From Head to Heart: Beta Blockers and Anxiety
Behavioral Health
July 25, 2022
From Head to Heart: Beta Blockers and Anxiety
Female provider consulting with older male patient

If you suffer from anxiety, you may be all too familiar with the bodily symptoms that can come along with it — a racing heart, clammy hands, feeling shaky, and having a hard time catching your breath. The same can hold true for infrequent and short-lived but anxiety-inducing moments, such as giving a big presentation or walking into a crowded party. In order to find relief, you’ve accept that you either have to ride it out or remove yourself from the situation.

So when television reality star Khloe Kardashian came forward saying she takes a beta blocker, a medication typically used for heart conditions, to help nip her nerves in the bud as-needed, it naturally piqued some public interest as another alternative.

But what does a heart medication have to do with tackling anxiety symptoms? Gonzalo Perez-Garcia, M.D., a psychiatrist and facility medical director at Texas Health Behavioral Health Dallas, says it comes down to the medication’s effect on how your body reacts to adrenaline.

“Beta blockers essentially ‘block’ the body’s natural response to the hormone epinephrine, more commonly known as adrenaline, by standing between a beta receptor and the adrenaline that is telling it to get in fight or flight mode. In return, you get a slower heart rate and lower blood pressure,” Perez-Garcia explains. “This is a positive attribute when tackling certain heart or vascular conditions in which a rapid heart rate and blood pressure could cause a lot of damage or be potentially fatal, but adrenaline also spikes when you’re anxious, hence the overlap here.”

The classic way that beta blockers have been used to treat anxiety has been in cases of social and/or performance-related anxiety in which these uncomfortable physical symptoms pop up but don’t go beyond the anxiety-inducing activity. Perez-Garcia notes that a lot of the time, controlling those physical symptoms can be enough to get the anxiety under control or to a manageable level where you can move forward with that event and get to the other side of it where there’s nothing to be anxious about anymore.

Who is a Good Candidate?

As with any medication, there are pros and cons to take into consideration. What works for one person may not work for you, and vice versa. When determining the best medication fit for his patients, Perez-Garcia says he always asks his patients how their anxiety tends to present.

“If your anxiety is more about constant worrying and losing sleep, a beta blocker isn’t going to help you as much as other medication options because they do not target psychological symptoms,” Perez-Garcia explains. “But if you feel like your anxiety causes a lot of physical discomfort, either because you have panic attacks or your heart is racing all the time from nerves, or again, it’s something that just crops up at the thought of talking in front of a big crowd, then a beta blocker may be something to consider talking to your doctor and/or psychiatrist about.”

Beta blockers can also be great ways to get the conversation (and treatment) started for those who are concerned about the stigma associated with traditional psychiatric medications.

“Sometimes it’s all about easing people into it, especially since there still is a stigma regarding mental health care,” Perez-Garcia explains. “For example, if I prescribed you an anti-anxiety medication, you may be averse to treatment because you’re thinking if you say yes to this medication, that means you must have a mental health problem. But if I tell you, ‘How about we get you started on this blood pressure medication at a low dose that will decrease those uncomfortable symptoms you’re feeling?’ You may be more open to that because you’re not on an anti-anxiety medication, you’re on blood pressure medication; that can be more appealing to someone.”

Beta blockers can also be great alternatives to more traditional psychiatric medications that can come along with potential side effects of dependency, opening the door to more people who either worry about becoming dependent or have dependency issues.

Understanding the Risks

While taking a beta blocker may sound as convenient as taking an ibuprofen for a headache Perez-Garcia warns that it’s not without its own risks. Additionally, it’s just one tool in the treatment arsenal.

“It’s rare that I ever have someone on just a beta blocker. I usually combine that with something more traditional, like an antidepressant and/or therapy,” he says. “You can use a beta blocker in conjunction with working with a therapist to learn ways to cope with and potentially overcome your anxiety, with the goal of one day not even needing the medication to help smooth things over.”  

Because taking a beta blocker can result in low blood pressure and a slow heartbeat, they’re not recommended for anyone who already has a history of low blood pressure and/or a slow heartbeat. Beta blockers generally are not recommended for those with asthma because of concerns that the medication may worsen asthma symptoms or trigger severe asthma attacks.

Patients with diabetes should also avoid beta blockers because they can sometimes mask signs of a hypoglycemic episode, such as a rapid heartbeat. It’s also contraindicated in patients with asthma or COPD because it can negatively affect lung function.

Common side effects of beta blockers can include:

  • Cold hands or feet
  • Fatigue
  • Weight gain

Less common side effects include:

  • Shortness of breath
  • Trouble sleeping

“I always look at your most recent blood pressure readings. If you’re on the low end, I’ll shy away from using a beta-blocker or I might limit it to an as-needed basis. But if you come in and you already suffer from hypertension and you have anxiety with physical symptoms, great, then we can treat two things with one medication,” Perez-Garcia adds.

The Takeaway

Beta blockers are commonly prescribed because of their ability to treat a wide range of health issues. However, there are still instances in which they are not the best choice. That’s why it’s always a good idea to talk to your health care provider about any questions or concerns you may have. Additionally, it is never recommended to take medication that has not been prescribed to you.

“While it’s nice that Khloe Kardashian’s comments about beta blockers are getting people talking about this great treatment option, it’s not okay that she took her mother’s medication. I know she has a lot of influence and I never want that to be perpetuated as something that is OK to do,” Perez-Garcia adds. “You want to make sure whatever you’re taking is approved by your doctor, and never assume your doctor knows everything you’re being prescribed by other doctors, either. Always, always, always provide an updated medication list to your entire provider team every time you see them.”

If anxiety or depression is keeping you from living your life, or doing the things you want to do, talk with your doctor about all of your available treatment options.

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