Propranolol for Public Speaking Anxiety
Propranolol is effective for managing physical symptoms of performance anxiety related to public speaking at doses of 10-40mg taken 1-2 hours before the event. 1
Mechanism and Efficacy
Propranolol works specifically for performance anxiety by:
- Blocking peripheral beta-adrenergic receptors, preventing physical manifestations of anxiety (tremor, palpitations, sweating) without causing sedation 1
- Reducing observable signs of anxiety in both verbal and non-verbal behavior during public speaking 2
- Decreasing heart rate and subjective feelings of anxiety in anxious individuals 2
Dosing Recommendations
- For public speaking/performance anxiety: 10-40mg taken 1-2 hours before the event
- Effects last approximately 4-6 hours 1
- Women may require lower doses (50-100% lower) due to higher oral bioavailability 1
Appropriate Use Cases
Propranolol is most appropriate for:
- Situational anxiety with prominent somatic symptoms (tremor, palpitations)
- Public speaking or performance situations where physical symptoms interfere with performance
- Individuals without contraindications (see below)
Contraindications
Propranolol should NOT be used in patients with:
- Asthma or COPD
- Heart block greater than first-degree
- Cardiogenic shock
- Heart failure 1
Important Limitations
- Propranolol is not recommended as first-line treatment for generalized anxiety disorder 1
- It is not effective for treating chronic anxiety disorders that meet DSM criteria 3
- May impair memory recall of difficult items in anxious individuals 2
- Potential to induce depression in predisposed patients (though evidence is limited) 1, 4
Side Effects to Monitor
- Bradycardia and hypotension (usually mild)
- Sleep disturbances
- Respiratory effects (labored breathing, wheezing)
- Discoloration with cooling of extremities 1
Clinical Pearls
- Propranolol targets the physical symptoms of anxiety but does not address cognitive aspects
- Best suited for discrete anxiety-provoking situations rather than chronic anxiety
- Can be used as an adjunctive treatment for residual somatic complaints when combined with established treatments 4
- Consider atenolol as an alternative if propranolol is not well tolerated 1
For public speaking anxiety specifically, propranolol offers a targeted approach to managing the physical manifestations that can interfere with performance, without causing sedation or cognitive impairment that might affect the presentation itself.