Risk-Benefit Analysis: Using Beta-Blockers for Anxiety

Without question, there is a fair deal of negative stigma surrounding traditional psychopharmaceutical treatments for problems such as anxiety, depression, and panic. While these medications of various classes have been proven effective and safe over the years, there remains a portion of the population that views them as risky, possibly addicting, and overall, not worth taking despite the experience of the uncomfortable symptoms associated with psychological problems. As a result, some people turn to “off-label” solutions for treating issues like anxiety and panic, such as supplements, homeopathic remedies, and other less-proven and not necessarily science-backed options.

Recently, the use of beta-blockers, which are intended to treat heart conditions such as high blood pressure or irregular heartbeat, has become commonly used as off-label treatments for anxiety and panic. Functionally, beta-blockers do just that: they block the rush of adrenaline that occurs when people experience anxiety, therefore reducing the physical symptoms associated with anxiety and panic. But while this sounds solid as an anxiety defense in theory, the practice and clinical research reveals another side of the story that should not be ignored.

Using medications in ways other than indicated always comes with certain risks. This is not to say that medications never have cross-efficacy, but that it is important to be aware of the possible risks and side effects that can come with using an off-label treatment. While there has been longstanding research (beta-blockers have been studied since the 1960s) to suggest that beta-blockers can indeed help reduce the effects of stress-induced anxiety, such as is associated with public speaking or performance, there is also conflicting research which suggests that beta-blockers can actually worsen the symptoms associated with anxiety.

A 1985 study (Kelly) states that “a number of clinical trials have shown the effectiveness of beta-blockers such as propranolol, sotalol and oxprenolol, in the relief of anxiety symptoms both in comparison to placebo and benzodiazepines.” But a much more current study by Archer, Et. Al (2024) concludes that “beta-blockers are increasingly prescribed for anxiety, yet there is a lack of robust evidence of effectiveness.” The information regarding the effectiveness of beta-blockers as a treatment for anxiety remains conflicted, and this is important for patients to understand before assuming that they are the “magic bullet” as a treatment option.

Further research indicates that severe reactions to beta-blockers when used off-label can occur. These include dizziness, fatigue, nightmares and insomnia, slow heart rate, low blood pressure, nausea, irregular heartbeat, and dry eyes. There is also evidence to suggest that withdrawal or the sudden cessation of taking beta-blockers can significantly increase anxiety and depression. It is also important to recognize that certain pre-existing conditions can make the use of off-label beta-blockers dangerous: these conditions include COPD, asthma, and diabetes.

Because of the immediacy and accessibility of information in our society, it can be easy to be influenced by quick fixes and “hacks” for the various problems we encounter. While these solutions can sometimes be effective, when it comes to medical interventions, it is vital to remain cautious and informed before assuming that there is a “miracle drug” that can cure all of our ills. Keep the following in mind anytime an off-label remedy becomes buzzworthy, as beta-blockers recently have:

• Consult with a psychiatrist or psychiatric nurse practitioner to help you determine what medication is best for you and for your unique symptoms. Be wary of self-diagnosis or self-medication.
• Understand what a particular medication is indicated for and if it is commonly used off-label, be sure to understand the associated risks and if you are a candidate for safe off-label use.
• Ensure that any information you find about off-label treatments is scientifically and medically backed. Be wary of anecdotal or non-medical information.
• Just because a new remedy has gained online traction does not mean that it is scientifically supported or safe. It is important to do your due diligence prior to adding a medication or supplement to your treatment.

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