Ifirst took beta blockers two years ago, when I was asked to give a eulogy. Terrible at public speaking on a good day, let alone at a funeral, my first instinct was to refuse to do it. I had made a speech at a friend’s wedding 15 years before and my legs shook so violently throughout that I thought I would collapse. This isn’t a case of being overcritical or dramatic: I find it almost impossible to stand up in front of a crowd and talk. It is an ordeal, for all involved – or it was before I took beta blockers.
Beta blockers are a prescription medication that blocks adrenaline and therefore temporarily reduces the body’s reaction to stress. Routinely given to patients with heart and circulatory conditions, including angina, atrial fibrillation and high blood pressure, as well as to prevent migraines, they are also prescribed for some kinds of anxiety. Some doctors will suggest taking them regularly, at certain times of the day. Others will suggest taking a specified dose when you feel you need it. “They work by reducing the effects of adrenaline on the heart, so you don’t get that heart-racing feeling, you may not get short of breath or sweaty, and they can reduce the symptoms of a full-blown panic attack,” says doctor and broadcaster Amir Khan, who has been a GP in Bradford for 16 years.
Prescriptions for anti-anxiety medication have soared in recent years – driven mainly byincreases among women and young people. According to a 2022 study by the University of Bristol’s medical school, which looked at prescriptions issued for anxiety between 2003 and 2018, for every man prescribed beta blockers, there were 2.33 women. The reasons for the uptick in prescriptions are complex – butGPs interviewed for the studysuggested that women and young people tend to be more open about anxiety. Also, beta blockers are generally considered lower risk and quicker-acting than other anxiety medications such as benzodiazepines, which are known to be addictive, and antidepressants, which can come with side effects. Patients did not consider beta blockers as “mental health drugs”, the study found, and therefore perceived them as “less stigmatising”.There has also been a cultural shift – celebrities including the actor Kristen Bell,Khloé Kardashianand cook Prue Leith have all spoken about taking beta blockers. When Robert Downey Jr went to collect his Golden Globe for Oppenheimer, he told the audience: “I took a beta blocker so this will be a breeze.” The writer and actor Sharon Horgan toldLouis Theroux on his podcast recently: “They do something very practical, physically, but I think the sort of mental stuff that goes with it … has had a real calming effect on me, and in situations that would normally kind of terrify me.”
It was a friend who suggested I try beta blockers for the funeral. She had been taking them on and off for years, although this was the first I had heard about it. “I’m not ashamed that I take them, but I also don’t need to advertise it,” she says. “I suppose I’m worried people would think it meant I’m not coping with life. I don’t know. But most people largely keep their medications to themselves, don’t they? It’s private.”
Well, yes, but once I told a few people that I was thinking of taking beta blockers, it was like a domino effect, with more and more of them revealing they had taken them, either for specific events or just now and then.
“I never leave home without them,” another friend tells me. “I bet I’m far from the only frazzled mum at the school gates who has them.”
Someone else I know takes them for perimenopausal anxiety, instead of upping her HRT, which could be another way to remedy the symptom. She says: “I’m also trying wild swimming, yoga and meditation. I’m really being proactive, not just leaping to drugs. But beta blockers work well for me.”
Despite the anecdotal evidence, the University of Bristol study says there is “no conclusive evidence” for the effectiveness of beta blockers for anxiety. They do not feature in guidance from the National Institute forHealthand Care Excellence (Nice) on treating anxiety. So why do doctors prescribe them?
“Although beta blockers can help with some of the physical symptoms of anxiety, they don’t treat the biology behind it,” says Khan. Instead, he says, Nice recommends a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs), which work by boosting levels of serotonin – known as the “happy hormone” – in the brain, alongside talking therapy, especially for those with generalised anxiety disorder.
“Saying this, many GPs and prescribers use beta blockers for situational anxiety – when you know you are going to be in a situation where you are likely to become anxious,” says Khan. “So, ‘if and when’ rather than long term.”
When I spoke to my GP, she said she prescribed beta blockers relatively often, to people who had to do big presentations at work, or lawyers about to make their closing speech in a trial. She advised me to have a practice run rather than trying them for the first time on the day of the funeral. Within 10 minutes of taking them, I felt like me, but calm. When I gave the eulogy, I was as fine as anyone could be in those circumstances.
Like most medications, beta blockers are not suitable for everyone. Dr Adrian Hayter, medical director for clinical policy at the Royal College of General Practitioners, says: “GPs take a holistic approach to assessing their patients and proposing treatment plans, in conversation with them. This will take into account a patient’s unique circumstances, the severity of their symptoms and their medical history, as well as possible side-effects and other medication they may be taking.”Side-effects of beta blockers includetiredness, dizziness and difficulties sleepingand they are not suitable for people with asthma. Taking more than your prescribed dose can be dangerous and you could end up in need of urgent treatment in A&E. Khan says: “Beta blockers are not addictive, but if you are taking them long term, you can’t suddenly stop them.” You need to be weaned off them. And he adds: “Interestingly, they have been linked to higher rates of depression, so I wouldn’t prescribe them for anyone who has depression alongside their anxiety.”
Khan says that in the broader picture of more and more patients being in contact with mental health services, he is seeing a rise in the number of patients with anxiety, and in particular work-related anxiety. “I don’t think I am specifically prescribing more beta blockers, but I am certainly treating more people for anxiety overall … I think life is becoming harder and harder for so many people that this is manifesting as anxiety.”
Last November, I lost the job I had been doing for 20 years, because of budget cuts. As I worked as a freelance, there was no redundancy pay out, just thank you, have a lovely Christmas. From the moment the bombshell was dropped, I felt constantly on the verge of a panic attack, as if sheer blind terror instead of blood was coursing through my veins. As an already anxious person, a phone call out of the blue that shattered my family’s financial security in an instant did not improve my mindset. After a discussion with my doctor, I now take beta blockers three times a day. They are helping to make my life manageable as I navigate my new normal.
We did talk about antidepressants instead, which I have taken in the past, but they didn’t feel like the right way to go at this time. The anxiety I was feeling was a reaction to my situation, to circumstances beyond my control, rather than a longer term issue.
And while they are working for me at the moment, I hope that I won’t need to take them indefinitely. Hayter says: “Wherever possible, GPs don’t want patients to have to rely on medication long term, and most patients don’t want that either. Best practice is for medication reviews to be held at regular intervals, where GPs and patients discuss whether there are opportunities to reduce the dosage or stop taking medication altogether.”
At some point, I’m sure I will feel able to stop taking beta blockers as regularly. But if another stressful public speaking event came up again, I can see myself heading back to my doctor.