Beta-blockers have different roles depending on what they are being prescribed for, says Tanuka Datta Piech, MD, a cardiologist at the University of Michigan Health Frankel Cardiovascular Center in Ann Arbor.
The drugs work by slowing the heart rate and relaxing smooth tissue in the blood vessels. This can help lower blood pressure.
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They also help slow down certain types of cell activity, managing the surge of adrenaline that drives the nervous system’s fight-or-flight response to an imminent threat. Adrenaline goes directly to receptors located throughout the body, Dr. Piech explains, causing the heart to race, the sweat glands to produce perspiration, and the muscles to move quickly, “which at a standstill manifests as shaking.”
Beta-blockers preempts this reaction by directly binding to adrenaline receptors in different parts of your body, “preoccupying” them so adrenaline has nowhere to go. “If adrenaline can’t bind to the receptors, you no longer feel symptoms of performance anxiety,” says Piech.
Why Do Doctors Prescribe Beta-Blockers for Heart Disease Patients?
“From a cardiac perspective, beta-blockers make your heart more efficient by lowering how much oxygen your heart muscle needs to do its job,” says Piech.
That’s why physicians may prescribe beta-blockers to reduce stress on the heart after a heart attack, to treat heart failure or cardiomyopathy (a progressive disease of the heart muscle), or to slow fast abnormal heart rhythms such as supraventricular tachycardia, atrial fibrillation, or atrial flutter, she says.
Why Do People Use Beta-Blockers ‘Off-Label’ for Anxiety?
Though many people have found beta-blockers helpful for performance anxiety, this is considered an “off-label” use of the medication, which means that there isn’t enough data from clinical trials for the U.S. Food and Drug Administration (FDA) to approve it for that use, says Luke Misquitta, MD, a clinical assistant professor in the department of psychiatry at The Ohio State University Wexner Medical Center in Columbus.
“However, since beta-blockers are relatively safe medications for most people, and there are currently no FDA-approved medications for performance anxiety, beta-blockers are commonly prescribed to improve performance anxiety,” he says.