Propanolol (Inderal) for stress - your experience?

In My Humble Opinion
1

Short version: I’d like tips from people who have taken Inderal/generic equivalent on an ad hoc basis for stress, as I just got some from my doctor and want to know how best to use it.

TLDR version: historically, I’ve been prescribed daily Inderal for migraines on a couple of occasions (at around age 25 and again at around age 38). It was very helpful and I took it for 6-12 months daily each time, feeling like it not only helped with the migraines but really improved how I felt overall. I’m the kind of no-nonsense person who never emotes stress, but as much as I hate to admit it, it is clear from a review of my health that I transmute stress into physical symptoms. (For example, I was diagnosed with IBS during a very stressful period in my life - it cleared up when my life improved.)

So here I am at age 56, feeling a great deal of grief and stress because of something happening in my community. I have felt very “heavy” in my chest, and all Google searches of my sensations indicated stress rather than a physical problem. I consulted my cardiologist, who did some tests and agreed when I said “I think this is just stress and not a physical problem, but damn, my chest feels horrible for several hours every day.” He put me on a long-lasting beta-blocker, Concor2 (2.5 mg) for 2 weeks, taken after breakfast, and it worked like a charm. Apparently, the Concor2 got me out of whatever bad daily stress reaction I had developed and I have been okay for about a week without taking anything.

Now I have about 10 more doses of Concor2 and 30 doses of propanolol (10 mg), which I’m supposed to take “as needed.”

But right now it is 9:30 at night, my chest is pounding in a shitty I-feel-stressed-way and…I dunno, should I take something? Probably not right now as I had about 3 ounces of rum an hour ago, but how about next time, if I didn’t already drink alcohol?

IMHO is great for this kind of question, because I’m curious about other people’s experiences. I know that Inderal is prescribed for “pounding heart” type of stress and obviously, that’s me. If it has been you too, what can you tell me about how you’ve used it most effectively?

REALLY TLDR addition: I have a cardiologist because I had to undergo general anesthesia for cataract surgery thanks to pathological myopia/retinal degeneration/posterior polar cataract (surgery had beautiful results, I can see great now). Cardiologist continues to follow me due to four leaky heart valves. I live in Indonesia but get all my significant medical care, including eye and heart stuff, in Singapore. Inderal is no longer available in Sing, I have no idea why, so that’s why the cardiologist gave me the generic instead.

2

I take atenolol (“a selective β1 receptor antagonist, a drug belonging to the group of beta blockers (sometimes written β-blockers), a class of drugs used primarily in cardiovascular diseases. Introduced in 1976, atenolol was developed as a replacement for propranolol in the treatment of hypertension.”) every day for the same reason.

I worked with my doctor for over 6 months on why my heart was racing when I went to bed. Lots of tests, nothing wrong with my heart. Finally he decided it was stress and I didn’t want to take any anti-depressants so I just started taking this atenolol (25mg) every night before bed.

Makes me a little tired but…I’m on my way to bed. I have taken it every day for man…maybe over a year now? I rarely have a racing heart anymore. Oddly enough, I just felt it the other day for the first time in ages.

Have you asked your doc if you can just use it every day? Seems like it would suck to have to anticipate when you might be stressed later.

FWIW I do not drink but there’s no warning on the bottle about drinking and the doc didn’t give me any special notices about it.

3

I’ve used it for performance anxiety - I take it about 30 minutes before hand - it works great. I’ve heard something like 25% of professional musicians use it! but I’m not sure how true that is. I’m not a musician, but use it for public speaking and the like.

The great thing about it a at least for me is that it isn’t like your typical anti anxiety drug - I don’t feel drugged. I do think the first time I took it I had to go to the bathroom, but other than that I can’t even tell I am on it.

4

I remember taking that for a few months, although it thought it was for hypertension, not anxiety. Anyway, I had to stop taking it because I was having epic long complicated and vivid dreams. It was as if I was up all night watching an 8 hour movie. My brain felt exhausted every morning.

For anxiety, I take Lorazepam. Works great for me.

My hubby takes Xanax and is doing fine on it.

5

I’m an artist. Hand tremor since I was a kid and that made it hard to paint the photo realistic stuff I wanted to paint since when I tried to make a detail the arm went everywhere.

Propanolal may have helped a bit–at least it calmed me and it might have steadied the arm. Though I think studying the Impressionists might have helped a bit too–weren’t they all on absinthe and they didn’t care where their arms went?

6

Taking 20 mg for panic for last three years. 30 years old.

Works very well. But, evidently is bad for libido.

7

It is approved for several heart related purposes - including hypertension, essential tremors, and migraines. It’s use for stage fright and anxiety is off label (doctors are allowed to prescribe most drugs for other than their approved uses if they deem it appropriate, but drug companies are not allowed to promote such uses).

It truly is a wonderful medication. The person who discovered it won the Nobel prize for his discovery.

The interesting thing about stuff like stage fright - is there seems to be some evidence (and my own experience backs this up) - is that by suppressing the flight or fight response - you brain/body learns to disassociate such encounters with stress and it is possible to be “cured” of such a problem and not even require it after one (or probably more times using it)*.

  • note this is a layman’s view of how it was explained to me - this might not be 100% accurate, but I believe the general concept applies (similar to how antidepressants don’t really fix a chemical imbalance - but that is a close enough approximation to what happens to be useful for understanding how it works).

Some studies/research have even suggested it might be useful in stuff like PTSD, but I don’t believe there is a general consensus on that.

I believe there will be even more uses found for it in the future.

ETA: it is powerful enough to be placed on the banned list of substances for the Olympics as people were using it for stuff like Archery/Target shooting.

8

I was prescribed it with a careful consolidation with my doctor less than a year ago. I can honestly say that it is one of the best things that ever happened to me. I used to have moderate to severe performance anxiety even for routine tasks like standing in line at a supermarket and it interfered with work and casual social interactions. I knew all the strategies to get through those but I never understood why I needed to while other people didn’t. I wasn’t truly scared of anything intellectually but I was terrified that my body would go into a feedback loop that made things worse and, of course, that was a self-fulfilling prophesy.

The first time I took Propranolol, I knew something was different even though it doesn’t make you high or anything like that. I was finally able to tackle everything I could have done the entire time if my nervous system didn’t start to short out every time I was faced with a stressful situation and even everyday life started to seem like a breeze. Just today, I had to give a demonstration in front of a bunch of bigwigs for something that was critical, never been tried before and required really good fine motor control at close scrutiny. I breezed right through it even though I could not have done that last year.

Propranolol is a beta blocker and completely unlike addictive benzodiazepines that are usually used for anxiety. I personally believe that it is underused because treating anxiety with benzodiazepines is very similar to treating it with timed shots of whiskey and addiction to them can be painful to fatal. Beta blockers like Propranolol use a different mechanism. They block your sympathetic nervous system from triggering an overactive response and all of the symptoms that go along with that.

They aren’t truly addictive in the normal sense of the word but there can be some risks. You cannot take them for a long period and then stop suddenly because you risk a rebound effect that can cause anything from nervousness to cardiac arrest in some people. Those are extreme cases however. For most people, it is a very safe drug to try and can be the best fit for some people well above all of the fancy psychiatric drugs (Propranolol is old and very cheap relatively speaking). I really wish a doctor had prescribed it to me many years ago.

9

I take 120mg of propranolol twice daily for essential tremor - it works fantastically well for me and my neurologist says I can go even higher on the dose if needed. There’s no reason you couldn’t take 10mg once daily every single day if you need to. This is a pretty benign medication and the dose you’re taking is very small; it’s a lot safer than Xanax or Ativan. I’ve never had any problems with stress, but I do find the drug has a calming effect. Make sure you also learn some other stress management skills to have in your toolkit - the drug is meant as an aide, not a complete solution. Regular exercise, breathing techniques, meditation, whatever works for you are also good helpers.

10

My doctor prescribed propanolol to me after I asked him for help in dealing with me having mild panic attacks if I ever had to give a presentation or lead a tour at work. It’s been a godsend. It completely surpresses my physical reaction to public speaking but other than that has no noticable effect. I still have the some of the mental anxiety in those situations, but it never manifests itself physically.

My doctor told me that sometimes surgeons will take it if they are to perform any surgery that requires a steady hand.

11

I take a different beta blocker, metoprolol, for atrial tachycardia and a wandering pacemaker. I never even knew that I felt constant physical symptoms of anxiety until the medication made it stop. It had been a way of life. I wish someone had given it to me 30 years ago. Would have saved a lot of wear and tear on my poor overworked heart, which was always hammering away like a humming bird on crack, even at rest.

I’ve since wondered if some people are hypersensitive to their own low levels of adrenalin.

12

And this is why it’s a banned substance for Olympic archers and shooters: it steadies the whole body and also slows the heart.

I’ve never taken beta blockers for stress, but I’ve known people who did and also dispensed them for this reason, and it’s usually very effective. No addictive potential, either.

13

I went through something similar, and it was due to low liver glycogen causing my blood sugar levels to drop while I was trying to sleep. Once I started eating about 100-200 calories in fructose before bed (on days I exercised, those are the only day it happened) it went away.

Reasearching it when I had it, there are about a half dozen potential biological culprits to why this happens. Hormonal changes, serotonin changes, liver glycogen, GERD, etc.

Back to the OP, I have an Rx for metoprolol. I take when I am getting too anxious, usually 25mg is sufficient to bring me down if I get too many physical symptoms of anxiety.

Also why are you using propranolol? That crosses the blood brain barrier and can cause drowsiness. That is helpful for conditions like PTSD (other beta blockers can’t get into the brain and help short circuit the PTSD response like propranolol does) but it causes drowsiness too.

There are over a dozen to pick from, and they affect you different. When I tried atenolol I got severe insomnia. However coreg or metoprolol never gave me insomnia. Ironically Terazosin (an alpha blocker) caused full body relaxation the one time I tried it. Like the other drugs listed above it totally fucked up my sleep but man that was amazing. All my stress was lifted off of me, stress I didn’t even know I was carrying.

Is the beta 1 receptor the one that is involved in the physical symptoms of anxiety?

14

I wonder if beta blockers up or down regulate a person’s adrenaline receptors. So if you do take them for a long time and you quit does your stress and anxiety get worse?

15

They aren’t truly physically addictive like benzodiazepines. Most people can also stay on the same dose for very long periods of time without needing to increase the dosage over time so the general answer to that is mostly not. However, there is a general warning to not try to stop them suddenly after a long period of use without a doctor’s instructions. A taper down is the way that is usually prescribed because some people may have medical conditions that become unmasked even more when they stop taking a beta blocker and that can cause anything including sudden death. That isn’t typical however.

I have never gotten tired after taking Propranolol. My doctor originally said that I should take it before bed for that reason and I tried that and it didn’t do anything for sleep except take away some stress. I switched to taking it right before I go to work to get the maximum effect when I need it and works just fine. He also said that it could cause erectile dysfunction. That didn’t happen either at all but it does for some men. There are a reason there are usually a number of only slightly different drugs in a class available. People react differently to very similar ones and nobody knows why :slight_smile:

16

True. I couldn’t stand atenolol, I was up for 3 days straight on a low dose of that (taken in the AM). However I’ve also tried propranolol, coreg & metoprolol and none of them caused insomnia.

Fatigue and depression are issues for me with beta blockers though.

17

It’s a weird and wonderful drug. For years I suffered from a shaking voice when I presented (even when I was confident); and then about four years ago my boss suddenly dropped on me that I’d be going on an 8-city speaking tour in front of about a hundred people a stop. I confided my nascent panic to a friend, who confided back that he’d been using this drug “Propranolol” in similar circumstances.

10mg seems like almost nothing, but its effect was remarkable - the general anxiety didn’t go away, but the tremors did absolutely. I was able to get through the tour (and did quite well), and then shortly after that was promoted to a bigger job with more speaking, and continued using it selectively.

One interesting thing, to DataX’s point, is that I’ve had to use it less and less often. A couple of weeks ago I used it for the first time in about half a year, but other than that haven’t needed it much. Clearly something is making it easier for me.

As for why it’s weird, a couple of times when I’ve taken it before presenting I’ve tried to intentionally provoke the fight-or-flight response (perhaps unwisely, right before speaking). No matter what scenarios/thoughts I’ve tried, I can’t get my heart rate to accelerate. That’s actually kind of a weird sensation.

18

That is an example of one good use for it. My educational background is in behavioral neuroscience and I have known about beta blockers for a long time and they always sounded like a good fit for me but no doctor ever suggested one even though they seemed to love more expensive medications with lots of side-effects and usually no to negative benefits. I feel kind of dumb for not suggesting it for myself a long time ago.

There is a real theory about what you are describing and I have noticed it myself. The summary is that your body gets trained to go into a panic response during certain situations and you can only overcome that conditioned response by having many good experiences in the same situation. Propranolol and other beta blockers let you get through public speaking and other stressful situations without that stress response long enough that your mind and body get reconditioned so that the situation and bodily stress response are not linked anymore. There have been studies where people took it long enough to relearn those behaviors and then never needed the beta blocker again. That sounds very similar to what you are describing and there is a potential scientific explanation for it.

19

Thanks everyone - this is very interesting to read. Many of you are describing experiences similar to my own past daily use. I was really struck by the general, completely unexpected improvement I felt. In fact I’m sort of vexed that my doctor has just given me enough to take occasionally.

A couple of things, though - libido reduction? Eek. Is that common and is it sex-linked? (I’m female, as my username suggests.) I don’t recall that being a problem in the past but I had sex drive to spare when I was young. Also - insomnia? That’s not something I want to court either, since I tend to have a problem with it already.

20

I think I’m the only one who mentioned insomnia (I assume it isn’t a common side effect, I don’t know). However I’ve used 4 different beta blockers in my life, and only 1 caused insomnia. The other 3 did not. If one doesn’t work you can always switch to another. Most of them are dirt cheap now.

Beta blockers have been great for panic attacks for me. During a really bad period I always had a few in my pocket just in case I had an attack.