Alternative anxiety treatment
If you are experiencing severe anxiety symptoms, please see the advice at the bottom of this NHS page.
Psychological therapies such as cognitive behavioural therapy (CBT) and applied relaxation are available on the NHS. These can be effective in treating anxiety and are usually the first treatment option for people with anxiety. In England, people can refer themselves for psychological therapies without a GP referral. This NHS page gives more information on local services.
These therapies can be used alone or with medication. There is good scientific evidence to show that they can be effective treatments for anxiety and other mental health conditions. CBT helps a person examine their negative thoughts and how these contribute to anxiety. It also helps them understand their behaviour in anxious situations.
The Scottish NHS website has a useful anxiety self-help guide that uses principles of CBT to help with anxiety symptoms. This may be a good first step for people who do not want to do CBT in person.
What is Propranolol?
Propranolol is a drug that was discovered in the 1960s and has been widely used since then. Propranolol is in a class of drugs called beta blockers. Traditionally beta blockers are used for people with heart problems. They are effective in treating high blood pressure, angina, an irregular heartbeat and for preventing a future heart attack.
In addition to the conditions above, propranolol can also be prescribed to help people with anxiety.
How does Propranolol work?
Anxiety is the main symptom of various conditions referred to as anxiety disorders. Examples of anxiety disorders are:
- Generalised anxiety disorder (GAD)
- Social anxiety disorder
- Panic disorder
- Post-traumatic stress disorder (PTSD)
Anxiety can affect people in different ways. Some people have anxiety that causes physical symptoms such as:
- Strong, fast or irregular heart beats (palpitations)
- Shaking or trembling
- A feeling of tightness in the chest
This can cause a vicious cycle of anxiety for some people. When people feel anxious, they may notice these symptoms happening which can worsen the anxiety.
For example, if someone is having a panic attack they may notice their heart rate has increased. This can be a frightening experience for the patient. It can worsen the panic attack which can increase their heart rate further.
Propranolol works by easing the physical symptoms associated with anxiety. It blocks the chemical messengers that cause the sweating, shaking and increase in heart rate. By reducing the physical symptoms, it can break the cycle of increasing anxiety.
Propranolol is not effective for the psychological symptoms of anxiety which include:
- Difficulty concentrating
- Difficulty controlling day-to-day worries
- Trouble relaxing
- Consistent feelings of fear/dread
People with anxiety often suffer both physical and psychological symptoms and may benefit from taking propranolol alongside other treatments. Psychological therapies such as cognitive behavioural therapy (CBT) are effective treatments for anxiety. They can be used prior to, or alongside, medication.
How to take Propranolol
The dose the doctor prescribes depends on the personal situation of the patient. Generally a 10mg or 40mg dose is taken once a day but can be taken up to three times a day. Propranolol tablets should have an effect on symptoms within 1 to 2 hours of taking a dose.
Sustained-release versions of propranolol exist and are sometimes prescribed. This is released slowly in the body. These are generally taken once a day.
Some people suffer from anxiety which is based on certain situations, such as before public speaking or flying. These people may be prescribed to take a dose shortly before these types of situations.
Selective serotonin reuptake inhibitors (SSRIs) are generally the first treatment prescribed for people with anxiety. They can also be prescribed for depression and other conditions.
SSRIs and other treatments for anxiety help with the psychological symptoms of anxiety. However, propranolol is one of the few medications prescribed for the physical symptoms of anxiety.
Propranolol can normally be used alongside SSRIs and this combination may be beneficial in treating both types of anxiety symptoms. One issue with SSRIs is they can take several weeks to start working. Taking propranolol when starting an SSRI may be helpful in treating symptoms whilst waiting for the SSRI to have an effect.
Sertraline, escitalopram and paroxetine are examples of SSRIs that may be prescribed.
Other treatments that can be used if SSRIs do not work:
- Serotonin and noradrenaline reuptake inhibitors (SNRIs) like duloxetine or venlafaxine
- Pregabalin (a medication commonly used for epilepsy, it can be effective at treating anxiety)
- Benzodiazepines like diazepam or temazepam (these are only used short-term if anxiety is very severe)
Please read the patient information leaflet for a full list of medications that interact with propranolol. Make sure to fill our online form completely, to enable our doctors to ensure propranolol is safe for you to use.
We have listed some medications below that should not be taken with propranolol without discussing with a doctor or pharmacist first:
- Heart disease medication such as verapamil, diltiazem and nifedipine
- Medicines to regulate heart rhythm such as flecainide or amiodarone
- Medicines to treat diabetes such as insulin
- Medicines to treat high blood pressure
- Medicines for asthma or chronic obstructive pulmonary disease (COPD)
When filling in our online form, it is important to mention any other medical conditions you have. This is to help our doctors ensure it is safe for you to take propranolol for your anxiety. You should also advise of any medications you are currently taking.
People with certain medical conditions may not be suitable to take propranolol. This must be assessed by our doctors. Listed below are some conditions that are affected by propranolol:
- Low blood pressure or a slow heart rate
- Asthma or other lung conditions
- Diabetes (it may hide the symptoms of low blood sugar)
- Heart failure
- Blood circulation problems
- An overactive thyroid (hyperthyroidism)
Type of drug
How it works
Treats physical symptoms of anxiety
Can include cold hands and feet, nausea, tiredness
Frequently asked questions
Is propranolol addictive?
Propranolol is not a physically addictive medication but if treatment is to stop it must be stopped gradually.
Can propranolol and alcohol be taken together?
Alcohol should be avoided whilst taking propranolol. Alcohol may cause propranolol to lower your blood pressure which can make people lightheaded and dizzy. Drinking alcohol may also worsen anxiety symptoms.
Can propranolol be taken every day?
Propranolol can be taken every day for anxiety although some people only use it before situations that may trigger their anxiety. If you take propranolol every day, do not stop taking it suddenly.
Propranolol side effects
All medication can cause side effects but many people will have none or only minor side effects with propranolol. The patient information leaflet contains all the information about propranolol including side effects. It is important to read this leaflet before taking the medication. The list below contains common side effects of propranolol:
- Tiredness, dizziness or weakness (these symptoms usually disappear with time)
- Cold hands and feet
- Difficulty sleeping and/or nightmares (more likely if taking propranolol at night)
- Slow or irregular heartbeat
- Raynaud’s syndrome
- Nausea or diarrhoea
Weight gain is not listed as a common side effect of propranolol. However, people may feel tired when taking it and may gain weight because they find it harder to stay active.
The side effects listed below are more serious. If they occur you should stop taking propranolol and speak to, or call, your doctor immediately:
- Symptoms that indicate a heart problem like swollen ankles or legs, chest pain, and/or an irregular heartbeat.
- Symptoms that indicate a lung problem like wheezing or shortness of breath.
- Symptoms that indicate an allergic reaction like a rash, itching, swelling of the face, lips, tongue or throat and difficulty breathing. A severe allergic reaction is a medical emergency.
If you take propranolol every day and want to stop taking it, you must gradually stop it. Seek medical advice from your doctor before stopping. If you stop propranolol suddenly it can be dangerous.
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