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Propranolol for Performance Anxiety?
  1. #1
    Irene Iesu is offline New Member
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    Default Propranolol for Performance Anxiety?

    I've struggled with depression/anxiety for 15+ years. Currently on Bupropion + Prozac and this combo seems to be helping me so far. If I don't have to go out and meet people, I'm perfectly fine. But when I have to attend a social event, I feel super uneasy and sometimes take Xanax.

    I think the reason I'm apprehensive of social events is somewhat similar to performance anxiety. Even though I rarely would be put in a public speaking type of situation, I still feel "I have to perform" to look cheerful so people have a pleasant time with me. It makes me nervous obsessing over if I'm saying the right thing or don't look/sound strange.

    I heard doctors often prescribe a blood pressure medicine (beta-blocker) Propranolol for performance anxiety. I read user reviews where people had very satisfactory results.
    https://www.drugs.com/comments/propr...e-anxiety.html

    So I asked my doctor and she prescribed me 20mg of propranolol and instructed me to take it every day (once a day) since I also have high blood pressure (145/90).

    My understanding was that, for occasional extreme anxiety, you take a much larger dose (40-100mg) an hour or so before the anticipated event ... So I don't know if taking a small dose every day would be just as effective?

    I'm wondering if anyone used the med, if so, can you share the experience with me, the pros and cons of the med?
    Last edited by Anonymous; 10-03-2016 at 07:49 AM.

  2. #2
    Thisweekforsure is offline Advanced Member
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    Start dose would be 20-40 mg for performance anxiety. I would not take more than that. If you are taking 20 mg once per day, if it were me, I'd ask the doctor if I could take one extra prior to occasional performances. You want your resting pulse around 65 BPM. This would indicate an effective dose.

  3. #3
    Irene Iesu is offline New Member
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    Thank you for your reply! I asked my doctor if I could take extra pills when attending social events, but she didn't like the idea. She wants me to take the med at a steady pace for my hypertension. According to Drugs.com, a typical initial dose is 40mg twice a day ... but best to follow my doc's orders ... She did say I may increase the daily dosage after a month if I don't feel relief from my anxiety symptoms (palpitation, sweating, etc.) ...

  4. #4
    Thisweekforsure is offline Advanced Member
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    Well if it were me I'd take that. Give it a month and see what happens. Not ideal but then I wouldn't be happy with being put on it daily when I was asking for it for only occasional use, but your BP is high and needs to be treated, so I see where the doctor is coming from. She wants to stabilize you on that steady dose. But she's starting very conservatively as you say, an initial start is 80 per day for hypertension. But your BP while high is not extremely so and it's always best to use as low a dose as needed for any drug, so I see her reasoning. I hate you have to wait it out another month but in my view, your BP is a greater danger than your anxiety and best let the doctor sort it out like she wants. In the meantime, you still have your Xanax? Did the doctor say it's okay to use that on occasion? I really agree with your exploring propranolol as an alternative to Xanax, because Xanax can be very addictive (even if you are not an addict and never abuse it, it creates physical dependency if you take it too often). As long as you only use the Xanax very infrequently, you might be better off sticking with it for your severe attacks, and let the propranolol be a steady blood level. Make sure to take the Xanax in small doses and according to the doctor's instructions as it can interact with the propranolol.

  5. #5
    Irene Iesu is offline New Member
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    I wonder if prescribing beta blockers for anxiety on an as-needed basis is 'off-label' use of the med? If so, then perhaps my doctor being rather conservative (kinda stickler to regulations), may be she doesn't want to prescribe the med in a way that the FDA hasn't approved ...

    Many say xanax works much better for anxiety than propranolol. I can still take xanax if I need. But as you say, it's highly addictive so I want to use it as less as possible. I try not to take more than 1mg a day, and not more than a few times a week. Sometimes I don't take it at all for a couple of weeks. My doc thinks I won't develop a dependence on it at this rate.

  6. #6
    Thisweekforsure is offline Advanced Member
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    Yes it is or at least used to be an off label use. I've known people who used propranolol that way on an as needed basis, such as performers doing a show. They've even done studies on it using musicians. Yes, Xanax does work much better but brings with it decline in performance. If you take breaks from the Xanax as long as two weeks and keep your use very minimal other than that you shouldn't have a problem but beware it sneaks up on you. I recommend keeping a written record of your use such as marking on the calendar when you take one. Increasing frequency of use can be insidious. I hope you feel a difference on the propranolol and maybe won't need the Xanax quite as often?

  7. #7
    Irene Iesu is offline New Member
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    My blood pressure went up about a half year ago after taking Effexor for a couple of months ... and after I switched my antidepressant, I thought my BP went back to normal; it was around 120/70 the last several times I checked it at home ... But alas, at the doctor's office the other day, it was 145/90 ... My doc said it may be due to the 'white coat' effect, but she couldn't yet permit me to get off BP meds ... She is my primary care physician.

    I'm thinking, once I have my hypertension completely under control, I may not have to take a beta blocker every day. And then my psychiatrist (whom I started seeing recently) may be willing to prescribe propranolol on an as-needed basis? (so my usage of xanax will be even less often) I'll have to ask her.

    Yes, I take what I call a medication diary, and record all the medicines I took (the time, dosage), and also if I felt anything different ... Since I take five different meds, this is the best way to keep track of them.
    Last edited by Anonymous; 10-06-2016 at 10:22 AM.

  8. #8
    Thisweekforsure is offline Advanced Member
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    Oh yes, that could be white coat effect. If it were me I'd keep a blood pressure monitor at home and take my BP every day maybe at different times, for a week and see what your average is. Make sure you've been sitting quietly for 5 minutes before you take it. The automatic ones you buy at the pharmacy aren't as accurate as the nurse with the stethoscope but they're not that far off. You can try taking that information in to the doctor, maybe she will accept it and let you not take the propranolol every day. If not, at least you will know for yourself not to worry. I guess you could always just not take it against doctor's orders but I certainly would never do that unless I was certain my BP was only white coat.

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