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Beta blockers are a medication sometimes prescribed to alleviate some of the physical sensations of anxiety, especially social anxiety. Generally they are reported to be safe and have few associated side effects apart from lowered blood pressure.

Anxiety can be an insufferable condition. People often reach the point where they would do anything not to feel a constant sense of fear, agitation and anticipation. The physical side effects are draining and the intrusive thoughts and constant rumination exhausting.

In the long term, psychotherapy and other holistic approaches are the only way you can rid yourself of your anxiety for good but what do you do in the short-term when you just need a break?

In these cases medication can prove extremely helpful. However, anxiety disorders are complex problems that cannot be solved simply. Many people seek a fast and easy cure through medication but sadly there no “magic pill”. Medications need to be taken within this context. They can be beneficial in the short term and as an adjunct to psychological therapies but in themselves they are not the solution, even when very effective at temporarily removing discomfort. Medication works at a superficial level by dampening down the physiological (or in some cases, depending on the medication, cognitive) symptoms of anxiety, but they don’t deal with the underlying emotional issue.

Uses of beta blockers

Beta blockers are one medication that is sometimes prescribed to alleviate some of the physical sensations of anxiety, especially anticipatory, social anxiety. They are often prescribed to control a racing heart or palpitations, shaking and trembling, and facial flushing in anxious situations.

Generally they are reported to be safe and have few associated side effects other than possible dizziness or sleepiness, insomnia, or meaning your hands and feet are more likely to feel cold. They are also not habit-forming. However, they do not always reduce symptoms sufficiently and can also lower blood pressure and slow heart rate so can be contraindicated in certain cases. For example they are not advised for those with respiratory issues or for those with insulin insufficiency such as diabetes.

Beta blockers work by blocking the effects of norepinephrine, which is a stress hormone otherwise known as adrenaline, which, along with other hormones such as cortisol, is part of the fight-or-flight response. Epinephrine gives you the energy surge required to fight off or escape an attack, so it is logical that scary situations trigger its release. They are more commonly used in the treatment of high blood pressure and congestive heart failure and work by dilating blood vessels, which causes a reduction in heart rate and blood pressure.

However they do not have an impact on the emotional or psychological aspects of anxiety, although one of the ways that beta blockers might work is that when you confront your fear without experiencing the associated physical symptoms you normally experience, the association is broken. Beta blockers can therefore be useful when combined with psychological therapies such as CBT to help people master specific fears and phobias. Using both beta blockers, repeated exposure and relaxation strategies, the fear can be reduced until manageable or gone altogether.

It seems most likely that propranolol works by breaking a vicious cycle of anxiety wherein people continually and catastrophically misinterpret bodily sensations, such as thumping heart beat or shortness of breath and this can feed disorders such as, panic attacks. Research seems to support this explanation as studies have found that participants experiencing high levels of general trait anxiety (the tendency to widely focus upon and report negative emotions like fears or worries) improved little on propranolol, whereas those suffering from performance anxieties had more favorable effects.

Many psychiatrists prescribed beta blockers for social anxiety and performance anxiety in the 1970's but subsequently they have been superceded by SSRIS and so are no longer considered a first-line treatment. This is, in part, due to their lack of effectiveness for those whose anxiety is less physiological and more cognitive or emotional. However, it has been reported that more recently however, the properties of propranolol have regained research attention, and, whereas it was formally just regarded as a general anxiety-reducing medication, it is now that its possible amnesic effect that has become the subject of interest. The idea is that propanolol may have an impact upon the way someone stores and recalls memories and that when the memories are fearful ones, can be of great benefit in reducing anxiety.

Common beta blockers that are prescribed

Propranolol (Inderal)

This is often used for short-term relief of social anxiety as it can reduce more physiological symptoms of anxiety, such as increased heart beat and perspiration and reduce general tension. It is therefore advocated for us in stage fright and with public-speaking fears.

Propranolol cannot be taken if you suffer from chronic lung disease, asthma, diabetes, and particular heart diseases, or in the case of severe depression.

Taken occasionally, propranolol is marketed as having almost no side effects. Some people report feeling a little light-headed or sleepy, or experiencing short-term memory loss, for example..

​Atenolol (Tenormin)

This beta-blocker can also be used for social anxiety. Atenolol has a longer-lasting effect than propranolol and reportedly fewer side effects although cold limbs as well as dizziness and tiredness are reported. However, if taken regularly (daily) withdrawal can lead to very high blood pressure and if taken with alcohol it can be more sedating and lower blood pressure significantly.

While it is clear the mechanism of action can be explained, secure evidence for the use of beta-blockers in anxiety (certainly in the long term) is scanty, even more so than for many other medications used to treat anxiety. A recent large-scale meta-analysis found that the quality of evidence for propranolol's efficacy was insufficient to support its routine use in the treatment of anxiety. Yet, increases in prescribing are being observed the world over: in the US there has been a steady rise in prescriptions from 9 million in 2006 to nearly 19 million in 2016).

This is concerning as it may be that anxiety may be masking underlying depression and therefore focusing on reducing the anxiety symptoms means this is overlooked. As a society we perhaps need to be focusing more upon why levels of distress seem to be increasing in incidence and tackle the underlying cause, rather than constantly looking to submerge our symptoms of distress.

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