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In the year 2017, 3.8% of people in the world, which roughly amounts to 284 million, were suffering from a kind of anxiety disorder. The numbers are surely harrowing and concerning. With ever-increasing stress owing to the typical fast life of the late-capitalist stage, mental health illnesses have been a common word or a feeling too many, unfortunately. Treatment of such mental symptoms of anxiety disorders is also advancing. In this article, let’s find out if we can use propranolol for anxiety.
1. What is an Anxiety Disorder?
Anxiety disorders are mental conditions that induce a person to behave a certain way. If someone has an anxiety disorder, they respond to certain situations with fear and dread.
However, anxiety disorders differ entirely from normal feelings of fear, dread, and anxiety. If you are not aware of the distinction, read on to find out!
1.1 Anxiety vs. Anxiety Disorders
Each one of us feels anxious from time to time. For instance, you feel worried, that is, sweaty palms, your heart beating fast, and restlessness before an important job interview or an examination. These feelings, of the healthy amount, are familiar to everyone. Instead of being harmful, anxiety can help notice defaults and induce thinking things through.
To assist you with fighting whatever makes you anxious, it’s your central nervous system that gets immediate signals from your brain, filling it with adrenaline and cortisol, designed to help you fight off the possible threat.
However, anxiety is different from anxiety disorders. The latter goes beyond the healthy amount of nervousness and starts creating lifestyle changes. If anxiety symptoms persist and hinder one’s ability to function daily, they often induce them to overreact. They can no longer control their responses to situations, and they probably need to seek treatment for anxiety disorders.
1.2 Who is at Risk?
The risk of anxiety disorders depends upon a blend of genetic, environmental, and other factors.
A person who has or had the following conditions as part of their overall health is at a higher risk of developing an anxiety disorder than others:
- Personality traits such as shyness or behavioral inhibition
- Anxiety disorders or other mental health concerns run in families.
- The traumatic or stressful events in childhood
Women are more at risk of being affected by anxiety disorders. Researchers also speculate that hormonal changes peculiar to women may be the reason for this fact. The hormone testosterone, which men have more, may also have a role to play.
Due to the inherently patriarchal nature of society, women also do not have access to treatment for anxiety which worsens the situation.
2. Types of Anxiety Disorders
2.1. Generalized Anxiety Disorder
A person suffering from Generalized Anxiety Disorder may feel extreme worry and tension regarding specific incidents or events in their lives. There would not be anything that triggers the anxiety most of the time.
You may feel worried about anything under the sun, your relationships, school, work, life in general, or your food. Often the topics are connected and follow one another.
Symptoms of Generalized Anxiety Disorder
- Persistent worrying or anxiety about events that are out of proportion
- Overthinking plans and solutions to the problems in worst-case scenarios
- Perceiving situations as threatening even if they aren’t
- Difficulty handling uncertainty
- Indecisive and fear of making the wrong decision
- Inability to set aside a worry
- Inability to relax or feeling restless for a prolonged period
- Difficulty in concentrating
Physical symptoms:
- Fatigue
- Trouble in sleeping
- Muscle aches
- Nervousness
- Irritable
- Sweating
- Nausea
2.2. Panic Disorder
A person suffering from Panic Disorder may get intense and sudden panic attacks. These sudden attacks may be induced by an incident or entirely unexpectedly. These attacks are harrowing.
People suffering from this tend to think about the next attack or may altogether avoid the situations that they think can induce an attack.
Symptoms of Panic Disorder
The following certain symptoms are common when a person suffers from a panic attack:
- Racing heartbeats
- Nausea
- Sweating
- Chest pain
- Shortness of breath
- Trembling
- Dizziness
- Numbness
- Hot flushes
- Dry mouth
- Ringing in your ears
- A feeling of dread of dying
- Feeling disconnected from your body
- Cold hands
Most panic attacks last from 5 minutes to 20 minutes, while some can last up to an hour.
Based on their condition, some people suffer from panic attacks once or twice a month, while others suffer several times a week. The latter could be at risk of developing a myocardial infarction.
2.3. Social Anxiety Disorder/Social Phobia
Also called social phobia, this disorder refers to the intense fear of social situations coupled with worry and self-consciousness. People suffering from these symptoms may even avoid social problems altogether to avoid a stressful situation where they might feel anxious.
Symptoms of Social Anxiety Disorder
The behavioral and emotional symptoms are:
- Fear of situations in which one may be judged negatively
- Worrying about humiliating and embarrassing situations
- Intense fear of strangers
- Fear of physical symptoms that may cause one to be embarrassed
- Avoidance of situations where one may be the center of attraction
- Fear of social situations
- The expectation of the worst possible outcomes
The physical symptoms are:
- Racing heartbeat
- Blushing
- Trembling
- Sweating
- Feeling that mind is blank
- Breathlessness
- Dizziness
- Nausea
- Sleep issues
2.4. Specific Phobias
Phobias refer to an intense fear of particular objects or situations. It may often seem that the reaction to a specific event or object is irrational. People may, at times, go to lengths to avoid anxiety-inducing events.
Symptoms of Specific Phobias
The physical symptoms of phobias are:
- A feeling of imminent danger or doom.
- The need to escape.
- Heart palpitations.
- Sweating.
- Trembling.
- Shortness of breath or a smothering feeling.
- A feeling of choking.
- Chest pain or discomfort.
2.5. Agoraphobia
Agoraphobia refers to a fear of being overwhelmed and unable to get help in certain situations making the person suffering from it avoid problems that may involve these. Examples of these situations include crowds, lines, queues, and others.
Symptoms of Agoraphobia
Cognitive and behavioral symptoms of agoraphobia are:
- Fear that a panic attack will make you land in embarrassing or humiliating situations.
- A fear that attacks like this will be life-threatening and that one has no control over it.
- Afraid of people staring.
- Afraid of being the center of attraction.
- Avoid situations that could lead to panic attacks, such as crowded places, and public buses, and public speaking.
- Not being able to leave the house.
Physical effects are:
- Rapid heartbeat
- Rapid breathing (hyperventilating)
- Feeling hot and sweaty
- Feeling sick
- Chest pain
- Difficulty swallowing
- Diarrhea
- Trembling
- Dizziness
- Ringing in the ears
- Feeling faint
2.6. Separation Anxiety
People suffering from Separation Anxiety often feel intense fear of being separated from people to whom they are attached. Those suffering from the illness must have a persistent fear, from four weeks in children to six months in adults.
The fear should also be irrational to their age and must prove to be a hindrance in daily functioning.
Symptoms of Separation Anxiety
- Recurrent and exaggerated anxiety over leaving or being away from home or loved ones
- Constant, extreme fear of losing a parent or other loved one due to illness or disaster.
- The constant fear that something horrible will happen, such as being lost or abducted, separating you from your parents or other loved ones.
- Fear of separation causes many to refuse to leave their homes.
- Not wishing to be alone at home without a parent or other loved one.
- Reluctance or refusal to sleep away from home without the presence of a parent or other loved one.
- Separation nightmares regularly
- When separation from a parent or other loved one is imminent, people frequently complain of headaches, stomachaches, or other symptoms.
2.7. Selective Mutism
Selective Mutism is an anxiety disorder wherein some people cannot speak in certain social situations. It usually starts with a childhood where children cannot talk in school but are talkative otherwise.
If untreated, it persists in adulthood too.
Symptoms of Selective Mutism
- Marked contrast in child’s ability to interact with different people and situations.
- Apprehensive, uneasy, socially awkward, unpleasant, uninterested, or sulky clinginess.
- Shy and reserved.
- Stiff, tight, or ill-coordinated.
- Obstinate or belligerent, throwing temper tantrums when they return home from school,l or becoming enraged when questioned by their parents.
3. How can Anxiety be Treated?
The following ways can help in treating anxiety:
3.1. Psychotherapy
This involves regular personal interaction between patients and healthcare professionals that may help a person change their cognitive and behavioral circumstances. Cognitive Behavioural Therapy is the most effective psychotherapy.
3.2. Medication
Medication is used to treat anxiety and insert serotonin into the brain. These medicines, like anti-depressants and buspirone, may help reduce anxiety symptoms.
3.3. A Combination of the Two
Some doctors prefer a combination of both psychotherapy and medication for some patients.
Check this article out to find out about healing crystals for anxiety!
4. What is Propranolol?
Propranolol hydrochloride is an FDA1-approved medication originally developed by the British scientist Sir James Black for the treatment of angina pectoris (about 50 years ago).
It was also used for treating myocardial infarction, high blood pressure, tremors, proliferating infantile hemangioma (oral propranolol, available as a liquid solution), and migraines. It comes under the class of drugs known as beta-blockers (beta-adrenergic blocking agents).
5. Can You Take Propranolol?
Propranolol symptoms have been prescribed off-label by doctors for a long time. That is because Propranolol hydrochloride slows the heart rate and affects the blood vessels so that it is easier for the heart to pump blood.
Often, people suffering from an anxiety disorder feel the physical symptoms of anxiety before certain events like an examination or an interview. They would sweat, tremble, feel nauseous, and get affected by all the other symptoms. Beta-blockers (β blockers), in this case, tackle the physical effects of anxiety so that such people can feel calmer in those situations.
Propranolol also blocks the effects of the stress hormones like noradrenaline which further helps reduce these symptoms.
However, beta-blocker does not affect the mental symptoms of anxiety-like worry, dread, or fear of the worst possible circumstances. Even if that is not the case, many sufferers of anxiety disorders have claimed that a reduction in physical anxiety symptoms has dramatically helped reduce the psychological symptoms.
6. How Quickly Does Propranolol Work?
Propranolol for treating anxiety works relatively fast in relieving situational anxiety symptoms like sweating and racing heartbeat. It reduces those symptoms in about an hour or even less, in 30 minutes.
Keeping that in mind, if a person has a stressful situation to face after a while, which is making them anxious, it is wise and advisable to take propranolol about 30-40 minutes before that event. For some people, it may also take a little longer to affect; hence, it is perhaps better to take beta blockers about an hour or two before the event.
However, this is not expert advice, and always take your doctor’s consultation before taking a beta-blocker.
7. How Long Does Propranolol Last?
Propranolol can last up to 3-4 hours, although it varies from person to person. During this short term, propranolol may help reduce the physical symptoms of anxiety. It will help with a racing heart, trembling, sweating, mental blackness or fogginess, and more.
You can substantially feel the difference.
8. How does Propranolol Help in Treating Anxiety?
Propranolol, a beta blocker type, stops neurotransmitters known as beta-adrenergic agents from attaching to their receptors. The term ‘adrenergic’ refers to the versions of the hormone adrenaline in your body that it makes naturally.
Adrenaline is responsible for your fight-or-flight responses. You would probably remember feeling an adrenaline rush when watching a scary movie. Your heart beats faster, blood flow increases to the brain and muscles, and the sugar is broken down into fuel.
The adrenaline rush is helpful when a real threat is imminent, but it becomes difficult to function daily if you live on an adrenaline rush all the time.
Propranolol can help block the beta-adrenergic agents (beta blockers), which block the physical symptoms of stress from manifesting. If a neurotransmitter isn’t attached to the receptor, it cannot signal the body to produce adrenaline. Propranolol gets attached to adrenaline receptors instead.
Propranolol may cause the ‘antihypertensive effect.’. The antihypertensive effects of propranolol reduce blood pressure by helping the blood vessels relax and expand, aiding in more manageable blood flow throughout the body, thus helping treat hypertension.
Although, this might prove to be a little unsafe for people with low blood pressure, and should only be taken by such people as a prescription drug after they get their condition medically reviewed.
9. Is Propranolol Good for Anxiety?
A lot of experts prescribe propranolol because it is considered safe to be taken for the long term. It isn’t inherently dangerous, but if you are pregnant or have some health condition that can worsen, it is wise not to take the medication. In all cases, it is essential that you consult a doctor.
It is important to take note of the fact that this medicine is a beta-blocker. Since it affects the response to nerve impulses as it works, it makes the heart beat slower, thus decreasing a person’s blood pressure. And in the case of low blood pressure, the amount of blood, as well as oxygen, is increased in the heart.
People that already have low blood pressure should get their prescription medically reviewed, just in case, because they might put themselves at risk of a heart attack.
9.1 Side Effects of Propranolol
Similar to any other medication, propranolol also has both risks and benefits.
The most common side effects of propranolol include the following:
- Drowsiness
- Slow heart rate
- Nausea or Diarrhoea
- Fatigue or Tiredness
- Dizziness
- Cold feet
- Nightmares
- Weight gain (especially in the first few months)
Some rare/serious side effects of propranolol may also include the following:
- Trouble breathing or swallowing
- Rashes/blisters/hives (Peeling skin)
- Weight changes
- Irregular heartbeat/unstable heart rhythms
In any case, do not stop taking propranolol suddenly or take a missed dose lightly since it may trigger other serious side effects like chest pain, sweating, and shaking or may make you experience other severe withdrawal symptoms.
10. Who can Take Propranolol?
Prescribed propranolol is generally safe for adults and children above the age of 12. However, it is not proven to treat high blood pressure or any other health conditions below the age of 12.
Taking beta blockers for anxiety may not be safe for everyone, so it is wise to consult your doctor before taking propranolol or any other medication.
An additional important point to be noted would be that people that suffer from Major Depressive Disorder (MDD) and alike are at risk of being at the end of severe mood changes. With the way propranolol affects norepinephrine and epinephrine, there’s also a chance of suffering from memory problems.
People with the following conditions may be at risk of taking beta blockers:
- Had an allergic reaction to propranolol or any other medications
- Heart failure/heart attack
- Have diabetes
- Have liver or kidney problems
- Have asthma or any lung disease
- Are you pregnant or are breastfeeding
11. Other Uses of Propranolol
Propranolol is used to treat a wide range of issues. It covers both physical and mental health issues.
Some of the health conditions that propranolol is used to treat, other than anxiety, are:
- Migraine
- High blood pressure (hypertension)
- Heart rhythm disorder (fast or irregular heartbeat/atrial fibrillation/arrhythmia)
- Chest pain caused by angina
- Overactive thyroid gland
- Infantile hemangioma
The list is not exhaustive. However, a person should make sure that they are taking beta blockers on a doctor’s prescription and are taking them according to the proper prescribed propranolol dose.
Some off-label uses of propranolol can include:
- Thyroid storm treatment
- Portal hypertension
- Neuroleptic-induced akathisia
12. How to Take Propranolol?
12.1. Regular release
This distributes propranolol into your body fast; thus, depending on your propranolol dose, you may need to take it numerous times per day. If you suffer from performance anxiety 2(stage fright), you may take it this way as an off-label use of beta blockers.
It can help with the following physical performance anxiety symptoms:
- Dry mouth
- Irregular pulse
- Tremors
- Nausea
- High blood pressure
12.2. Slow-release
The drug is released gradually, so you don’t have to take it as frequently; once per day is typically plenty.
If you take it once per day, your doctor may encourage you to take your first propranolol dosage before sleep since it might induce dizziness. If you do not feel dizzy after the first propranolol dosage, take it in the morning.
Propranolol normally does not cause stomach distress, so you can take it with or without meals. It’s preferable to do the same thing every day.
13. In a Nutshell
Hence, people prescribe propranolol because it is safe to be taken and is used to treat a wide range of issues. It blocks the neurotransmitters from attaching to the receptors and helps reduce the physical symptoms of anxiety-like sweating, racing heartbeats, trembling, and many others.
Although it does not help with mental symptoms, the reduction in physical symptoms helps in reducing the mental symptoms too.
However, you should make sure that you are taking propranolol after consulting your doctor. It might be especially necessary to ask for professional medical advice for people that suffer from peripheral vascular disease, post-traumatic stress disorder, hypertrophic subaortic stenosis, are on other anxiety medication or prescription medicines, have experienced a heart attack/heart failure before, drunk alcohol, cardiovascular diseases, liver disease, kidney disease, some lung disease, have diseases that have something to do with heart and blood vessels as part of their medical history, obsessive-compulsive disorder, are not very immune to allergic reactions, or other medical conditions.
14. FAQs
14.1. Is it safe to take a beta blocker when you’re breastfeeding?
Research suggests that propranolol so far isn’t known to cause any side effects in babies that breastfeed since it passes into breast milk in very tiny amounts. Even during pregnancy, taking a beta blocker3 won’t cause any side effects.
14.2. Is propranolol an over-the-counter medication?
Over-the-counter medications are medicines you can buy without a prescription. Propranolol 4comes under prescription medication. You cannot start taking it without approval from healthcare professionals, no matter what health problem you have.
14.3. What should I do in case of a missed dose?
If you’re taking propranolol for a medical condition that requires you to keep a strict watch on your medication schedule, you need to take the missed dose the very moment you remember it, if possible.
But if it’s close to the time of your next dose, skip the former dose and go on with your next medicine as you were typically prescribed by your healthcare provider.
14.4. Can I take propranolol with my food?
With or without food, propranolol’s efficacy remains unchanged. Research suggests that taking propranolol before or after, with or without food, has no significant effects.
It’s still best to check with your healthcare provider, though, in case you suffer from heart disease or usually need to get your prescription medically reviewed.
- Darrow, Jonathan J., Jerry Avorn, and Aaron S. Kesselheim. “FDA approval and regulation of pharmaceuticals, 1983-2018.” Jama 323.2 (2020): 164-176. ↩︎
- Chellappa, Sarah L., and Daniel Aeschbach. “Sleep and anxiety: From mechanisms to interventions.” Sleep medicine reviews 61 (2022): 101583. ↩︎
- Ziff, Oliver J., et al. “Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment.” BMC medicine 18 (2020): 1-11. ↩︎
- Kalam, Muhammad N., et al. “Clinical pharmacokinetics of propranolol hydrochloride: a review.” Current Drug Metabolism 21.2 (2020): 89-105. ↩︎
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