An overwhelming sense of tension, accompanied by a rapid heartbeat and a relentless stream of thoughts that make it almost impossible to concentrate on anything else. Anxiety, a condition that can take many forms and result from a variety of triggers, affects countless people in the United States. Statistics show that approximately 31.1% of adults in the United States[1] have experienced symptoms of an anxiety disorder at some point in their lives.
The impact of these anxiety symptoms on daily life can be significant. Fortunately, there are a number of tools available to help manage anxiety and provide much-needed support to those struggling with its effects. One such tool is the drug propranolol, which is known for its effectiveness in reducing anxiety. In this article, we look at propranolol’s role in anxiety management, how it works and what individuals can expect when prescribed treatment.
What is Propranolol?
Propranolol, known under the brand name Inderal, has served a variety of medical purposes since its introduction in the 1960s. As a beta-blocker, its original use was primarily to lower blood pressure and protect the heart after a myocardial infarction (heart attack). Backed by the FDA [5], propranolol has been approved to treat the following conditions
- Angina pectoris (chest pain)
- Atrial fibrillation (irregular heartbeat)
- Essential tremor (involuntary shaking, often of the hands)
- Hypertension (high blood pressure)
- migraine headache
- Myocardial infarction (heart attack)
Characterised as a non-selective beta-blocker, propranolol’s effects extend beyond the cardiovascular system, allowing doctors to prescribe it for a variety of purposes over time. Some of its benefits have been discovered by chance while treating patients for unrelated conditions. In particular, propranolol has shown efficacy in the treatment of physical symptoms of anxiety, which can be attributed to the effects of beta-blockers.
Is propranolol an effective treatment for anxiety?
Anxiety, a condition that can significantly affect daily life, often leads to sleep disturbances, social challenges and even appetite loss due to nausea. Over the years, many avenues have been explored in the search for relief, from prescription drugs to home-based solutions such as CBD. However, when considering such products, it is imperative to conduct thorough brand research and ensure reliability and quality through measures such as independent third party testing, as in the case of CBDfx.
Propranolol, a drug introduced in the 1960s [4], has been used to treat anxiety and has proven to be helpful in various capacities over time. As a broad term, “anxiety” can be further subdivided into specific disorders as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):
- Anxiety disorders (including generalised anxiety disorder, panic disorder and specific phobias such as stage fright)
- Trauma and stressor-related disorders (such as PTSD)
- Obsessive-compulsive disorders
Treatment approaches tend to vary depending on the specific diagnosis. In general, a combination of medication and cognitive behavioural therapy (CBT) sessions with a licensed therapist has shown promising results. Propranolol has traditionally been used to reduce performance anxiety and physical anxiety symptoms, and recent research suggests that it may also be effective in treating PTSD.
How Quickly Does Propranolol Work For Anxiety?
The effectiveness of propranolol in reducing anxiety depends on a number of factors such as age, liver and kidney function, which affect its metabolism. Regular release tablets typically begin to work about 30 minutes after they are taken and provide relief for about three to six hours. Extended-release capsules, on the other hand, continue to work for about 12 hours before gradually wearing off. As a result, some practitioners prescribe multiple doses per day to optimise therapeutic benefits.
Understanding how propranolol works in the treatment of anxiety
1. The multifaceted nature of anxiety symptoms
Anxiety, a common psychological condition, manifests itself in a variety of ways. Its symptoms can be divided into psychological and physical manifestations. Often intertwined, these symptoms create a cyclical pattern that exacerbates the individual’s distress and even leads to anxiety rooted in the anxiety symptoms themselves.
Psychological symptoms revolve primarily around thought patterns. While experiencing occasional anxiety is a natural aspect of being human and can serve as a protective mechanism, when fear and worry become excessive and disrupt daily life, anxiety can be considered a disorder.
On the other hand, physical symptoms are an extension of the body’s innate fight-or-flight response. Anxiety triggers physiological responses such as increased blood pressure, muscle tension, difficulty breathing, rapid heartbeat and chest pain. These involuntary physical effects can be unsettling even for the person experiencing them.
2. Propranolol’s role in regulating the stress response
Propranolol, a beta-blocker, plays a key role in the treatment of anxiety disorders by targeting the body’s fight-or-flight response. This response is partly regulated by the actions of epinephrine (adrenaline) and norepinephrine, chemicals released by the sympathetic nervous system. This system and its receptors are collectively known as the adrenergic system.
What makes propranolol different is its ability to act in several areas of the body, making it particularly effective in treating anxiety. By blocking the beta receptors responsible for transmitting adrenergic messages, including within the central nervous system, propranolol effectively slows down the body’s fight-or-flight response. As a result, it helps to control rapid heart rate, increased blood pressure and tension – the physical symptoms associated with anxiety.
Recent studies have also looked at propranolol’s effect on memory recall. The drug has shown promise in offsetting some of the adverse effects of recalling traumatic events[2]. This potential benefit offers hope to people with a history of trauma, such as those affected by post-traumatic stress disorder (PTSD).
3. Assessing the side effects of propranolol for anxiety
Propranolol is generally considered to be safe and is a good alternative to other anti-anxiety drugs. Compared with benzodiazepines[3] such as alprazolam, clonazepam and lorazepam, propranolol is not habit-forming and has a lower risk of drowsiness. However, as with all prescription medicines, propranolol is not without risks and it is important to be aware of these:
Low blood pressure: Propranolol can lower blood pressure, which may be beneficial in some people. It is advisable to monitor your blood pressure regularly to ensure that it remains within normal limits, especially if you experience dizziness or lightheadedness.
Masking symptoms of hypoglycaemia: Caution is advised in diabetics, especially those taking insulin or drugs that lower blood glucose levels. Propranolol may mask the symptoms of low blood glucose, requiring frequent blood glucose monitoring.
Drug interactions: Combining propranolol with certain heart or blood pressure medications, such as verapamil or diltiazem, may cause a dangerous decrease in heart rate (bradycardia). Propranolol can also interfere with breathing treatments for asthma or chronic obstructive pulmonary disease (COPD) that use beta-agonists such as albuterol. Finally, drinking alcohol while taking propranolol can increase its effects, increasing the risk of dizziness and a drop in heart rate or blood pressure.
Propranolol dosage for anxiety
Propranolol is available in two forms: slow-release (short-acting) and extended-release, with prescribed doses varying widely depending on the treatment goals. The choice of release form depends on the therapeutic goals.
Typically, lower doses are prescribed initially and may be adjusted based on the drug’s efficacy and potential side effects. Initial doses are often between 10mg and 20mg. Regular follow-up visits with your doctor and open feedback about your experience will help determine the most appropriate dose for your specific needs.
Prolonged-release capsules, on the other hand, offer greater strength and are designed to provide a steady level of propranolol in the bloodstream over time, comparable to regular-release tablets. Trials focusing on the treatment of anxiety have looked at total daily doses of propranolol ranging from 240mg to 320mg [6].
When to take propranolol for anxiety
If your goal is to prevent anxiety symptoms and you plan to take the medication daily, an extended-release capsule may be a better choice. This type of capsule simplifies your medication routine and maintains a constant level of the medication in your system throughout the day.
Alternatively, if your goal is to treat anxiety symptoms as they occur or before specific events such as public speaking, propranolol can be taken as needed. In such cases, a slow-release tablet may be more commonly prescribed.
Frequently asked questions
Is it safe to take propranolol during pregnancy?
Propranolol is a category C drug, which means that the risks associated with its use during pregnancy should be discussed carefully with your doctor if you are pregnant or planning to become pregnant. Although many patients have used propranolol during pregnancy, the potential benefits and risks need to be assessed on a case-by-case basis to ensure the best decision is made for each individual.
Conclusion
In summary, propranolol has been used to treat anxiety for half a century and has proven its efficacy in many different ways. During this time, other drugs such as SSRIs have emerged as alternatives for the treatment of anxiety, and many patients have chosen these options instead. Nevertheless, propranolol remains a valuable choice, and ongoing research aims to further explore its potential benefits. In particular, propranolol offers a suitable alternative for people who wish to avoid habit-forming drugs such as benzodiazepines. Its continued presence in the field of anxiety management demonstrates its importance in the therapeutic armamentarium available to patients.
Sources
Ashley Bujalski is a second year clinical psychology doctoral student at William Paterson University. She holds a MA in Forensic Mental Health Counseling from John Jay College, and has worked as a mental health clinician at Riker’s Island Correctional Facility and Crossroads Juvenile Detention Center. At present, she is a graduate assistant at the William Paterson University Women’s Center, where she implements programs to raise awareness on campus and in the community about prevention of violence against women. Her research interests include trauma and posttraumatic stress disorder in forensic populations and among those who have been victimized by interpersonal violence.
Claire Galloway is a post-doctoral fellow at Emory University. She received her Bachelor of Science in psychology from Georgia State University in 2011, her Master of Arts in psychology from Emory University in 2013, and her Doctor of Philosophy in psychology (neuroscience and animal behavior program) from Emory University in 2017. Claire studies the nature of hippocampal dysfunction in Alzheimer’s disease and how brain regions important for memory, the amygdala and hippocampus, interact during memory tasks.
