{"id":59867,"date":"2023-08-11T09:35:18","date_gmt":"2023-08-11T13:35:18","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=59867"},"modified":"2024-10-25T10:34:24","modified_gmt":"2024-10-25T14:34:24","slug":"propranolol-for-anxiety","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/propranolol-for-anxiety\/","title":{"rendered":"Propranolol for anxiety: Does it work?"},"content":{"rendered":"

Propranolol is an old drug that just won’t go away, for good reason. It touts a <\/span>50-year history<\/span><\/a> of utility, originally as a treatment for heart disease and later as a preventive treatment for migraine, a use that has landed it on the World Health Organization’s list of <\/span>essential medications<\/span><\/a>. A role for propranolol that you may find more interesting is in the treatment of anxiety. Effective in a limited number of clinical studies, propranolol’s proclivity for helping the physical signs of <\/span>anxiety<\/span><\/a> is a topic that you should learn more about.<\/span><\/p>\n

What is propranolol (Inderal, Hemangeol)?<\/span><\/h2>\n

Propranolol<\/span><\/a>, also known by its brand name Inderal, is one of the patriarchs of the <\/span>beta blocker class of drugs<\/span><\/a>. It blocks both type 1 and 2 beta-adrenoreceptors. Hence it is characterized as a non-selective beta blocker. Blocking beta receptors, propranolol’s activity in the peripheral circulation results in lower blood pressure and slower heart rate. <\/span><\/p>\n

Consequently, it has Food and Drug Administration-approved uses for <\/span>hypertension<\/span><\/a> (high blood pressure), angina, supraventricular tachycardia, <\/span>atrial fibrillation<\/span><\/a>, and pheochromocytoma, an adrenaline-secreting tumor. <\/span>Hemangeol<\/span><\/a>, another brand-name version, is indicated for the treatment of infantile hemangioma, an abnormal, congenital mass of blood vessels.<\/span><\/p>\n

The unique <\/span>ability of propranolol to cross the blood-brain barrier<\/span><\/a> allows it to engage the central nervous system (CNS). Besides blocking beta-adrenoreceptors, propranolol may weakly stimulate alpha-1 adrenoreceptors and antagonize certain serotonin receptors, actions that could be relevant in the CNS. These mechanisms may partly explain why propranolol has FDA indications for essential <\/span>tremors<\/span><\/a> and prevention of <\/span>migraine<\/span><\/a> headaches. The drug does not have FDA approval for anxiety treatment.<\/span><\/p>\n

Propranolol for anxiety<\/span><\/h2>\n

Both peripheral circulatory and central nervous system effects could contribute to the therapeutic action of propranolol for physical anxiety symptoms. Much of the discomfort of anxiety is related to physical reactions, namely a racing heart, elevated blood pressure, and shakiness, rather than just the psychological symptoms of anxiety. Physical symptoms of panic disorder, panic attacks, and situational anxiety related to events like public speaking can largely be explained by the surge in the effects of adrenaline. Propranolol’s beta-adrenergic receptor blockade and other receptor activity could explain how it helps these symptoms. Its rapid absorption after being taken and the onset of action within 1-2 hours is certainly a plus as well.<\/span><\/p>\n

In particular, a number of subsets of anxiety have shown promising improvement with propranolol therapy. The medication may be beneficial for post-traumatic stress disorder (<\/span>PTSD<\/span><\/a>) by influencing the reconsolidation of traumatic memories. Another example, <\/span>stage fright<\/span><\/a>, has been alleviated by propranolol in clinical trials. A reduction in stage fright’s physical effects is likely at the heart of the improvement, but in a <\/span>study of chronic anxiety<\/span><\/a>, propranolol relieved both physical and psychological symptoms of anxiety in most participants. <\/span><\/p>\n

Keep in mind that there is insufficient evidence of the efficacy of propranolol for anxiety, and <\/span>selective serotonin reuptake inhibitors (SSRIs)<\/span><\/a> along with <\/span>cognitive behavioral therapy<\/span><\/a> remain first-line treatments for most anxiety disorders, particularly when long-term need is present. <\/span>Benzodiazepines<\/span><\/a> are a common option for short-term use on an as-needed basis, albeit an option with habit-forming potential. Interestingly, a <\/span>systematic review<\/span><\/a> did not find a significant difference in outcomes for panic disorder between benzodiazepines and propranolol.<\/span><\/p>\n

Propranolol side effects<\/span><\/h2>\n

Now that you know the effects of propranolol on the cardiovascular system, such as slowing heart rate and lowering blood pressure, and the CNS as well, you can understand why it can have the following list of <\/span>common side effects<\/span><\/a>. Of note, the possibility of nausea and less appetite typically means that there is not a significant risk of weight gain with the drug. Also, the possibility of depression from propranolol is something to take seriously, given the common co-occurrence of anxiety and depression symptoms. The potential side effects include: <\/span><\/p>\n