From the Research
Propranolol is not recommended for performance anxiety due to the lack of robust evidence of its effectiveness, as shown in the most recent and highest quality study 1. Instead, cognitive-behavioral therapy (CBT) has been found to be effective in managing mental health and stress-related disorders, including anxiety disorders, as reported in a recent review 2. When considering medication for performance anxiety, it is essential to weigh the potential benefits against the risks and side effects. Some key points to consider include:
- Propranolol's mechanism of action, which involves blocking beta-adrenergic receptors to prevent physical symptoms of anxiety, may not address the underlying causes of performance anxiety.
- The medication's effects last approximately 4-6 hours, which may not be sufficient for prolonged performances or events.
- Potential side effects, such as fatigue, dizziness, and cold extremities, may impact an individual's ability to perform.
- Contraindications, including asthma, certain heart conditions, and diabetes, must be carefully considered before prescribing propranolol. In light of these factors and the lack of strong evidence supporting propranolol's effectiveness for performance anxiety, alternative approaches, such as CBT, should be prioritized. Additionally, if medication is still considered necessary, a thorough evaluation of the individual's medical history and potential risks should be conducted, and the medication should be used under the guidance of a healthcare provider. It is also important to note that propranolol is not intended for daily, long-term management of anxiety disorders, and its use should be limited to situational anxiety where physical symptoms are the predominant concern. Overall, a comprehensive approach that addresses the underlying causes of performance anxiety and incorporates evidence-based treatments, such as CBT, is likely to be more effective in managing this condition.