Understanding Beta Blockers for Anxiety
Beta blockers are a class of medications that can effectively manage symptoms of anxiety, particularly when linked to specific events or situations, by blocking the effects of adrenaline. This action helps reduce physical symptoms of anxiety such as a rapid heartbeat, shaking, and sweating. Beta blockers work by blocking beta-adrenergic receptors, also known as adrenoceptors, throughout the body, which are activated by neurotransmitters like epinephrine and norepinephrine. By competing with these neurotransmitters for receptor sites, beta blockers slow down certain types of cell activity, making them useful in treating a wide range of illnesses. This handout provides detailed information about the use of beta blockers for anxiety, including benefits, dosing, timing, potential side effects, contraindications, and FDA approval status.
There are different types of beta-blockers, each working in unique ways. Some can enter the brain and affect both the brain and the rest of the body, while others only work on the heart and blood vessels. Additionally, some beta-blockers target more than just adrenaline receptors. Because of these differences, we choose specific beta-blockers based on the patient's specific needs and situation.
Managing Daily Anxiety
For managing daily anxiety, Metoprolol ER is our preferred choice. We typically start with a dose of 25 mg each morning, and if additional relief is needed, we can increase it to 50mg after 3-5 days.
Anxiety Coupled with Depression
When anxiety is coupled with depression, Pindolol at 5mg twice a day proves effective. Doses can increase to 10 mg 2x per day. Pindolol has a unique pharmacological profile compared to other beta-blockers, as it not only blocks beta receptors but also has partial agonist activity at certain serotonin receptors (5-HT1A receptors) in the brain. This dual action has led to its investigation as an augmenting agent for anxiety disorders and depression.
Special Considerations
Performance Anxiety: For anxiety tied to specific anxiety provoking events, such as public speaking or for fear of flying, Propranolol (10-20mg) should be taken about an hour to an hour and a half before the anticipated event to help manage symptoms.
Patients with Asthma: For individuals with asthma, Metoprolol ER is a safer option because it primarily affects the heart and is less likely to impact the lungs or airways.
Pregnancy: During pregnancy, it is crucial to consult your OB-GYN first, but Labetalol is generally considered safe. It is typically prescribed at 100 mg twice daily, and if anxiety spikes in the evening or before bed, a single dose at night might suffice.
Best Time to Take Beta Blockers
Metoprolol ER is long acting and is generally recommended for morning use to manage symptoms throughout the day.
Pindolol is typically taken 2 or 3 times a day because it is short-acting. When used to help with depression, maintaining consistent levels in the body is important.
Propranolol for event-related anxiety should be taken approximately 1 to 1.5 hours before the anticipated stressful event.
Potential Side Effects
Common side effects, affecting less than 5% of patients, include fatigue, cold hands or feet, upset stomach, dizziness, and difficulty sleeping.
Rare but serious side effects may include shortness of breath, slow heart rate, sudden weight gain, and swelling in the hands or feet.
For those engaging in intense physical exertion, be aware that beta blockers will lower the maximum heart rate you can normally achieve, so peak performance may be impaired.
For those with asthma, please discuss adding a beta blocker with your PCP as beta blockers can exacerbate asthma related symptoms.
Potential Contraindications
Patients who are pregnant or with asthma, COPD, or certain cardiovascular conditions should consult their healthcare provider before starting beta blockers, as these medications can exacerbate certain symptoms.
FDA Approval Information
Beta blockers are FDA-approved primarily for cardiovascular conditions, but beta blockers are commonly used off-label for the management of situational anxiety symptoms.
Sources
Cleveland Clinic: https://health.clevelandclinic.org/beta-blockers-for-anxiety
Texas Health: https://www.texashealth.org/areyouawellbeing/Behavioral-Health/Beta-Blockers-and-Anxiety
The Independent Pharmacy: https://www.theindependentpharmacy.co.uk/anxiety/guides/propranolol-guide
This handout is designed to provide a preliminary overview of the off-label use of beta blockers for anxiety, helping patients and healthcare providers make informed decisions about treatment options.
