Beta blockers for anxiety: Insights from a top psychiatrist

Beta blockers such as propranolol and atenolol may help some people ease the physical symptoms of anxiety, according to Dr. Max Pemberton, a leading psychiatrist. These drugs, developed decades ago to treat high blood pressure and heart rhythm problems, blunt the body’s fight-or-flight response by blocking adrenaline. The result can be a slower heart rate, lower blood pressure, and reduced sweating, trembling, and shortness of breath during stressful moments.

Propranolol emerged from work in the 1960s by Sir James Black at a British company, and the medicine soon found a second life outside strictly cardiovascular use. Clinicians have increasingly prescribed beta blockers to help with performance anxiety, public speaking, and other scenarios that trigger acute physical symptoms. Yet the medical literature is mixed: some studies show the drugs can be very helpful for short-term anxiety or stage fright, while others show limited or inconclusive benefits for longer-standing anxiety disorders. They are generally considered less effective than antidepressants for longstanding anxiety, and they do not address the underlying psychological distress.

Many patients report that beta blockers offer a safe, non-addictive, non-sedating option to regain control of physical sensations during moments of stress. They do not treat thoughts or emotions directly, but by reducing adrenaline’s effects they can make it easier to cope with a difficult public appearance, exam, or performance.

Hollywood has highlighted their use this year: Kristen Bell, Rachel Sennott, and Natasha Rothwell spoke about taking beta blockers before public appearances. Khloe Kardashian and Robert Downey Jr. have also acknowledged past use. Dr. Pemberton notes that in his own practice he has prescribed them for specific situations; he once took propranolol himself in a staged test of performance anxiety.

His anecdotal experience underscores a broader point: a perceived ritual or belief about the medication can contribute to its perceived benefit. He recalls a period when he used a small dose about an hour before live studio appearances; after one day he forgot the dose and realized he had felt calm for ten minutes before the nerves returned. That experience led him to wonder whether the effect was physiological or partly psychological, and he stopped taking them altogether for his own work.

Pemberton also recounts a case of a colleague who froze while addressing an audience. After suggesting a beta blocker to take before speaking, the speaker returned months later transformed—smiling, confident, and able to improvise. The anecdote illustrates how the drugs may help some people manage performance anxiety while they work on longer-term strategies for underlying distress.

Nonetheless, doctors emphasize that beta blockers target symptoms rather than the root causes of anxiety. They are not appropriate for everyone and can interact with other medical conditions or medications. They can cause dizziness, fatigue, and other side effects, and should be used under medical supervision, particularly for people with certain heart or lung conditions.

Separately, the doctor notes a life story that can offer perspective to patients dealing with stress. Reading obituaries of notable figures who faced adversity can remind people that resilience is possible. The most recent example cited is that of Robert Redford, who died at 89 after a life marked by early hardship—polio, a serious car accident, and personal losses. The obituary of stars like Redford can illuminate how people have endured and continued to find purpose.

With the approach of autumn, Dr. Pemberton urges vitamin D supplementation for many people. He says blood tests showed deficiency in some patients, a common issue in months with less sun. Vitamin D3 is preferred to D2 because it is more easily absorbed by the body, and many clinicians now recommend it as a practical, daily supplement during the fall and winter.

Ultimately, beta blockers can be a helpful option for some people when used appropriately and as part of a broader strategy that may include therapy, lifestyle adjustments, and other medications. They are not a universal remedy for anxiety, but they can offer a temporary respite that allows individuals to function while they work on underlying issues. Anyone considering them should discuss risks and benefits with a GP or psychiatrist, balancing potential relief with possible side effects and interactions.