Propranolol for Anxiety Treatment
Propranolol is effective for treating performance anxiety and can provide symptomatic relief for anxiety disorders with prominent physical symptoms, though it is not considered first-line therapy for generalized anxiety disorder or panic disorder. 1, 2
Mechanism of Action and Efficacy
- Propranolol, a non-selective beta-blocker, works by blocking the peripheral effects of adrenaline, reducing anxiety symptoms like rapid heart rate, tremors, and nervousness 2
- It is most effective for anxiety presentations with prominent physical symptoms, particularly those with cardiovascular manifestations 3
- Propranolol is specifically indicated for performance anxiety (stage fright) and can effectively reduce physical symptoms that interfere with performance 2, 4
- Dosages typically range from 20-40 mg, one to three times daily, with clinical efficacy most established for treatment periods under 4 weeks 4
Clinical Applications
- In panic disorder, propranolol is commonly prescribed for symptom relief, often combined with cognitive behavioral therapy and/or selective serotonin reuptake inhibitors 1
- For performance anxiety, propranolol can be combined with non-pharmacological approaches such as cognitive behavioral therapy and relaxation techniques 2
- Beta-blockers like propranolol are particularly useful for treating anxiety disorders that are characterized by somatic symptoms related to increased adrenergic tone 4
- Propranolol may provide symptomatic relief for patients with residual somatic complaints (e.g., palpitations and tachycardia) when combined with other treatments 5
Limitations and Considerations
- SSRIs and SNRIs remain the first-line pharmacological treatments for most chronic anxiety disorders with stronger evidence for efficacy 3
- Propranolol is contraindicated in patients with asthma, chronic obstructive pulmonary disease, bradycardia, heart block, or heart failure 2
- Common side effects include bradycardia, hypotension, fatigue, cold extremities, and sleep disturbances 2
- Propranolol should be used with caution in patients with diabetes as it may mask symptoms of hypoglycemia 2
- There is concern about potential depression induction in predisposed patients, so it should be used cautiously in patients with concurrent depressive illness 5
Specific Anxiety Conditions Responsive to Propranolol
- Performance anxiety/stage fright: Highly effective for reducing physical symptoms 2, 4
- Specific social phobias: Beneficial when limited in number in the same patient 4
- Post-traumatic stress disorder: Some evidence suggests propranolol may reduce arousal symptoms, though results from small studies have been mixed 1
- Anxiety disorders of moderate intensity seen in general practice, especially those of recent onset 4