Beta-Blockers for Anxiety: Types, Uses, Side Effects, & More

What Are Beta-Blockers & How Do They Work?

When anxiety is present, the heart and vessels constrict and your body releases stress hormones.¹ When these hormones are blocked, they can help relieve anxiety symptoms, such as increased heart rate and blood pressure. Some beta-blockers can also work on blood vessels in the brain and help prevent and reduce the intensity of headaches.¹

How Do Beta-Blockers Help Anxiety?

Beta-blockers are medications typically used for heart conditions but some are also used for relieving anxiety symptoms.^{1, 2} They work on beta receptors in the heart and sometimes blood vessels to cause relaxation. Beta-blockers block the molecules that makeup norepinephrine and epinephrine in blood vessels, leading to blood vessel dilation and, therefore, reduced anxiety symptoms.

Beta-blockers can be used to treat the following anxiety disorders:^{2, 3, 4, 5}

• Generalized anxiety disorder (GAD)
• Panic disorders
• Post-traumatic stress disorder (PTSD)
• Specific phobias
• Performance anxiety

Here are some ways beta-blockers may help anxiety symptoms:

• Prevent a fast heart rate
• Prevent shaky voice and hands
• Reduce sweating
• Prevent dizziness
• Help with falling asleep and staying asleep
• Reduce shortness of breath
• Prevent heart palpitations
• Prevent and reduce migraine severity

Are Beta-Blockers Effective for Reducing Anxiety?

Beta-blockers are helpful for preventing the physical symptoms that anxiety causes but do not prevent anxiety itself. They are used to treat different types of anxiety disorders, including GAD, panic disorders, post-traumatic stress disorder, specific phobias like going to the dentist, and performance anxiety.^{2, 3, 4, 5} However, beta-blockers do not help treat social anxiety.

In comparison, beta-blockers have been shown to be as helpful as benzodiazepines, such as Xanax, for treating anxiety.⁶ Beta-blockers are also better tolerated than benzodiazepines. Selective and non-selective beta-blockers have not been compared in controlled trials yet for their effectiveness on anxiety.

How Do You Take Beta-Blockers for Anxiety?

Beta-blockers are taken by mouth. Your dose may be determined based on your kidney, liver, and heart function, age, and dosage form.^{7, 8, 10}

• Atenolol is taken as a tablet and as 50 mg-100 mg per day.⁷
• Metoprolol is taken as a tablet and at 25-100 mg once or twice per day.^{8, 9}
• Propranolol is supplied as a tablet, extended-release capsule, and solution (liquid) and is typically taken as 80-240 mg for anxiety.^{10, 11, 12}

How Long Do Beta-Blockers Take to Work for Anxiety?

It can take 30 minutes to an hour to begin to feel the effects of beta-blockers.¹ Effects peak at about 1-4 hours and can last 15-30 hours.¹ Symptoms will continue to improve over two weeks.¹² Examples of symptoms that improve over two weeks include decreased heart rate and blood pressure, hand-sweating, and shaky voice.

Types of Beta-Blockers

There are two categories of beta-blockers, including selective and non-selective beta-blockers. Selective beta-blockers work on beta-1 receptors in the heart.⁷ Non-selective beta-blockers work on beta 1 receptors in the heart and beta 2 receptors in the blood vessels.¹⁰ The decision of selective or non-selective beta-blockers is chosen based on other medical conditions you may also need to treat or avoid.

Selective Beta-Blockers

Selective beta-blockers work only on the heart.⁷ They work on the heart by blocking the hormones norepinephrine and epinephrine. These hormones are released during anxiety and can cause increased blood pressure, heart rate, sweating, and other physical symptoms of anxiety. Selective beta-blockers do not prevent anxiety but help mask the symptoms and help you physically feel better.

These are the most commonly prescribed selective beta-blockers for anxiety:

• Atenolol (Tenormin)
• Metoprolol tartrate (Lopressor)
• Metoprolol succinate (Toprol XL)

Non-selective Beta-Blockers

Non-selective beta-blockers work on the heart and the vessels to cause relaxation within the body, also blocking norepinephrine and epinephrine.¹⁰ Psychological symptoms of anxiety that are not affected by beta-blockers may include feelings of anxiousness and dread.

These are the most commonly prescribed non-selective beta-blockers for anxiety:

• Propranolol (Inderal)

Potential Side Effects of Beta-Blockers

Side effects from beta-blockers can occur from the medication, reducing pressure on blood flow. The result is feelings of tiredness and dizziness and possibly a slowed heart rate. After about two weeks, though, the body will get used to the medication, and these side effects should wear off. Since side effects are mild, you can stay on beta-blockers for anxiety until your anxiety has subsided.

Side effects of beta-blockers may include:*⁸

• Tiredness
• Dizziness
• Depression
• Diarrhea
• Shortness of breath
• Slow heart rate
• Rash

*All medications, including beta-blockers, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Are Beta-Blockers Safe?

An advantage of beta-blockers is that they are not habit-forming and are not addictive, unlike some anxiety medications. Also, beta-blockers tend to have mild side effects that are not very common. However, while it is not common, some people may experience serious side effects from beta-blockers. If you experience severe side effects, you should contact your doctor right away.

Serious side effects of beta-blockers may include:*^{7, 8, 10}

• Chest pain or heart attack: If you have heart disease and suddenly stop taking your beta-blocker, serious heart effects can occur.
• Worsening heart failure: If you have heart failure and your doctor increases your dose, your body’s receptors may increase at first, causing the opposite effect of the medication to occur.
• Masked low blood sugar symptoms: If your blood sugar is too low, beta-blockers can hide low blood sugar symptoms.
• Thyrotoxicosis: If you have an overactive thyroid and suddenly stop taking your beta-blocker, serious side effects, like increased heart rate, can occur.
• Peripheral vascular disease: If you have blood clots in your arms or legs, beta-blockers can make these symptoms worse.

*All medications, including beta-blockers, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Who Should Avoid Beta-Blockers?

You should not take beta-blockers if you have certain medical conditions, as beta-blockers can slow the heart’s function, making these conditions worse. They can also hide symptoms of certain conditions, risking coma or death. Some beta-blockers can also act on the lungs, making it harder to breathe.

People who should not take beta-blockers include:^{7, 8, 10}

• People with asthma: Some beta-blockers should not be taken if you have asthma. Non-selective beta-blockers may act on the receptors in the lungs and cause restriction of airflow.
• People with heart failure, heart attack, or chest pain: Both types of beta-blockers may temporarily cause an increase in the number of beta receptors. As a result, they can worsen or cause serious heart conditions to occur.
• People with a slow heart rate or low blood pressure: Beta-blockers are normally used to decrease heart rate and blood pressure. You should not use beta-blockers if your levels are low or unstable.
• People with unstable blood sugar levels: Beta-blockers can increase blood sugar levels or mask symptoms of low blood sugar. It can be very dangerous to take beta-blockers if you have uncontrolled blood sugar levels.

Questions to Ask Your Healthcare Provider About Beta-Blockers for Anxiety

You may want to know more about the serious side effects that beta-blockers may cause, such as if you are at risk for serious side effects and what you should do if you experience them. While there are no beta-blockers over the counter, you can ask your doctor, psychiatrist, or therapist if they believe beta-blockers are right for you. Online psychiatry services may be a good option if you need to change prescribers.

Questions to ask your care team about the side effects of beta-blockers include:

• How long will it take for me to adjust to taking beta-blockers for anxiety?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• What is the best dosage to ensure fewer side effects?
• Is there anything I should tell my therapist about this new medication?
• Is there a certain beta blocker I should take to avoid depression?
• What other side effects make occur from beta-blockers?
• Who is most likely to experience side effects?
• How can I prevent side effects from occurring?
• Which beta-blocker should I take if I also have headaches or migraines?
• Is it safe for me to take a beta blocker for anxiety if I have a heart or vascular condition?
• Which beta blocker for anxiety has the least amount of side effects?
• Which beta blocker is the most effective for anxiety?

In My Experience

In my experience, many people tolerate beta-blockers well. They are a common medication and can be used alone or with other anxiety or depression medications. It’s important to talk to your doctor and follow their guidance because beta-blockers can have serious side effects if combined with certain medical conditions.