Beta-blockers for anxiety: What are the Most Common Indications, Interactions and Side Effects of Beta-Blockers

Beta-blockers for anxiety: what are the most common side effects of beta-blockers?

Beta-blockers are excellent medications in controlling fight-or-flight bodily response in addition to minimizing its impact on the heart. This means that this class of medication helps in stress related effects
on the heart and body.

Beta blockers are also used for anxiety treatment. This is because anxiety is as a result of the fight-or-flight effects on the brain and body.

Beta blockers even though very effective as anxiety treatment medication, pose a number of side effects. This means that you should always talk to anxiety treatment doctors about the medication before taking it.

What medical conditions are treated with beta-blockers?

Beta-blockers have effects on fight-or-flight body response and the reduction of heart rate. The beta-blockers are effective therefore in heart related conditions and other conditions. Thus, beta-blockers are effective in the following medical conditions:

  • Hypertension or high blood pressure
  • Congestive heart failure
  • Heart attack or myocardial infarction
  • Irregular heartbeat or atrial fibrillation
  • Anxiety disorders
  • Angina pectoris (Chest pain emanating from low blood supply to heart muscles)
  • Migraine
  • Some tremors
  • Glaucoma
  • Hyperthyroidism

It should be noted that primarily beta-blockers are medications for heart problems. For anxiety disorders, doctors prescribe beta-blockers on an ‘off-label’ basis.

How do beta-blockers work?

Beta blockers are also known as beta-adrenergic blockers. This means that they work in the heart by preventing adrenaline from attaching to the heart’s beta receptors. Adrenaline (epinephrine) is known as the stress

Adrenaline is a neurotransmitter produced in the brain and adrenal glands which together with noradrenaline prepares the body for the fight-or-flight actions in the body. After production, the two neurotransmitters are released into the blood as chemical mediators to send messages to all body systems.

Adrenaline fight-or-flight response include the following actions that are seen during moments of stress and anxiety. It increases the heart rate, increases blood pressure, opening and widening the airways in the lungs, enlargement of the pupils in the eyes, increasing blood flow to muscles and changes in metabolism.

Some beta-blockers also relax your blood vessels. Relaxation of arteries and veins in the body function to reduce the blood pressure. All the other actions of adrenaline discussed above are also affected by beta-blockers.

Because of the level of action of beta-blockers, they are classified as selective and non-selective beta-blockers. Selective beta-blockers affect the heart majorly while non-selective beta-blockers affect other parts of the body.

Examples of beta-blockers

There are several beta-blockers that are available. Some work only in the heart while others work in the blood vessels in addition to the heart.

Some of the oral beta-blockers include:

  • Propranolol (Inderal)
  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta)
  • Metoprolol (Lopressor)
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)

Other common beta-blockers include:

  • Timolol (blocadren)
  • Sotalol (betapace)
  • Labetalol (trandate)
  • Penbutolol (levatol)
  • Betaxolol (Kerlone)
  • Carvedilol (Coreg)
  • Pindolol (Visken)

How long do beta-blockers take to work for anxiety?

How long do beta-blockers take to work for anxiety?

“How quickly does propranolol work for anxiety?” is one of the most commonly asked questions about anxiety. It emanates from requiring a quick relief from a panic attack. A panic attack gives you the feeling that you are having a heart attack or dying.

Every person will want a fast acting medication for panic attacks to alleviate the symptoms. The anxiety treatment drugs preferred must be able to clear the symptoms rapidly.

Beta-blockers are some of the fast-acting medication for panic attacks and other anxiety related symptoms.

Even though they are used on a ‘off-label’ basis, they are the closest to instant anxiety relief medication. This means that they offer relief almost immediately after taking them.

Beta-blockers full effects will however be felt 1 to 2 hours after taking them. The effects including a sense of calmness, slowing heart rate and reduced restlessness will start taking place immediately but will
fully be felt after 1 to 2 hours.

The other fast-acting anxiety treatment medications include benzodiazepines and GABA.

How long do beta blockers last?

Beta-blockers like propranolol are produced majorly as an extended-release capsules which are taken once a day (OD). Because of the slow release nature of the drug presentation, the drug is released slowly into the blood stream. This means that the anxiety treatment drug is able to be released for a full day into the blood stream.

The effect of this is that beta-blockers effects in the body will last for 24 hours.

The serum half-life of different beta blockers differ in length. According to the study, having the highest half at 15.5 hours, was seen to have 52% of peak blood level after 24 hours as compared to atenolol. This is because atenolol had a half life of 5.5 hours meaning according to the study, it had just 20% of the peak blood level at 24 hours.

What are the most common side effects of beta-blockers?

The most common side effects of beta-blockers include:

  • Fatigue
  • Weight gain
  • Weakness
  • Dizziness
  • Having cold feet or hands
  • Headaches
  • Upset stomach

The other side effects include:

  • Depression
  • Shortness of breath
  • Sleeping problems and sleep disturbances
  • Dizziness
  • Weakness
  • Dry mouth, skin and eyes
  • Diarrhea or constipation
  • Vomiting and nausea
  • Trouble breathing or wheezing

The less common side effects of beta blockers include:

  • A decrease in sex drive
  • Changes in sexual performance
  • Alopecia (hair loss)
  • Swelling of the hands or feet
  • Confusion and memory problems
  • Slow heartbeat
  • Skin rash
  • Sore throat
  • Joint pain
  • Back pain

Some of these symptoms being mild go away as the body starts getting used to the anxiety medication. In case of long term side effects of beta blockers, consult your doctor.

Among the symptoms listed above, some severe less-common symptoms exist. These are breathing problems (bronchospasms), slow heart rate, allergies, sudden weight increase. Swelling of extremities like legs, ankles or
feet, sudden alteration of blood sugars, sleeping problems and hallucinations.

For asthmatics, Beta-blockers may trigger an asthma attack. For this reason, they are not generally used for people with asthma.

For diabetics, beta-blockers may hide the symptoms of low blood sugar level. Low blood sugar levels present with symptoms like a rapid heartbeat. If you have diabetes, kindly ensure that you regularly check your
blood sugars while taking beta-blockers.

Intake of beta-blockers may alter the cholesterol and triglyceride levels in the blood and body. The bad fats (triglycerides) are increased while good cholesterol (high-density lipoprotein- HDL) is reduced. Even though temporary, these changes need to be monitored.

Beta-blockers are not recommended for pregnant women and nursing/ lactating women. Also. kindly note that babies below kgs re not given beta-blockers like propranolol. Also, children weighing below 2.1 Kgs should
not use beta-blockers.

While beta-blockers are generally safe, it is recommended that you should have a slow withdrawal process. An abrupt withdrawal from taking beta-blockers may lead to a heart attack or other heart conditions.

Beta-blockers interactions

All medications have a mode of action in the body. Some drugs might inhibit the mode of action of another drug or layer into it. The effects of the drug interaction can be to increase the potency of a drug or to reduce it.

Therefore, it is very important to learn about drug reaction and interactions before taking them Every time a doctor prescribes a drugs/he always considers the effects of drugs interactions in the body.

Other medications can affect the action of beta-blockers in the body. Drugs for the treatment of heart rhythm problems can interfere with the workings of beta-blockers like propranolol. Therefore, discuss with your doctors before taking a beta-blocker if you are already using the heart rhythm conditions treatment medication.

If the beta-blocker is used for blood pressure management in a person already taking another blood pressure medication, switching from one of the medications for blood pressure to a beta-blocker should be done
gradually. This reduces the side effects. The other medication dosage is reduced gradually while increasing the beta-blocker dose.

Never take 2 types of beta-blockers at the same time. This increases the potency of the medication which can drop the heart rate to unsafe points and can even cause heart failure. For the same reason, ACE inhibitors,
calcium channel blockers and alpha-blockers should not be taken with beta-blockers.

NSAIDs (nonsteroidal anti-inflammatory drugs) can reduce the beta-blockers effects in the body. Therefore, NSAIDs such as ibuprofen should be avoided or be taken as advised by a doctor if you are taking a beta-blocker.

Beta-blockers have effects on other drugs including anesthetics, warfarin, anti-ulcer medications and HMG-CoA reductase inhibitors.

In addition to drugs, beta-blockers also interact with alcohol, caffeine and other substances. Taking alcohol while taking a beta-blocker can make the side effects graver.

Different beta-blockers may have different interactions with the above medications and substances.

It is therefore imperative that you have a comprehensive discussion with your doctor or pharmacist on the interactions.

It is very important to discuss with your doctor if you are taking other medication before a beta-blocker is prescribed.

Beta-blockers and the African descent population

Beta-blockers for blacks: Do they work?

Beta-blockers may not be as effective in the population who have a descent from Africa as compared to the other races.

According to recent studies, diuretics and calcium antagonists should be used as first line in black
hypertensives rather than beta-blockers or ACE inhibitors. The reason is the black population has a low renin profile as compared to other races.

Beta-blockers may also not be very effective on older patients. The patients who are above 60 years should also discuss the drugs with their doctors before taking them.

Other anxiety management methods

Anxiety disorders can be managed by other medication, therapy and symptom management. These methods enable you to have a better quality of life.

Some of these management methods include:

  • Anxiety disorder drugs (anxiolytics) like buspirone.
  • Antidepressants
  • Psychotherapy including CBT methods like the transdiagnostic treatment approaches such as the unified protocol, CT, MATCH among others.
  • Home remedy of anxiety disorders: These include relaxation techniques like massage, diet, exercise, reduction in uptake of stimulants and alcohol, and getting enough sleep among others.

The anxiety disorder management methods listed above are either used in isolation or combined together.

Your doctor will help you to know which methods to you need to use in treatment of anxiety disorder.

The bottom line

Beta-blockers are good medication for the management of emotional disorders including anxiety disorders. However, beta blockers come with side effects and contraindications.

The medication is recommended for anxiety disorders but with direction from a doctor.