Anxious before a big job interview? Worried about giving a speech? First date nerves?
The solution, some digital start-ups suggest, is a beta blocker, a type of drug that can slow the heart rate and lower blood pressure – masking some of the physical symptoms of anxiety.
Usually a trip to the doctor’s office is required to get a prescription, but a number of companies are now connecting patients with doctors for quick virtual visits and shipping medicine to people’s homes.
“No more ‘Shaky and Sweaty,'” promises one online ad. “Easy quick 15 minute application.”
That worries Dr. Yvette I. Sheline, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.
“The first question is: What’s going on this year?” Said Dr. Sheline. Are they depressed in addition to anxiety? Do they have chronic anxiety or is it just a temporary case of stage fright? “You don’t want to end up prescribing the wrong thing,” he adds.
In addition, although beta blockers are generally considered safe, experts say that they can bring unpleasant side effects and should be used with caution.
What are beta blockers?
Beta blockers such as propranolol hydrochloride has been approved by the Food and Drug Administration for chest pain, migraine prevention, involuntary tremors, abnormal heart rhythms and other uses.
Some are still prescribed for hypertension, although they are preferred treatment is no longer consideredmainly because other drugs are more effective at preventing stroke and death.
Beta blockers can alleviate the physical symptoms of the “fight or flight” response to stress, such as tremors, sweaty palms or a racing heart, but they are not FDA-approved to treat anxiety disorders.
For decades, doctors have been prescribing them for issues other than their approved uses, including for problems like stage fright. In recent years, celebrities like Robert Downey Jr. and Khloé Kardashian said the drugs helped them overcome performance anxiety.
How do they work?
When we begin to feel anxious or worried, our body produces adrenaline, which prepares us to respond to perceived danger. The hormone signals our heart to beat faster and narrows our blood vessels to redirect blood to vital organs like the heart and lungs. Breathing quickens, and we begin to sweat.
Beta blockers work by “blocking” the effects of adrenaline. They cause the heart to beat slower and exert less force, which helps lower blood pressure.
But if you’re feeling particularly anxious, “your mind will still be racing, you’ll still be thinking and worrying,” says Regine Galanti, a psychologist in Cedarhurst, NY, who treats people with have anxiety disorders.
In other words, beta blockers won’t address the root of your fears. “If it becomes weekly, ‘Oh, I’m just having a hard time with this course. I just pop a beta blocker every time.’ I would say, ‘What’s the long-term goal here?’” she added.
Patients are usually only prescribed certain pills for specific situations where they may experience performance anxiety, Dr. Joseph Bienvenu, a professor of psychiatry at Johns Hopkins University School of Medicine. But some online companies distribute up to 48 at a time.
Are there any side effects?
Yes. Beta blockers can make people feel dizzy. Others potential impact include fatigue, cold hands or feet, trouble sleeping and nightmares. They can also cause stomach problems such as nausea or diarrhea and, less often, difficulty breathing.
This is why some doctors tell their patients to avoid taking them for the first time on the day of a big event.
Advised by Dr. Patients are welcome to try the drug first on the weekend, or “when you have nothing else to do.”
“I just want people to know how it’s going to affect them,” he said.
Is it OK to bring them along for a potentially intimidating task, like a big presentation?
Probably. But experts suggest visiting your general practitioner first.
Beta blockers may not be advised for some people with diabetes, low blood pressure or bradycardia, which is a slow heartbeat — or people with asthma or other lung disease. And some medications, including some cholesterol and cardiovascular medications, can interact with them.
Online doctors don’t have your full medical history and haven’t examined you in person, says Arthur Caplan, a professor of bioethics at the NYU Grossman School of Medicine.
Without a physical exam, some patients may not know they have an underlying issue such as an irregular heartbeat, he added. And they may not know who to call if they have questions after getting a prescription.
“You have to manage these types of drugs,” he said.
For those who frequently face anxiety-provoking tasks like public speaking, experts say, it may be more helpful to try breathing techniques or exposure therapywhich involves facing directly what makes it difficult for us to break the pattern of fear and avoidance.
“Covering over your anxiety symptoms won’t teach you how to manage your anxiety symptoms,” says Dr. Galanti
