Beta-blockers are a class of drugs used chiefly to treat cardiovascular diseases. These drugs work by blocking beta receptors that exist in three forms: beta-1, beta-2, and beta-3.

Farzam K, Jan A. Beta Blockers. StatPearls Publishing. Updated December 13, 2021.

 

The FDA has approved beta-blockers for the treatment of hypertension, tachycardia, myocardial infarction, coronary artery disease, aortic dissection, congestive heart failure, cardiac arrhythmias, and portal hypertension.

 

More about beta-blockers

Epinephrine (also known as adrenaline) and norepinephrine are catecholamines that bind to B1 receptors leading to an increase in cardiac automaticity and conduction velocity.

The B1 receptors aso increase blood pressure by inducing renin release. On the other hand, binding to B2 receptors induces smooth muscle relaxation in addition to increasing metabolic effects.

Beta-blockers, also known as beta-adrenergic blocking agents, prevent adrenaline from binding to the heart’s beta receptors. Once beta-blockers bind to B1 and B2 receptors, they have an inhibitory effect on the heart, slowing down heart rate and decreasing blood pressure.

While there are a myriad of beta-blockers available on the market, commonly prescribed ones include:

Brown M. Beta-blockers for anxiety: benefits, side effects, and risks. Healthline. Updated June 11, 2018.

 

• Propranolol (Inderal)

• Atenolol (Tenormin)

• Metoprolol (Lopressor)

• Carvedilol (Coreg)

• Acebutolol (Sectral)

• Bisoprolol (Zebeta)

Atenolol and propranolol are most commonly prescribed to treat anxiety-related disorders.

 

Beta-blockers and anxiety

Shortly after propranolol was discovered in the early 1960s, its anxiolytic effects were recognized, prompting increasing interest in its off-label use. There have been numerous studies exploring its use to treat substance use and withdrawal, high trait anxiety, autism, aggression, and schizophrenia.

In addition, propranolol has been shown to help individuals suffering from exam nerves, stage fright, performance anxiety, or those who are anxious about undergoing surgery.

A 2016 systematic review and meta-analysis published in the Journal of Psychopharmacology explored the efficacy of oral propranolol compared with placebo or other medications as a treatment option for patients suffering from anxiety disorders.

Steenen SA, van Wijk AJ, van der Heijden GJ, et al. Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis. J Psychopharmacol. 2016;30(2):128–139.

 

The authors determined there was no statistically significant difference between propranolol and benzodiazepine in the short-term treatment of panic disorders, with or without agoraphobia.

"For many people, beta-blockers do a really good job of blocking the physical symptoms of anxiety like a racing heart, sweating, or tremors," said psychiatrist Sarah Gupta, MD, in an article published by VeryWell Mind.

Styx L. Beta blockers are the buzzy new anti-anxiety medicine, here’s what you need to know. Verywell Mind. Updated May 25, 2022.

"And a lot of the time, just dialing down the physical symptoms can be enough to get anxiety under control."

 

 

Beta-blockers versus anxiety medications

Serotonin serotonin reuptake inhibitors (SSRIs) and benzodiazepines are two commonly prescribed medications for the treatment of anxiety disorders.

SSRIs typically require a long period of time—potentially up to 12 weeks—to take effect. Therefore, adjuvant treatment with propranolol may be considered early on.

Benzodiazepines, on the other hand, carry a risk of tolerance, cognitive impairment, dependence, and undesired sedative effects. Compared with benzodiazepines, SSRI side effects are often temporary, reversible, and relatively mild, although tend to occur more frequently.

Treatment with beta-blockers also comes with some risks such as reduced heart rate and low blood pressure. Furthermore, they have been shown to exacerbate asthma symptoms.

Other common side effects of beta blockers include cold extremities, weight gain, and fatigue. Less common side effects include insomnia, shortness of breath, and depression.

When determining which medication offers the most advantages for his patients, psychiatrist Alex Dimitriu, MD, said in the VeryWell Mind article, "I always ask my patients if they feel anxiety more in the mind—rumination, catastrophic thoughts, worry—or the body—racing heart, tight chest, shortness of breath, tremor.”

More globally, it should be recognized that either beta-blockers or other medication such as Xanax or Klonopin are patches.

"If someone needs a patch too often, it might be better to take something that works all the time, usually SSRIs," Dimitriu concluded.