Propranolol is a beta-blocker sold under the brand names Bedranol and Inderal. While it is often prescribed for conditions such as high-blood pressure, angina and irregular heartbeats, this scientific review will analyze studies on its effects in treating anxiety, the side effects and reported dosages. 

The beta-blocker works by blocking the action of organic chemicals, such as epinephrine. Therefore, propranolol has been explored as an off-label treatment for epinephrine-induced anxiety attacks or panic attacks.  

This review of propranolol for anxiety disorders will look at studies that include panic disorder with or without agoraphobia, social anxiety and posttraumatic stress disorder (PTSD). 

Propranolol Versus Benzodiazepine 

A study published in The Journal of Clinical Psychiatry, 212 patients were given propranolol, a benzodiazepine or a placebo. The study found that patients in the trial reported an improvement in anxiety based on the clinical scales when taking propranolol and the benzodiazepine. In the second week, propranolol was better than placebo based on two clinical scales used to measure anxiety.  

The side effects of the beta blocker reported in the study were drowsiness and indigestion. Drowsiness was a side effect found in both drugs. Chlordiazepoxide (Librium) was the benzodiazepine used in the study and the subjects experience a change in sexual desire more frequently with this medication. 

Treatment of Specific Phobias 

A study published in Clinical Pediatrics found that a 40-milligram dose of the beta blocker improves test (exam) anxiety when taking one hour before. The researchers found that the students, who were prone to this form of anxiety performed better when the test was retaken with the medication.  

The peer-reviewed Journal of Psychopharmacology also notes that the drug is effective in treating milder forms of anxiety, such as stage fright and performance anxiety in musicians and surgeons, who may experience shaky hands as a symptom of stress. 

Propranolol for Social Anxiety

In a study, sixteen patients underwent a one-month social training program to help combat social anxiety. The process was conducted by volunteers who were not therapists and the treatment involved a workshop and rehearsals of social interactions in a real-life setting.  

According to The Journal of Nervous and Mental Disease, the patients were subsequently given either a placebo or propranolol. Their general social anxiety, self-image and overall tension in social situations were measured one month prior to treatment and immediately after.  

After a month of treatment both the patients who took a placebo or propranolol experienced significant improvements in their social phobias. Therefore, the medication has no significant effect in treating anxiety because the placebo effect garnered the same results. The study determined that both clinical and real-life behavioral therapy was an effective treatment for social phobias.  

It is also worth noting that this study did not take into account the physical symptoms that some sufferers of social anxiety may experience, such as sweating, stuttering and shaking. Some evidence suggests that the medication could help reduce these symptoms. 

Propranolol: An Additional Treatment For Posttraumatic Stress Disorder

 PTSD is a form of anxiety where sufferers relive traumatic events through nightmares or replay the distressing event in their memories.  

Dr. Alain Brunet and colleagues published a study in the European Journal of Psychotraumatology on the effects of the beta-blocker in treating symptoms of PTSD in 33 patients with the condition. [1] Under controlled conditions, a brief trauma reactivation under the influence of propranolol help reduce symptoms of PTSD.  

The medication also helped reduce the mental and physical symptoms during a trauma-related script-driven imagery scale, which is a tool used to provoke symptoms and measure the state of PTSD. The treatment was more effective in women than men and age did not play a factor.  

The researchers stated that the effectiveness of the medication was likely based on propranolol blocking memory reconsolidation. The results of the study were from an open trial; therefore, a randomized trial is required for more definitive results.  

Memory reconsolidation is when a previously consolidated memory, such as a traumatic event, is being recalled, strengthen or altered. In people with PTSD, this can cause anxiety, sleeplessness and a range of physiological symptoms when the memory is triggered.

A randomized and double-blind study published in the Journal of Psychiatric Research further detailed the beta-blockers effect as a treatment for PTSD. Patients took 40 milligrams of a short-acting version of oral propranolol given before exposure therapy. With a follow-up dosage of 60 milligrams of modified-release oral propranolol, patients experienced a reduction in physiological symptoms during exposure therapy a week later.  

Despite these promising results, there is no concrete evidence that the medication helps reduce PTSD symptoms via blocking memory reconsolidation.

Propranolol may be effective in treating in PTSD when used in combination with psychotherapy.  

Propranolol Effects On Panic Attacks With Or Without Agoraphobia

Benzodiazepines, such as Xanax and Valium, are considered first-line pharmaceutical treatment for panic disorders. However, some studies show that propranolol is just as effective in treating panic disorders while others garnered mixed results. 

A scientific study published in the Archives of General Psychiatry compared the effects of diazepam (valium) and propranolol in 21 subjects with panic disorder and agoraphobia. The patients took either medication in a double-blind trial. The study found that diazepam was more effective in all factors observed. Researchers observed that 18 of the 21 patients showed moderate improvements while only seven had similar benefits on propranolol. 

Another study in the Journal of Clinical Psychopharmacology compared the beta blocker with Xanax. The six-week, double-blind study found that propranolol and Xanax were both effective in stopping panic attacks and agoraphobic behavior.

The only difference noted in the study was that Xanax had a more rapid anti-panic effect.  

When combining results from multiple studies, researchers published in The Journal of Psychopharmacology found that there was no statistical difference between propranolol and benzodiazepines in reducing panic attack frequencies.  

Due to benzodiazepines side effects such as drowsiness and physical impairment, propranolol could be a better alternative as a long-term treatment for panic attacks. Addiction experts rank benzo’s high in addiction, physical harm, and social harm. 

Propranolol side effects are less common and it may include sleep disturbances such as insomnia and nightmares. 

Propranolol Dosages 

40 milligrams of propranolol is often prescribed for the short-acting form of the drug. 60 to 80 milligrams are more common for a modified-release or long-acting version. Dosages of 120 milligrams of propranolol have been reported.  

The dosage prescribed usually depends on your reaction to the medication. A doctor may increase or decrease your dosage.  

Conclusion 

The evidence available suggests that propranolol may not be the best option for treating anxiety disorders apart from panic attacks. The medication can be effective in treating bodily sensations associated with anxiety, such as heart palpitations, hyperhidrosis or excessive sweating and the frequency of panic attacks. 

It is worth consulting a doctor about exploring propranolol as part of a treatment course for some anxiety disorders; especially if you have had negative experiences with selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines.