From the Guidelines
Metoprolol can be considered for managing physical symptoms of anxiety, particularly in cases of performance anxiety or situational anxiety, as evidenced by its use in treating panic disorder and performance anxiety 1. When considering metoprolol for anxiety symptoms, it's crucial to understand its role in alleviating physical symptoms such as rapid heartbeat, trembling, and sweating, which are often associated with adrenaline effects. The typical dosage for anxiety symptoms can range from 25-100 mg, either taken as needed before anxiety-provoking situations or divided throughout the day. However, it's essential to note that metoprolol is most beneficial for specific types of anxiety, such as performance anxiety, where physical symptoms are predominant, rather than generalized anxiety disorder or panic disorder, although it is used in the latter 1. Potential side effects include fatigue, dizziness, and lowered blood pressure, necessitating cautious use in individuals with asthma, certain heart conditions, or diabetes. Given that metoprolol addresses the physical manifestations of anxiety without tackling the psychological aspects, its use should be part of a comprehensive treatment plan incorporating therapy, lifestyle changes, and possibly other medications specifically designed for anxiety disorders. Key considerations include:
- The specific type of anxiety disorder being treated, as metoprolol's efficacy varies among them.
- The importance of combining metoprolol with other therapeutic approaches for a holistic treatment plan.
- The need for careful patient selection and monitoring due to potential side effects and interactions with other health conditions. In clinical practice, the decision to use metoprolol for anxiety symptoms should be individualized, taking into account the patient's medical history, the nature of their anxiety, and the potential benefits and risks of treatment 1.
From the Research
Metoprolol for Anxiety Symptoms
- There is limited research on the use of metoprolol for anxiety symptoms, but studies on beta-blockers, a class of medications that includes metoprolol, provide some insight.
- A study from 1987 2 found that beta-blockers, such as propranolol, may be effective in treating anxiety disorders accompanied by physical symptoms, especially cardiovascular complaints, when combined with benzodiazepines or in non-responders to conventional treatment.
- However, a more recent systematic review and meta-analysis from 2025 3 found no evidence for a beneficial effect of beta-blockers, including metoprolol, compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia.
- The use of beta-blockers, including metoprolol, for anxiety disorders is not well supported by current evidence, and their use may be associated with adverse effects, such as depression 2.
- Other medications, such as selective serotonin reuptake inhibitors (SSRIs), are generally considered more effective and safer for the treatment of anxiety disorders 4, 5, 6.