Propranolol and other beta-blockers

At a glance

Compared with other treatments

Barely tested. A review found only one placebo-controlled trial of propranolol in social phobia, with 16 people. In a US trial of 74 people, the beta-blocker atenolol did not differ significantly from placebo.

What it takes

A tablet, often taken shortly before a stressful event. It must be prescribed by a doctor, who checks it is safe for you.

What it is

Propranolol is a beta-blocker: a medicine that blocks some effects of adrenaline. It was made for heart problems and high blood pressure. It can reduce shaking hands, a trembling voice and a pounding heart.

Doctors in many countries prescribe it for nerves before public speaking, exams, interviews or performances. People usually take it shortly before the event, rather than every day. A doctor decides whether it is right for you and how to take it.

What people report

Propranolol is the medicine people with social anxiety ask about most. On Reddit, the reports are strikingly consistent. People say it stops the shaking and the racing heart, but not the anxious thoughts. Some call it life-changing for presentations. Others say it did little because their fear was mostly in their head, not their hands.

Doctors and therapists sometimes disagree about whether to take it only before events or every day. Some people report tiredness or nausea. These are reports from people, not trial results.

What the trials show

• Almost no trials for social anxiety disorder. A review of propranolol for anxiety found only 8 trials across all anxiety disorders. Just one was in social phobia, and it had 16 people. The reviewers judged the evidence too weak to support routine use.
• A related beta-blocker did not beat placebo. In a US trial of 74 people, 30% improved on atenolol and 23% on placebo, a difference that could be chance. Most people in that trial had the general form of social anxiety. The MAOI phenelzine helped 64%.
• Guidelines do not recommend it. Canada’s guideline lists propranolol and atenolol as not recommended for the general form of social anxiety disorder.
• Performance nerves are a different question. Beta-blockers have long been used for stage fright, for example by musicians. Whether they help people with performance-only social anxiety has not been tested in modern trials.

Why it may not help with the fear

Social anxiety is driven by a fear of being judged, self-focus and safety behaviours. Propranolol only acts on the body. It can quiet the signs you worry others will see. It does not touch the thoughts that keep the fear going.

There is another catch. If you only ever face a talk with a pill, you may learn “I only got through because of the pill”. Leaning on a protective habit like that is a kind of safety behaviour, and safety behaviours keep fear going. No trial has tested whether this happens with propranolol.

Side effects and risks

Common side effects include dizziness, tiredness, diarrhoea and constipation. Propranolol is not safe for everyone. Tell your doctor if you have asthma or other lung disease, a slow or irregular heartbeat, heart problems, diabetes, or thyroid problems, or if you are pregnant. Details are on the MedlinePlus propranolol page.

If you take it regularly, do not stop suddenly without talking to your doctor. Stopping abruptly can cause serious heart problems.

Never take someone else’s propranolol. It is only safe once a doctor has checked your health.

What to do instead or as well

If physical symptoms are your main worry, see shaking hands and voice and performance anxiety. For social anxiety as a whole, cognitive therapy for social anxiety and SSRIs and SNRIs have far stronger evidence.