It seems like every few weeks, there’s a new “miracle fix” for anxiety trending on social media. The latest is a decades-old heart medication that more and more people are saying helps them stay calm under pressure.
Many celebrities and influencers — from the Kardashians to Robert Downey Jr. — have spoken openly about their experiences with beta blockers. Singer Shawn Mendes told a crowd full of fans that he’s been taking the medication before every show he’s played in the last year, and writer and comedian Rachel Sennott had some words of advice on a recent red carpet appearance.
“I look in the mirror, and I go, ‘Take that beta blocker, girl. Swallow it down and lock in,’” she said. “Numb is in.”
This medication — designed to lower blood pressure — is now being repurposed by some as a quick fix for nerves before job interviews, first dates or public speaking events.
Dr. Jerry Rosenbaum, chief emeritus of psychiatry at Massachusetts General Hospital and an expert in psychopharmacology and anxiety disorders, joined GBH’s All Things Considered host Arun Rath to break down what the medication can and can’t do. What follows is a lightly edited transcript of their conversation.
This is a segment of “Reality Check,” in which GBH’s All Things Considered and NOVA put viral health trends to the test with real science. The conversation conveys general advice. Always consult your doctor about your particular needs.
Arun Rath: Let’s start with the basics. Beta blockers are nothing new — or at least I’ve known about them for heart conditions for decades. Give us a quick rundown, though, for people who aren’t familiar: What do beta blockers do exactly, and how do they work in the body?
Dr. Jerry Rosenbaum: Sure. One of the ironies of this conversation is that the first professional talk I ever gave was in 1975 on the use of beta blockers and propranolol in psychiatry. And here we are, 50-some years later, talking about it.
I’ll give one other little incident that might help explain how beta blockers do what they do. A researcher in my department was studying the effects of the beta blockers on performance anxiety and had catheters in the veins of presenters at this course, and measured the release of catecholamines — epinephrine and norepinephrine — along with the presentation.
[They] noticed it was universal: Every speaker had a sort of surge at the start of their talk.
But there was a very great difference in response. More experienced and senior presenters kind of took that feeling to be, “I’m pumped and ready to go. Put me in, coach!” And people like me, who were junior and less experienced, experienced the sensation as distressing. We focused on the hand trembling and heart rate increasing from the catecholamines as threatening and embarrassing, and it would influence our cognitions.
The beta blockers [are] blocking the beta-adrenergic effects of epinephrine that lead to that feeling of being pumped, which manifests in your body with tremors, increased heart rate, sweating and so forth. If you experience that as you’re starting to talk — particularly if you’re a little uncertain, or perhaps more predisposed to anxiety — that can be distracting and distressing.
You can get [into] a vicious cycle of going from body to mind and accelerate the anxiety. The beta blockers, basically, depending on the dose, reduce or block that so you don’t experience the bodily sensation. Clearly, there is an interaction between the sensations in your body and how you’re interpreting them cognitively. It influences how you feel and how you subsequently behave.
Rath: That’s fascinating. You mentioned that this was 50 years ago that you gave this talk about beta blockers and propranolol. I’m certainly familiar with that being used for anti-anxiety; I actually used it myself with a doctor’s prescription when I first started doing live radio. How long have beta blockers been used for anxiety in this way, [that has] only been coming up more recently on social media?
Rosenbaum: Well, since I gave the talk in 1975, it had to have been around for a while. I’m not sure when beta blockers were introduced, but I would guess in the 1960s.
They’ve sort of fallen out of acceptance as a mainstay of treating anxiety because if you take beta blockers regularly or continually, you do have some drawbacks.
They slow your heart rate; they’re not good for athletic performance for that reason. You can feel tired with them. There is some debate, but I think increasing evidence that for some people, they can be conducive to depression. So, continual use of beta blockers for anxiety is probably less recommended.
But intermittent use — a dose here, a dose there, you know, for a flutist who wants to be smooth or a piano player who doesn’t want a tremor — doesn’t have those drawbacks.
Rath: For those kinds of situational uses, is that, in general, safe? Are there people who should avoid this? What kind of concern should people have about using it sort of episodically or sporadically?
Rosenbaum: There are individual differences, and then there are differences in dosing.
If you take too much, you can have adverse effects. You could have headaches. You know, if you’re older, I suppose you could have some confusion. You can get lightheaded. You can lose your verve — as I said, the point of the catecholamines is to pump you up and get you going.
But the risks of a moderate or low dose to take the edge off physical symptoms of anxiety are pretty benign.
I think people who already have some cardiac condition associated with heart rate slowing or bradycardia need to be cautious about their use. People who have had falls due to syncope, or sudden blood pressure drop, should be cautious about their use.
As far as the concern about mood changes or depression — again, I don’t think a single use from time to time involves that risk. That’s more associated with moderate to higher-dose sustained use.
Rath: We’re seeing more people get beta blockers through telehealth sites. Should we be concerned about that? What are the risks?
Rosenbaum: I don’t think there’s a specific risk attendant to beta blockers in telehealth that is different from telehealth more generally. You’re not laying hands on a patient, you’re not necessarily getting an accurate estimate of pulse rate, or whether there’s any arrhythmia that might have you concerned about a beta blocker. You’re not getting a blood pressure [test]. You have to trust that, if it’s an online prescription, you know the patient and their cardiac history well enough to avoid the rare but potentially adverse effects.
If a person can check their blood pressure sitting and standing and can take their pulse and know whether it’s regular, I think it’s probably very safe, especially for low- to moderate-dose intermittent use.
But again, it does have cardiac effects, and you probably would like to know that the person has had a normal physical exam within the last six months.
