
While beta blockers may not be a stand-alone approach to the treatment of anxiety, they can be helpful in alleviating the physical aspects of the disorder.
They have been shown to be most effective with the treatment of symptoms associated with social anxiety disorder and performance anxiety, also demonstrating promise with the treatment of panic disorders.
When prescribed, beta blockers are normally used in combination with cognitive-behavioral therapy as well as other, more traditional, anti-anxiety medications.