Beta blockers / propranolol for social phobia and panic

Propranolol has a small beneficial effect for me. Much like Etizolam, it’s another slightly useful tool to have.

Propranolol is a beta blocker, a chemical which can block the physical symptoms of anxiety (fast heartbeat, sweating) and reduce the fight or flight response. It’s commonly used off label by musicians, public speakers, and others, for performance anxiety.

Some socially anxious people claim propranolol to be highly effective. It’s likely these are people with a strong physical manifestation of their anxiety (panic attacks etc).

Since it can affect the heart this is probably something which a sensible person would check with their doctor before taking.

In the UK, this is a “prescription only” medication with no recreational potential. While sellers of this medication are required to ask for a valid prescription, it is legal to possess without one. Purchasing from abroad allows you to bypass the prescription requirement. (I believe there are some restrictions on buying very large amounts from abroad.)

I ordered 10mg Ciplar branded tablets from an Indian pharmacy.

Dosages

Researching the various social anxiety forums, suggested doses vary widely, from 10mg up to 60mg or higher. Most people seem to use on the lower end of 10mg – 30mg. Taking too high a dose might cause tiredness, or even slow the heart dangerously.

Test 1

I took 10mg before going out to a supermarket with a family member. No noticeable effects. Usual feelings of stress, fear, overly conscious of people looking at me, and a desire to get out of there as quickly as possible.

Test 2

Took 20mg before going out to a firework display with family. Lots of people milling around; this type of environment is usually very stressful for me, though I can cope. It’s not as bad as the shopping centre, since it being in the dark is easier as fewer people can see my face, and I can find a view point and stay there without much other human interactions.

The effects were not hugely noticeable. The propranolol did not stop me having a slight panic in my stomach on the way there. However, I did act fairly relaxed as the evening progressed. At the end of the display, about 1 hour 45 mins after taking the propranolol, I was able to wander around a little by myself, without having my usual great desire to leave.

There were no noticeable negative effects. I felt tired at the end of the evening, but was fairly late so it was probably natural tiredness.

It seems this may have had some small effect, in making me more relaxed when in the heat of a semi-social situation. I think I need to try a higher dose, and in a more stressful situation where I am more visible by people.

Test 3

Took 30mg when going out to a shopping centre by myself, a highly stressful enterprise.

It’s hard to know for sure what the effects were, as they were subtle.

I’m fairly sure this did kill any panicky feelings in my stomach. There were no obvious twinges of fear as I walked around; I felt almost a little robot-like to be free of these physical sensations. I still worried, and wanted to get out of there, but there were no pure “flight” twinges of panic.

I felt very tired later in the evening, and lacking in energy, perhaps unnaturally so, and I also thought my arms felt a bit heavy when driving. So in the future I think I will stick to 20mg.

Conclusions

I have since used propranolol numerous times when going out places, generally in a 20mg dose.

Though far more subtle in its effects than a benzodiazepine, I find this to be more useful in a practical sense, since it does not impair me physically in any way (beyond some tiredness if I take too much.) I find it slightly reduces stress and relaxes me a little. It makes semi-stressful situations a little less so.

Much like Etizolam, however, it is not a magic solution. It does not reduce my mental fears at all nor does it motivate me in any way. It’s not a substance that will get me up from a depressed wallowing and inspire me to do anything outside of the house.

I have once or twice tried this in combination with small amounts of Etizolam, however the more noticeable effects of the Etizolam (especially the negative ones) tend to overshadow the propranolol, so it’s hard to know if the propranolol really adds anything there.

I should probably try 30mg or higher of propranolol again sometime, to see if the effects of tiredness are repeated, and in some more stressful environments, to see if the reductions in physical anxiety sensations are more pronounced.

I find propranolol to be another useful tool, which reduces the physical sensations of fear and anxiety.

Footnote: Propranolol and fear extinction

An interesting possibility raised for propranolol is in “fear extinction”:

“Animal studies have shown that fear memories can change when recalled, a process referred to as reconsolidation. We found that oral administration of the beta-adrenergic receptor antagonist propranolol HCl before memory reactivation in humans erased the behavioral expression of the fear memory 24 hr later and prevented the return of fear. Disrupting the reconsolidation of fear memory opens up new avenues for providing long-term cure for patients with emotional disorders.”

– from Beyond extinction: erasing human fear responses and preventing the return of fear

I did wonder if my simply going out in public on propranolol would work in a similar fashion, however if there has been any permanent benefit it is subtle enough for me to not have noticed.