Propranolol For Anxiety: How It Works, How To Take It & What To Expect

You feel tense, your heart pounding, your mind racing – it becomes hard to focus on anything other than how you feel. Anxiety can take on different forms for different people and can have various triggers, ranging from hormones to exposure to a certain sound or smell. You are not alone if you’ve felt this way or something similar. It is estimated that almost a third – 31.1% of adults in the United States^[1] have experienced symptoms of anxiety disorders at some point in their lives.

These anxiety symptoms can have a significant impact on your day-to-day life. Fortunately, many tools are available to help treat anxiety and provide support to make navigating these symptoms easier. Medications like propranolol can be very helpful for anxiety. We will discuss the role of propranolol in anxiety management, how it works, and what to expect while taking the medication if it has been prescribed.

How Does Propranolol Work For Anxiety?

Anxiety Symptoms

For many individuals, anxiety can bring a variety of symptoms. These are most easily divided into two basic categories: psychological symptoms and physical symptoms. If you have managed anxiety, you may know these individual symptoms do not exist in a vacuum. Many individuals experience a cycle in which these symptoms feed into each other, and at times, a portion of the fear experienced is related to the symptoms of anxiety themselves.

Psychological symptoms are characterized by thought patterns. Being anxious at times is normal – it is part of being human and can keep us safe in some situations. Anxiety may be considered a disorder if feelings of fear or worry become excessive, overwhelming, and interfere with day-to-day life.

Physical symptoms are essentially an extension of the body’s fight-or-flight response. Anxiety can bring increases in blood pressure, muscle tension, trouble breathing, racing heart, or chest pain. These physical effects are involuntary and can feel out of place even for the person experiencing them.

Beta Blockers And Regulation Of Stress Response 

Taking propranolol can help with the treatment of anxiety disorders by targeting this fight-or-flight response. Part of our body’s response to stress is regulated by the activity of epinephrine (adrenaline) and norepinephrine. The release of these messengers is regulated by the sympathetic nervous system. The adrenal gland releases the messengers, which is why this system of messengers and their receptors are called the adrenergic system.

Propranolol’s ability to act in different areas of the body is what makes it helpful for anxiety. Propranolol blocks beta receptors responsible for carrying adrenergic messages in different areas of the body, including within the central nervous system. This helps to slow down the body’s fight-or-flight response, making it particularly helpful for regulating rapid heart rate, increased blood pressure, and tension – the physical symptoms of anxiety.

Recent studies have also explored propranolol’s effect on memory recall. It seems some of the harmful effects of recalling traumatic events^[2] can be offset with propranolol use. This has shown some promise for helping people manage their experiences with a history of trauma, such as PTSD.

Side Effects Of Propranolol For Anxiety

In general, propranolol is considered very safe. When compared with alternative medications for anxiety management, it can be considered a favorable alternative. Many patients use SSRIs (selective serotonin reuptake inhibitors) as first-line treatment because they are safe, and could be considered more “targeted.” Propranolol could certainly be considered safer than benzodiazepines^[3] (alprazolam, clonazepam, lorazepam, etc.) because they are non-habit forming, and do not carry the same risks of drowsiness.

As with any prescription medications, taking propranolol carries risks. It is important to be aware of these:

Low Blood Pressure

Propranolol decreases your blood pressure, which may be an intended effect for some individuals. It can be helpful to check your blood pressure while using propranolol to ensure it stays in a normal range. Checking blood pressure is particularly important if you feel dizzy or light-headed.

Masking Symptoms Of Hypoglycemia

Individuals with diabetes – particularly those using insulin or a medication that can cause drops in blood glucose – should be aware that propranolol can make it more difficult to identify low blood sugar based on their symptoms. Regularly checking blood sugars is helpful.

Interactions with Other Medications 

• Certain Calcium Channel Blockers – Taking propranolol with certain heart or blood pressure medications like verapamil or diltiazem can cause unsafe drops in heart rate, known as bradycardia. 
• Breathing Treatments for Asthma or COPD – A mainstay of treatments for improved lung function include both long and short-acting beta-agonists (albuterol, etc.). Propranolol’s effects directly counteract this activity at the beta receptor, which may make these treatments less effective. 
• Alcohol – Propranolol’s effects can be increased when drinking alcohol, increasing the risk of dizziness and a drop in heart rate or blood pressure.

Is Propranolol Good For Anxiety?

Anxiety can impact daily life in many ways, causing difficulty sleeping, trouble in social situations, and even difficulty eating due to nausea. Over the years, many remedies have been tried to help find some relief. Many prescription medications have been used, and many home remedies such as CBD have been used as well. If considering these kinds of products, it is important to research brands. Options like CBDfx submit to independent third-party testing to verify product quality, making them more dependable. 

Propranolol has been used for treating anxiety since the 1960s^[4] and has helped in varying capacities over time. The overarching term “anxiety” can be further broken down into distinct disorders within the following categories, as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5):

• Anxiety Disorders (Generalized anxiety disorder, panic disorder, specific phobias – including performance anxiety, like stage fright)
• Trauma and Stressor-Related Disorders (PTSD, etc.)
• Obsessive Compulsive Disorders

Treatment approaches can vary depending on a specific diagnosis. In general, when medications are used, they have been particularly helpful when combined with cognitive behavioral therapy (CBT) sessions provided by a licensed therapist. Propranolol has traditionally been used to help with performance anxiety and physical anxiety symptoms. More recent research is also showing additional promise for PTSD.

What is Propranolol?

Propranolol (brand name Inderal) has been used for a wide range of purposes since its introduction in the 1960s. Like other beta blockers, it was originally used primarily to reduce blood pressure and protect the heart after myocardial infarction (heart attack). Propranolol has FDA approval^[5] for:

• Angina Pectoris (chest pain)
• Atrial Fibrillation (irregular heartbeat)
• Essential Tremor (involuntary shaking, often affecting hands)
• Hypertension (high blood pressure)
• Migraine
• Myocardial Infarction (heart attack)

Propranolol is considered a nonselective beta blocker, extending its activity beyond the heart and cardiovascular diseases specifically. This has allowed doctors to prescribe propranolol for many purposes over the years as some benefits became more apparent with time, sometimes discovered by chance while treating patients for other conditions. Propranolol’s efficacy, particularly for physical anxiety symptoms, can be explained by taking a closer look at beta-blocker effects.

Propranolol Dose For Anxiety

Propranolol is available in both a regular release (shorter acting) and extended-release delivery, and the doses prescribed can vary significantly. The choice of release characteristics depends on the goals of therapy.

Lower doses are usually prescribed first and may be increased if needed, depending on how well propranolol works and whether it has caused any side effects. Initial doses may be as low as 10mg or 20mg. Consistent follow-up with your doctor and open feedback about your experiences ensures you will ultimately receive the best dose for you.

Extended-release capsules are higher strength and are meant to deliver similar, but steady blood levels of propranolol over time when compared with regular-release tablets. Total daily doses of propranolol have reached 240mg – 320mg when studied for anxiety^[6] management.

When To Take Propranolol For Anxiety 

If your goal is to prevent anxiety symptoms and you intend to take the medication daily, you may be more likely to use an extended-release capsule. These can simplify your routine and keep your system more steady throughout the day.

If you aim to help manage symptoms as they arise, propranolol can be taken as needed or before an event like public speaking. A regular-release tablet may be more likely to be prescribed in these instances.

Conclusion

Propranolol has been used to treat anxiety in varying capacities for 50 years. Other medications (like SSRIs) have also become available during this time frame to help treat anxiety, so many patients have been using these instead. Propranolol remains a helpful option, and research is underway to explore some of these benefits in more detail. It can be particularly helpful for individuals who wish to avoid using habit-forming medications like benzodiazepines.

---