Beta blockers for public speaking

How They Work

Beta blockers are prescription medicines mainly used for heart conditions such as high blood pressure and angina. Propranolol is a non-selective beta blocker; atenolol is a selective one. The main effect of a beta blocker is a slower heartbeat, and non-selective types can also be used for anxiety.

Target Adrenaline

When you are anxious, your brain makes adrenaline and noradrenaline. They speed up your heart and make you sweat or shake. Propranolol blocks their effects, which reduces the physical signs.

Calm Physical Symptoms

People with a phobia such as public speaking often get a rapid heart rate, sweating and tremors; providers may prescribe beta blockers off-label to manage these.

short-term, acute tool

The NIMH describes them as useful as needed for severe anxiety in the short term, and the NHS says you usually take propranolol for anxiety only for a short time.

Timing

Whether and when is your doctor's call; this page gives no timing.

MedlinePlus lists atenolol as a beta blocker that relaxes blood vessels and slows the heart rate, used for high blood pressure and angina. For propranolol it notes the medicine "is also sometimes used to treat anxiety" and asks you to talk to your doctor about the risks.

Common Side Effects & Risks

Side effects are unwanted effects a medicine can cause. The risk of a beta blocker depends on your health, which is why a doctor checks first. The NHS notes that not everyone gets side effects and that the main ones for propranolol are usually mild and do not last long.

Side effects

The main ones listed for propranolol are feeling dizzy or tired, cold hands or feet, difficulty sleeping and nightmares. If you feel dizzy, do not drive, cycle or use machinery.

Contraindications

Tell your doctor first if you have:

• asthma or another lung disease
• a slow or irregular heartbeat
• low blood pressure
• heart failure
• diabetes
• liver or kidney problems
• severe circulation problems
• pregnancy or breastfeeding

MedlinePlus adds: never stop propranolol suddenly without talking to your doctor, and tell your doctor or pharmacist about any allergies. The NIMH notes that beta blockers are generally not recommended for people with asthma or diabetes because they may worsen the symptoms of both.

Questions to ask your doctor

non-sedating

Is it non-sedating for me? Tiredness and dizziness are listed side effects.

non-addictive

Is it non-addictive, and how would I stop it safely?

What the research says

The evidence for beta blockers in anxiety is thinner than their reputation. The NIMH says providers may prescribe them off-label for short-term anxiety symptoms, even though they are not approved for that purpose. A 2016 meta-analysis of eight randomized trials found the evidence insufficient to support routine propranolol use for any anxiety disorder; only one of those trials, with 16 people, looked at social phobia. Four trials covered panic disorder, two specific phobia and one PTSD; for panic disorder, propranolol performed similarly to benzodiazepines in the short term. AmberWillo's guide to medication for glossophobia makes a related point: beta blockers are a short-term strategy and may not address the thinking side of the fear, and you should not change your dose without your doctor.

non-medication strategies

Non-medication strategies are ways to calm the body and shrink the fear without a prescription. Many doctors prefer medicine-free treatments for anxiety, such as talking therapies like cognitive behavioural therapy, according to the NHS. If you are having talking therapy, a doctor may prescribe propranolol at the same time for the physical symptoms. The National Institute of Mental Health calls CBT the "gold standard" psychotherapy for social anxiety, and notes that exposure therapy, a CBT method, confronts fears step by step.

• Breathing. AmberWillo's racing heart guide describes box breathing: in for four, hold for four, out for four, hold for four, repeated a few times.
• Exposure. Gradual exposure makes each practice a little harder than the last, as AmberWillo's anxiety guide describes.
• Skill. A public speaking coach works on the skill side.

When you're ready to test that with real listeners, AmberWillo's small online rooms are a gentle first audience. It is an online platform for public speaking nerves: you take turns on camera in a group capped at fifteen, and every round hands back a confidence rating, a milestone to aim at and written notes from coaching. Getting started is free.

Neither replaces your doctor. Both build the part a pill cannot reach, and if you want the full picture, here is a plan for how to improve public speaking step by step. Wondering how to practise this today? Record one thirty second rep and see your score.