Propranolol for Performance Anxiety in Oregon and Washington

What It Is

Propranolol is a beta blocker, originally developed for heart conditions and high blood pressure. It's used off-label for performance anxiety, social anxiety, and physical symptoms of anxiety. Not a controlled substance, not psychoactive, just blocks your body's physical stress response.

Comes in regular release and extended release. For performance anxiety, most people use immediate release 10mg, 20mg, or 40mg tablets taken as needed.

What It Does

Propranolol blocks the physical symptoms of anxiety. Racing heart, shaking hands, sweating, trembling voice, all that adrenaline-fueled fight-or-flight response. It stops your body from freaking out even when your brain is nervous.

Doesn't touch the anxious thoughts or worry. Your brain still knows you should be nervous about that presentation or job interview or whatever. Your body just doesn't respond to that nervousness with physical panic symptoms.

How It Works

Propranolol blocks beta-adrenergic receptors, which are part of your sympathetic nervous system (fight-or-flight system). When adrenaline tries to bind to these receptors to make your heart race and your hands shake, propranolol is already sitting there blocking the receptor. The adrenaline can't do its thing, so your body stays physically calm.

This is why it works for performance anxiety but not for generalized anxiety. It's stopping the physical cascade, not the mental worry.

What It Feels Like When It's Working

You're about to give a presentation or walk into a job interview or perform on stage. Normally your heart would be pounding, hands shaking, maybe sweating through your shirt. With propranolol, your body stays calm. Heart rate normal, hands steady, voice doesn't tremble.

Your brain still registers that this is a stressful situation. You're still nervous mentally. But your body doesn't betray you. The physical symptoms that usually make anxiety worse don't happen.

For a lot of people this is game-changing. When your body stays calm, it's easier to perform well, which reduces anxiety over time.

Common Side Effects

Lowered blood pressure and heart rate, which is the point but can cause lightheadedness or dizziness in some people.

Fatigue or feeling a bit slowed down. Some people feel less energetic on propranolol.

Cold hands and feet. Beta blockers can reduce circulation to extremities.

Dizziness, especially when standing up quickly.

Some people feel a bit foggy or mentally slower, though this is usually mild.

Sleep changes, including vivid dreams or insomnia, can happen.

GI issues like nausea or stomach upset are possible.

In people with asthma or breathing problems, beta blockers can worsen breathing. If you have asthma, propranolol might not be safe for you.

What It Looks Like When It's Not Working

You take it before a stressful situation and your heart is still racing, hands still shaking. Physical anxiety symptoms are still there.

Sometimes the dose is too low. Sometimes the timing is off (you need to take it 30-60 minutes before the event). Sometimes your anxiety is mostly mental rather than physical, and propranolol doesn't address that.

If you're taking it and not seeing any reduction in physical anxiety symptoms, it might not be the right tool for your situation.

Timeline for Noticing Effects

Propranolol works within 30 to 60 minutes. Peak effects are around 1 to 2 hours after taking it. Effects last 3 to 4 hours for immediate release.

For performance anxiety, you typically take it 30 to 60 minutes before the stressful event. By the time you need to perform or speak or whatever, your body is physically calm.

Real Talk About Propranolol in Oregon and Washington

Propranolol is the secret weapon of performers, public speakers, musicians, anyone who deals with performance anxiety. It's not well known outside medical and performance circles but it's extremely effective for what it does.

Musicians use it before performances to keep hands steady and prevent tremors that would mess up their playing. Public speakers use it to keep their voice from shaking. People doing job interviews use it to stay physically calm even when they're mentally nervous. Students take it before big presentations or exams where physical anxiety symptoms would interfere with performance.

The cool thing about propranolol is that it doesn't make you high, doesn't make you sleepy, doesn't impair your thinking. It just stops the physical freakout. Your brain stays sharp, you're still alert, you can perform at your best. You're just not fighting against a racing heart and shaking hands while you do it.

It's not a daily medication for most people using it for anxiety. It's as-needed for specific situations. Take it an hour before the scary thing, your body stays calm during the event, and you're done. No withdrawal, no dependence, no tolerance issues.

Some people do take it daily for certain types of anxiety or for heart conditions, but that's different. For performance anxiety specifically, as-needed use is typical.

The dose is usually pretty low. 10mg to 40mg immediate release. Some people need more, some need less. You can trial it before a high-stakes situation to figure out what dose works for you.

Our team prescribes propranolol throughout Oregon and Washington (Portland, Eugene, Salem, Spokane, Vancouver, Bellingham) fairly often for performance anxiety, especially for people who give presentations regularly, perform music, or deal with high-stakes professional situations where physical anxiety symptoms would be a problem.

It doesn't cure anxiety. If you have underlying anxiety disorder, you need to address that separately. But for specific performance situations where physical symptoms are the main issue, propranolol is incredibly useful.

Not a good option if you have asthma, certain heart conditions, very low blood pressure, or diabetes (it can mask symptoms of low blood sugar). Your provider needs to know your full medical history before prescribing it.

Can interact with other medications, particularly other blood pressure or heart medications. Make sure your provider knows everything you're taking.

Performance Anxiety and Anxiety Treatment Throughout Oregon and Washington

LiveWell Psychiatry and Men's Health provides anxiety treatment for patients throughout Oregon and Washington, including Portland metro, Vancouver and Clark County, Salem, Eugene, Corvallis, Bend, Spokane, Tri-Cities, and surrounding communities. If you're dealing with performance anxiety or physical anxiety symptoms that interfere with your life, we can evaluate whether propranolol or another approach makes sense.

Propranolol is a simple, effective tool for managing physical anxiety symptoms in performance situations. It's not going to fix underlying anxiety disorders and it's not a substitute for therapy or other treatment. But for what it does (stopping your body from physically freaking out), it works really well and it's safe for most people to use as needed