Is propranolol good for social anxiety?

What type of medication is propranolol?

Propranolol is a medication included in the class of drugs called beta blockers.

Beta blockers, also known as beta-adrenergic antagonists, block the stress hormones (adrenaline and noradrenaline) to bond with the beta receptors located in the heart muscles, kidneys, airways, smooth muscles, and other parts of the sympathetic nervous system. The sympathetic nervous system is responsible for the body’s fight-or-flight response (a psychological reaction to threats).

Propranolol is marketed under different trade names such as:

  • Inderal

  • Inderide (when is in combination with a diuretic)

  • Ciplar

  • Hemangeol

  • Innopran

  • Sumial

  • Avlocardyl

When is propranolol prescribed?

FDA approved the prescription of propranolol in the treatment of the following medical conditions:

  • hypertension

  • cardiac arrhythmia

  • hyperthyroidism

  • migraine

  • chest pains

  • tremor

  • pheochromocytoma (a tumor developed in the adrenal glands that causes an abnormally high release of adrenaline and noradrenaline)


Prescription of propranolol for social anxiety

FDA did not approve propranolol as a suitable medication to treat mental disorders. Nonetheless, many doctors keep prescribing propranolol in the treatment of:

  • social phobia

  • aggressive behavior that occurs in patients with brain injuries

  • withdrawal from drugs

  • bipolar disorder

  • post-traumatic stress disorder

Propranolol is considered useful for social phobia because it lowers a series of symptoms specific to anxiety such as:

  • excessive sweating

  • palpitations (increased heart rate)

  • facial blushing

  • irritability

  • hands shaking

  • sweaty hands

  • high blood pressure

  • increased breathing frequency

  • dry mouth

  • tremor

Clinical trials about propranolol efficiency in patients with social phobia revealed that the medication is effective when is administered in low doses that range from 10 to 40 mg, taken prior the anxiety-inducing event.

  • Stage fright and propranolol

Stage fright (commonly known as performance anxiety) is related to the individual’s fear to perform in the front of a group of people. A lot of musicians, dancers, and actors admit that they use propranolol to better coping with anxiety during performances and to improve the quality of their artistic message.

Although stage fright is mostly associated with the world of artists, many other people go through a similar experience when they need to:

  • speak directly to a live audience (public speaking)

  • make a self-presentation in job interviews

  • give speeches

  • participate in stand up projects

Also, surgeons take propranolol to reduce the hand tremors during complex and high accuracy surgery, while athletes involved in precision sports like archery, shooting, billiards, and golf, go for this medicine to hold their hands and arms steady. However, the usage of beta blockers in professional competitions has been prohibited by the World Anti-Doping Agency.

  • Possible side effects of propranolol

  • Sleeping problems (insomnia or sleepiness)

  • Dry eyes

  • Vomiting

  • slow heart rate

  • vertigo

  • sore throat

  • abdominal pains

  • skin itching

  • cold extremities (hands and feet)

  • bleeding under the skin

Most of these side effects are moderate and temporary so that in general, they do not require the withdrawal of treatment.

Special precautions when using propranolol:

  • patients with renal, lung or liver impairments

  • diabetics

  • smokers

  • allergic reaction to any type of beta blockers

  • heart abnormalities

  • bronchial asthma

  • breast-feeding

  • pregnancy

  • before having a dental procedure that requires anesthesia

Ceasing the therapy abruptly may lead to tachycardia, chest pains and heart attack.

  • Conclusion

Propranolol is a FDA approved medication for treating various heart diseases, tremors and high blood pressure. Despite that, many physicians prescribe it “off-label” to reduce social anxiety symptoms especially in people who deal with stage fright when performing in public.

It has been noticed an increased tendency to overuse the drug. This is why psychiatrists recommend taking the medicine about one hour before the stressful event and avoiding a regular use. Moreover, it is advisable to have a trial dose one day before the performance to check if the drug is well tolerated.

The nondrug approaches like learning about anxiety management techniques are consider better options than medications at all times.

There are no substantial proofs, based on an extensive and well-planned medical study, to strongly state that propranolol does decrease anxiety. You should consider using propranolol only after discussing with your doctor both the benefits and risks of the treatment.