Does Bystolic work for anxiety?

In this article:

• Bystolic for anxiety
• Bystolic dosage for anxiety
• How long does it take to work?
• Alternatives
• The bottom line

In this article

• Bystolic for anxiety
• Bystolic dosage for anxiety
• How long does it take to work?
• Alternatives
• The bottom line

Bystolic (nebivolol) is a brand-name beta blocker that is FDA approved for treating high blood pressure (hypertension). Because this type of drug calms a racing heart by lowering the rate and force of blood pumping through the heart, Bystolic and other beta blockers are sometimes prescribed off-label for anxiety. However, Bystolic will not work for all types of anxiety. The best way to know if Bystolic will relieve your anxiety symptoms is to work with a healthcare provider familiar with your medical conditions and the other prescription or over-the-counter medications you take.

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Does Bystolic help with anxiety? 

In some cases, yes. Bystolic helps calm some anxiety symptoms, but it is not a first-line anxiety treatment. It is not an FDA-approved anxiety treatment, and of the beta blockers prescribed off-label for anxiety, Bystolic is not the most common. Most studies on beta blockers for anxiety have used propranolol, not nebivolol, the active ingredient in Bystolic. 

“I have seen beta blockers help patients significantly with situational anxiety,” says Chrissie Ott, MD, a dual board-certified integrative internist and pediatrician in Portland, Oregon. 

Here’s why beta blockers work for situational anxiety: Beta blockers decrease sympathetic nervous system activity, which is the body’s built-in fight-or-flight response, says Sid Khurana, MD, a board-certified psychiatrist and medical director of Nevada Mental Health. People with situational anxiety, such as stage fright, experience a fight-or-flight response—heart palpitations, sweating, or shakiness—even when there is no real danger. Bystolic and other beta blockers help calm that overactive response.

“One of my favorite success stories with this medication is a mid-40-year-old woman who had been to the ER for chest pain, palpitations, and shortness of breath,” says Troy Alexander-EL, MD, board-certified internal medicine and primary care physician in Portland, Oregon. ”She was started on a low-dose beta blocker twice a day, and when she came back a few weeks later, she was smiling, her skin was glowing, and she was finally sleeping.”

It’s important to understand that though beta blockers have been used for anxiety for a long time, there is insufficient evidence for the long-term efficacy of beta blockers for anxiety disorders. Healthcare providers continue to prescribe beta blockers like Bystolic off-label—meaning, for a use not approved by the FDA—because they can calm or prevent physical anxiety symptoms for patients whose anxiety spikes in specific, predictable situations. 

In other words, Bystolic may relieve physical symptoms of anxiety, but it is not usually healthcare providers’ first choice. Keep in mind that there is a lack of studies on Bystolic for anxiety specifically and a lack of evidence for beta blockers for anxiety in general. It’s important to consult a healthcare professional if you are interested in using Bystolic or another beta blocker for situational anxiety, such as stage fright or fear of flying.

How much Bystolic should I take for anxiety?

Bystolic is FDA-approved for high blood pressure, not anxiety. When taken for hypertension, Bystolic dosage ranges from a starting dose of 5 mg to a maximum dose of 40 mg taken orally once per day. However, because Bystolic for anxiety is an off-label use of the drug, there is no set dosing protocol for anxiety. Patients should be aware that this medication may lower a normal blood pressure and cause symptoms of hypotension: dizziness, fatigue, and blacking out.

You should only use Bystolic as directed by your healthcare provider. Dosing instructions may be situation-dependent and based on your prescriber’s knowledge of your medical history and health conditions. For instance, if you have performance anxiety or stage fright, your provider may recommend taking Bystolic about 30 minutes before a performance or speaking event. Take precisely the dose recommended—do not take Bystolic more often or in higher doses than prescribed by your healthcare provider. 

How long does it take for Bystolic to work for anxiety?

Beta blockers typically kick in within 20-30 minutes and last for four to six hours, according to Dr. Khurana. Nebivolol reaches its peak concentration one to four hours after dose administration. 

Because they take time to kick in, Dr. Khurana says beta blockers are most effective for anxiety symptoms when taken before a known anxiety-provoking event rather than to end a panic attack. For example, a person with social anxiety might be instructed by their healthcare provider to take a beta blocker before a public speaking event to help keep their heart rate lower throughout the event. Or a person with flight anxiety might take a beta blocker before flying to prevent a fast heartbeat and jitteriness, causing anxiety throughout the flight. Dr. Khurana says you may still experience anxious thoughts and emotions if you take Bystolic or another beta blocker for anxiety. However, physical symptoms such as shakiness, sweating, or a racing or pounding heart should dissipate.

Alternatives to Bystolic for anxiety

Bystolic is not the right anxiety treatment for everyone. “If I’m seeing a patient with generalized anxiety or panic attacks, then a beta blocker would not be as appropriate as another tool, such as an SSRI or the very occasional fast-acting anxiety relievers,” Dr. Ott says. In addition to being less effective, beta blockers like Bystolic may not be recommended for people with a history of heart disease or heart conditions such as heart block, heart failure, or heart attack.

SSRIs

People who need long-term anxiety treatment are typically prescribed a daily selective serotonin reuptake inhibitor (SSRI) combined with cognitive behavioral therapy. SSRIs are antidepressants that treat both anxiety and depression. Unlike Bystolic, they affect brain chemistry. They boost serotonin, a neurotransmitter that helps regulate mood, sleep, and energy. SSRIs may have different dosage protocols and side effect profiles than Bystolic. For instance, the most common side effects of Bystolic are headache and fatigue. SSRIs can also cause fatigue and headaches, as well as nausea, weight gain, sleep problems, and sexual performance issues. 

Common SSRIs for anxiety include: 

• Lexapro (escitalopram)
• Zoloft (sertraline)
• Prozac (fluoxetine)
• Celexa (citalopram)

A different beta blocker

If your healthcare provider does recommend a beta blocker for anxiety symptoms, they’re unlikely to prescribe Bystolic first. Most healthcare providers prefer propranolol to Bystolic. There are a few reasons for this. 

Dr. Khurana prefers propranolol because, as a non-selective beta blocker, it affects receptors throughout the body. In contrast, nebivolol, the active ingredient in Bystolic, is a selective beta-1 agonist that primarily affects heart tissue. However, Dr. Ott says propranolol’s effect on more receptors can also “lead to slightly more potential for undesirable side effects” compared to Bystolic.

Unlike other beta blockers, Bystolic is also a vasodilator. It widens blood vessels by releasing nitric oxide, which helps to relax them. This can be a good or bad thing, depending on your other health conditions and medications, but it’s something a healthcare professional would keep in mind when considering whether to prescribe Bystolic or another beta blocker. This vasodilation can cause low blood pressure, which may feel like dizziness or nearly blacking out.

Finally, propranolol is a generic rather than brand-name drug. “I use propranolol due to its ease of access,” Dr. Alexander-El says. “It is not an expensive medication, and because the dosage range is very wide, the medication can be started at low doses and titrated to fit the patient’s needs.” Propranolol for anxiety is also an off-label use of the medication, so there is no standard dosing protocol. 

This article is for informational purposes. If you are interested in SSRIs, propranolol, or any other prescription treatment options for anxiety, it’s essential to seek medical advice from a healthcare professional. 

The bottom line

Bystolic may be effective at calming physical symptoms of anxiety, such as shakiness, sweating, a pounding heart, or a fast heart rhythm. However, it is not a preferred treatment for anxiety. SSRIs are the gold standard for the long-term treatment of anxiety disorders. For people who simply want symptom relief for situational anxiety, such as stage fright or performance anxiety, propranolol is the beta blocker of choice. 

Bystolic may or may not be an effective treatment for your anxiety symptoms. If you have an adverse effect from Bystolic, stop taking it and let your prescriber know. Never start or stop Bystolic, or change your dosage, without consulting your prescriber. Talk to a healthcare provider for an individualized treatment plan for new or worsening anxiety symptoms.