From the Guidelines
Propranolol is the most effective beta blocker for managing performance anxiety, with a recommended dose of 10-40 mg taken 30-60 minutes before the anxiety-provoking event. This is based on the fact that beta-blockers, such as propranolol, are commonly prescribed for symptom relief in panic disorder, which is closely related to performance anxiety, as noted in a 2022 study published in Hypertension 1. The dose of 10-40 mg is a common recommendation, with 20 mg being a typical starting point for occasional use. Propranolol works by blocking the physical symptoms of anxiety, such as rapid heartbeat, trembling, and sweating, without affecting the psychological aspects of anxiety.
- Key benefits of propranolol include:
- Effective in reducing physical symptoms of anxiety
- Can be taken as needed, 30-60 minutes before the anxiety-provoking event
- Generally well-tolerated, with mild side effects such as fatigue, dizziness, or cold extremities
- Important considerations:
- Individuals with asthma, certain heart conditions, diabetes, or those taking specific medications should avoid propranolol
- It's essential to try the medication before an important event to gauge your individual response
- Propranolol is not recommended as a long-term solution for chronic anxiety, and alternative treatments, such as cognitive behavior therapy and/or selective serotonin reuptake inhibitors, should be considered. As noted in the 2022 study, beta-blockers are often used in combination with these treatments for psychiatric comorbidities, including performance anxiety 1.
From the Research
Beta Blockers for Performance Anxiety
- Beta blockers, such as propranolol and oxprenolol, have been established as effective in the treatment of anxiety, including performance anxiety 2.
- These medications are particularly useful in reducing somatic or autonomic symptoms, such as tremor and palpitations, which are commonly associated with performance anxiety 3.
- Propranolol has been shown to be effective in the treatment of stage fright, a type of performance anxiety, with doses as low as 40 mg/day 3, 4.
Dosing and Efficacy
- The effective dose of propranolol for performance anxiety can range from 40 mg/day to 160 mg/day, with improvement noted within 1 to 2 hours of administration 3.
- However, a recent systematic review and meta-analysis found no evidence for a beneficial effect of beta blockers compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia 5.
- The use of propranolol in the treatment of anxiety disorders, including performance anxiety, is considered off-label in most countries, and its efficacy and safety have not been fully established 4, 6.
Comparison of Beta Blockers
- Propranolol and oxprenolol are the most clearly established beta blockers in the treatment of anxiety, with propranolol being the most commonly used and studied 2, 3.
- Other beta blockers, such as atenolol, have also been shown to be effective in the treatment of anxiety, but their efficacy and safety have not been as well established as propranolol 2.