Propranolol for anxiety: What experts want you to know

What is propranolol?

Propranolol is a type of beta blocker that is FDA-approved to treat a handful of cardiovascular conditions including high blood pressure and irregular heartbeats, certain types of tremor, and migraines. But it’s also commonly given off-label to help with certain anxiety symptoms.

Beta blockers come in two varieties: selective and non-selective, which refer to the receptors in the body that they target (for instance, some only target receptors in the heart).

Propranolol is a non-selective beta blocker, explains Kate Hanselman, a board-certified psychiatric nurse practitioner at Thriveworks, which means that it affects multiple systems throughout the body. This is what makes it powerful for quelling a multitude of physical symptoms of anxiety, panic, and PTSD, versus say, simply reducing your heart rate and nothing else.

Propranolol is also more lipid soluble than some other beta blockers, which helps it more easily cross the blood-brain barrier where it can act directly on the central nervous system, according to research in the International Journal of Molecular Sciences. “It can make you feel a little bit cognitively chill,” Hanselman says, “although that’s not really what we’re using it for.”

How does propranolol help with anxiety?

Propranolol helps with anxiety by tamping down the physical symptoms that can create an anxious feedback loop between your mind and body. It does this by attaching to beta receptors, a type of protein that exists on many cells throughout the body and brain. Stress hormones like adrenaline and noradrenaline attach to these beta receptors and tell the nervous system how to react in a fight-or-flight situation. When it latches onto these beta receptors, it blocks stress hormones from sending out their call to action and dampening the physical reaction you’d otherwise have.

“It essentially tells all of the receptors ‘We’re good,’ so that when any of the neurological chemicals in your body say ‘Turn your blood pressure up, turn your heart rate up, there’s a bear coming!’ your body’s natural signals can’t take effect, which then means that your heart rate is not going to go up, your blood pressure is not going to go up, and you’re not getting those internal signals that something’s wrong,” Hanselman explains.

It’s best used on an as-needed basis, right before you anticipate a big stressor. That’s because it starts working quickly (in about an hour) and the effects only last for about three to six hours, depending on how fast your body metabolizes it, Hanselman explains. This also means that you can take it a couple times a day, if needed, Hanselman adds. Other fast-acting medications that are approved for anxiety, like benzodiazepines, work by sedating your central nervous system, which can affect mental clarity and cause dependence with long-term use.

It’s not meant to be taken daily since it doesn’t stay in your system very long and there are other anxiety medications that work better for lasting anxiety relief. That said, you could theoretically take propranolol every day if you anticipate a recurring event or situation that is particularly anxiety-inducing and hard to get through.

For instance, one situation where daily propranolol might be suggested is in helping to reduce a recurring stress response. Hanselman gives the example of someone who works in a corrections facility and had a traumatic experience so is now afraid to go to work every day. Just approaching the door drums up paralyzing anxiety. In that situation, taking propranolol every morning for a couple of weeks might allow the person to dampen their stress response enough to signal to their brain that it’s not as dangerous as they thought. This can reduce the association between work and fear, allowing that person to feel more physically comfortable.

That said, if you’re living with persistent anxiety that isn’t just physical, a daily long-acting anxiety medication (like SSRIs and SNRIs) is likely a better choice.

Signs propranolol might be a good fit for you

Propranolol isn’t usually the first anxiety medicine your provider will prescribe, but it could be helpful in certain situations, or as an addition to other meds and therapy. Here are a few instances when it could be right for you:

You mostly feel anxiety in your body.

For some people, anxiety is more cognitive. It causes the mind to race, but physically, you feel fine. For others, anxiety manifests in the body: you hear your heart pounding in your ears, your palms are shaky and sweaty, and your whole body feels like it’s revving up before a stressful event. Those are the people who could benefit from propranolol, Hanselman says.

You have predictable triggers or situations where you tend to get “stuck”.

Since propranolol is best used on an as-needed basis, it may be helpful if the same triggers often come up again and again for you. For example, every time you have to give a work presentation you’re overcome with fear and anxiety. Your chest starts to tighten up, your heart rate skyrockets, maybe you feel faint, and it prevents you from doing your job. Propranolol could be a tool to quiet your body so that your brain can start to access other coping strategies. “If your body is calm, it’s easier to listen to your thoughts, and then we can start working through them,” Hanselman says.

You want something fast-acting and non-sedating.

Unlike benzodiazepines, which are also an as-needed anxiety medication, propranolol is non-sedating. So while the former might be a great option before a long flight if you’re afraid of flying, the latter will be preferable if you need to stand up in front of your entire company to give a speech and public speaking terrifies you.

You already take an SSRI or other daily anxiety medication and need a little bit more help.

Hanselman says that propranolol for anxiety is best used in addition to a daily medication to treat anxiety disorder, like an SSRI. If you’re already taking anxiety medication and feel like you need an extra something when particularly difficult situations crop up, propranolol could be a good fit.

Signs propranolol might not be right for you

As with any medication, propranolol comes with risks and side effects, so it’s important to talk to your provider to make sure it won’t interfere with anything else you’re taking or any other medical issues you have, Hanselman says. If you have a heart condition or are on any cardiovascular medications, you may still be able to take propranolol, she says, but it warrants a conversation. “They can determine whether it’s appropriate for you or not,” she says.

In general, beta blockers are not typically recommended for people with asthma. Chronic low heart rate (bradycardia) and low blood pressure (hypotension) “are known side effects of propranolol,” Hanselman adds, “so if a patient has these conditions already, it could worsen them.” People who experience frequent lightheadedness or fainting episodes may be at risk for those side effects when taking a beta blocker, too.

And if you’re relying on propranolol to do all of your anti-anxiety heavy lifting, it’s worth talking to your provider about whether another treatment method could be a better fit.

How to talk to your provider about propranolol

If you’re already seeing a psychiatric provider for anxiety medication and feel like you need some help managing your remaining symptoms, let them know, Hanselman says. It’s fine to tell them you read something on the internet about propranolol for anxiety and wonder if it might be right for you, she adds. “Don’t be shy to bring it up if this sounds appealing to you.”

If you’re not already seeing somebody, but you can relate to those scenarios above, it’s worth making an appointment to talk about your symptoms. You could start with your primary care provider or go right to a psychiatric provider (both can prescribe medications). They might have other suggestions for you, Hanselman says, but getting assessed is the first step to finding a treatment plan that works for your anxiety.

Frequently asked questions (FAQs)

Is propranolol the same thing as a beta blocker?

Propranolol is one type of beta blocker, a class of medications that target beta receptors in the body and block the effects of stress hormones such as adrenaline and noradrenaline.

How quickly does propranolol work for anxiety, and how long does it last?

Propranolol works quickly. After taking a dose, you should feel a difference in about 30 minutes to an hour. The medication lasts for about three to six hours, depending on how quickly your liver metabolizes it, Hanselman says.

Can you take propranolol every day for anxiety, or is it only for specific situations?

At doses used for anxiety, propranolol is safe to take everyday, Hanselman says, but it’s typically prescribed to be used on an as-needed basis, not as a daily maintenance medication.

Does propranolol help with the mental or emotional side of anxiety or just the physical symptoms?

Propranolol may have a slight calming effect in some people, but overall, it’s best used as a tool for calming the physical symptoms of anxiety. This can allow you to use other tactics to work on the mental and emotional side of things without your body feeling too revved up to do that work.

Is propranolol habit-forming?

No, unlike benzodiazepines such as Xanax, propranolol is not habit-forming.

Can you take propranolol if you’re already on an antidepressant or other anxiety medication?

Yes, propranolol is often prescribed to be used in addition to other mental health medications. For example, you may take an SSRI daily but add on propranolol before a particularly anxiety-inducing situation or when you know you’ll have to do something that causes a strong stress response in your body.