How do beta blocker heart drugs actually work for anxiety?

by Nial Wheate, Jasmine Lee, The Conversation

edited by Lisa Lock, reviewed by Andrew Zinin

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A reality TV star's claim that a beta blocker dulled their emotions and made them appear calm on camera has sparked a wave of social media commentary.

These medicines, first developed to manage high blood pressure, are now also used to treat anxiety. But beta blockers are not "chill pills" in the way many people assume.

So what are beta blockers, and how can they help manage anxiety?

They counter the effects of adrenaline

Beta blockers are a group of medications that reduce the effects of adrenaline in the body. Adrenaline is one of the hormones released as part of the body's natural "fight-or-flight" response, which prepares us to react to danger, stress or excitement.

By blocking the effects of adrenaline, beta blockers can slow the heart rate and reduce physical symptoms such as trembling and sweating.

They are most commonly used to treat heart and circulation conditions, including high blood pressure, irregular heart rhythms, heart failure and angina (chest pain). They can also be prescribed to prevent migraines.

Can they help with anxiety?

Yes, but not in the way regular anxiety medicines do.

Generalized anxiety disorder is usually treated with a family of drugs called selective serotonin reuptake inhibitors (SSRIs). Other drugs include serotonin and noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants. These drugs help alleviate feelings of anxiety.

When we feel anxious, the body's fight-or-flight response can kick in even when there is no physical danger, leading to the release of adrenaline. This can cause symptoms such as a racing heart, sweaty palms and tremors.

For some people, these changes from the body's stress response can feed into the anxiety, making it worse and creating a cycle that can be hard to break in the moment.

Because beta blockers can help control or minimize these physical symptoms, some performers and celebrities use them to manage nerves before public appearances.

Beta blockers don't stop anxious thoughts or "switch off" emotions. Unlike regular anxiety medicines that make you feel calmer or more relaxed, they only control the body's physical response to stress, rather than the feeling of anxiety itself.

This is why research suggests they may be useful for easing nerves during one-off, high-pressure events such as public speaking or performing.

But they aren't suitable for the long-term management of anxiety.

Are there any side effects?

No medicine is risk-free. Beta blockers have a range of side effects related to lower blood pressure. These include dizziness and lightheadedness, fatigue and weakness, and cold hands and feet.

They can also disturb sleep through insomnia, vivid dreams and nightmares.

It's important that once a person starts taking daily beta blockers, they do not abruptly stop. This is because it can cause a spike in blood pressure and induce heart palpitations.

Deciding if they're right for you

If you suffer from acute anxiety and think beta blockers may help you manage those situations, speak to your doctor.

But if you have more ongoing general anxiety, then regular anxiety medications may be more suitable for you. Or your anxiety might be treatable with a non-drug solution, such as cognitive behavioral therapy.

If your doctor and you decide a beta blocker is the right treatment, you'll be able to access one through the Pharmaceutical Benefits Scheme with a prescription.

Key medical concepts

Generalized Anxiety DisorderSelective Serotonin Reuptake InhibitorsAntidepressive Agents, TricyclicSerotonin and Noradrenaline Reuptake Inhibitors

Clinical categories

Clinical pharmacologyPsychology & Mental healthPsychiatryCardiology Provided by The Conversation Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

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