Are you anxious before an important interview? Worried about giving a speech? Are you nervous on your first date?
The solution proposed by some digital startups is beta-blockers, a type of drug that slows the heart rate and lowers blood pressure, and can mask some of the physical symptoms of anxiety.
Typically, you would have to go to a doctor's office to pick up a prescription, but many companies are now connecting patients and doctors for quick virtual visits and delivering medications to people's homes.
“No more 'shaking and sweating,'” one online ad promised. “Easy to take in 15 minutes.”
That worries Dr. Yvette I. Sherine, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania.
“The first question is: What is going on with this person?” Dr. Sherine said. Are they depressed in addition to anxiety? Do they have chronic anxiety or temporary stage fright? “I don't want to end up prescribing the wrong thing. ” she added.
Additionally, while beta blockers are generally considered safe, experts say they can have unpleasant side effects and should be used with caution.
What are beta blockers?
Beta-blockers, such as propranolol hydrochloride, are approved by the Food and Drug Administration for chest pain, migraine prevention, involuntary tremors, and abnormal heart rhythms.
Although some drugs are still prescribed for hypertension, they are not considered preferred treatments, primarily because other drugs are more effective at preventing stroke and death.
Beta-blockers reduce the physical symptoms of the “fight or flight” response to stress, such as tremors, sweaty palms, and a racing heart, but they are not approved by the FDA to treat anxiety disorders.
For decades, doctors have prescribed them for problems outside of their approved uses, including problems such as stage fright. In recent years, celebrities such as Robert Downey Jr. and Khloe Kardashian have said the drug helped them overcome performance anxiety.
How do they work?
When we begin to feel anxious or stressed, our bodies produce adrenaline to prepare us to respond to the perceived danger. This hormone signals the heart to beat faster and narrows blood vessels to divert blood to vital organs such as the heart and lungs. Your breathing becomes rapid and you begin to sweat.
Beta blockers work by “blocking” the effects of adrenaline. They cause the heart to beat more slowly and with less force, which helps lower blood pressure.
But if you're feeling particularly anxious, “your mind is still racing and you're going to ruminate and worry,” says Regine, a psychologist who treats patients with anxiety disorders in Cedarhurst, New York. Galanti says.
In other words, beta blockers do not address the root of your fear. “Once it becomes like a weekly thing, you're like, 'Oh, I'm just having a hard time with this course.' I just take a beta blocker every time.” “The long-term goal here is What is it?'' I said. ” she added.
Dr. Joseph Bienvenu, a professor of psychiatry at Johns Hopkins University School of Medicine, said patients are typically prescribed only a few pills for specific situations in which they might experience performance anxiety. However, some online companies offer up to 48 pieces at a time.
Are there any side effects?
yes. Beta blockers may make you feel dizzy. Other potential side effects include fatigue, cold hands and feet, trouble sleeping, and nightmares. It can also cause stomach problems such as nausea and diarrhea, and in rare cases, difficulty breathing.
This is why some doctors tell patients to avoid taking the drug for the first time on the day of a big event.
Dr. Bienvenu advises patients to try the drug first on the weekend, “when there's nothing else to do.”
“I just want people to know how it affects them,” he said.
Is it okay to take them to potentially scary tasks like big presentations?
probably. But experts suggested visiting your family doctor first.
Beta-blockers may not be recommended for some people with diabetes, low blood pressure, slow heartbeat (bradycardia), or people with asthma or other lung diseases. Also, certain medications can interact with them, such as some cholesterol and cardiovascular drugs.
Arthur Caplan, a professor of bioethics at New York University's Grossman School of Medicine, said online doctors don't know your full medical history and have never examined you in person.
Without a physical exam, some patients may not realize they have an underlying problem, such as an arrhythmia, he added. You may also not know who to call if you have questions after receiving your prescription.
“These types of drugs need to be used and controlled,” he said.
Experts say that for people who frequently face anxiety-provoking tasks, such as public speaking, it's best to try breathing techniques and exposure therapy, which involve directly confronting the anxiety trigger to break patterns of fear and avoidance. He said it might be possible.
“Hiding your anxiety symptoms doesn't teach you how to deal with them,” Dr. Galanti says.