Like many people I tuned into the Golden Globes last night, mostly for the fashion escapades, truth be told. But during the awards I was intrigued to hear Robert Downey Jr. mention in his speech that he had taken a beta blocker before getting up on stage.

Committed to bringing important information to our Health Insider audience, I instantly went in research mode, trying to understand why Downey Jr. would take what is essentially a blood pressure medication for stage fright.

As it turns out, Downey Jr. is in good company. According to an international study, nearly three-quarters of musicians have tried beta blockers for stage fright, including pop star Katy Perry, who reportedly takes them to help ease the pressure of performing in front of tens of thousands of people.

Not only do actors and musicians use the drug, but it turns out that poker players, surgeons and corporate executives among others are prescribed it off-label to calm their racing hearts and still their trembling hands.

The demand is so high that a San Francisco startup called Kick launched a few years ago to bring the beta blocker to consumers in the US, and some online pharmacies here in Canada seemingly readily dole it out as well.

With so many performers and public speakers on board with the trend, we decided to do a little more digging to understand to get a better sense of the good and bad around beta-blockers to help with anxiety.

Beta Blockers for Anxiety

Beta blockers (also known as beta-adrenergic blocking agents) are medications that are often prescribed to patients suffering from high blood pressure. The medication helps control high blood pressure by causing the heart to beat more slowly and with less force. It also helps widen veins and arteries to improve a restricted blood flow.

Some beta blockers target mainly the heart, while others are formulated to target both the heart and the blood vessels.

There are many different beta blockers for your doctor to choose from, depending on your needs, however the most common two prescribed for anxiety are propranolol and atenolol.

Anxiety causes the brain to make more of the chemicals noradrenaline and adrenaline, both of which can make your heart beat faster and cause debilitating physical effects.

Beta blockers short-circuit the effects of these chemicals, thereby reducing the symptoms of anxiety, including the performance-killing effects of a racing heart, sweating, shaking and other physical effects of anxiety.

These medications don’t treat the underlying feelings of anxiety (this is where CBT and other forms of psychotherapy come in), only the physical symptoms that come with it.

Common Side Effects

Even though propranolol and atenolol are old drugs with strong safety profiles, they are powerful medications with a small but real range of possible side effects.

These can include lightheadedness, breathing difficulties, trouble sleeping, all the way up to reports of congestive heart failure and anaphylaxis.

If you are taking beta blockers, check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, or weight gain.

How to Take Beta Blockers for Performance Anxiety

Your GP will prescribe the appropriate dosage of the beta blocker based on your needs. Be transparent with your doctor about how you wish to use it as the dosage should vary depending on the severity of your anxiety and the situation in which you’ll be taking it. 

Generally considered a short-term solution for anxiety, beta blockers should be taken only as needed, usually about an hour before the anticipated anxiety-provoking situation.

What to Avoid When Taking Beta Blockers

Avoid drinking alcohol while on beta-blockers, as it can decrease the effectiveness of the medication. Also avoid eating or drinking products that have caffeine or taking over-the-counter cough and cold medicines, antihistamines, and antacids that contain aluminum.

Too much potassium can be risky for the heart and kidneys so if you are taking a beta-blocker, your GP may recommend that you keep an eye on your consumption of bananas and other high potassium foods such as papaya, tomato, avocado and kale.

Performance anxiety is far more common than most of us think. If nondrug approaches don’t work, you might want to consider beta-blockers only after their risks and benefits have been thoroughly explained to you and properly assessed with respect to your individual health profile.

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