Using a beta blocker for presentations and public speaking

Why your body reacts on stage

Standing up in front of a room triggers the same stress response as any perceived threat. Your adrenal glands release adrenaline, your heart speeds up, your hands may shake, your mouth goes dry and your voice can tighten. These reactions are normal. For some people they are mild; for others they become the main thing the audience notices.

The physical symptoms can also feed the worry. Noticing your hands shake makes you more anxious, which makes them shake more. Breaking that loop is the idea behind using a beta blocker before a performance.

How a beta blocker helps

Beta blockers occupy some of the receptors that adrenaline acts on in the heart, blood vessels and muscles. With those receptors partly blocked, your heart rate rises less and fine tremor is reduced. The National Institute of Mental Health notes that beta blockers help control physical symptoms such as a racing heart, sweating and tremors and are commonly the medication of choice for the performance type of social anxiety.

Propranolol is the beta blocker most often used this way. It is FDA-approved for conditions such as high blood pressure, certain heart rhythm problems, tremor and migraine prevention. Using it for performance nerves is off-label, a common and legal practice when a clinician judges it appropriate.

What it will not do

A beta blocker does not change your thoughts. If your fear is mostly about being judged, forgetting your words or catastrophizing in the days before, the medicine will not touch that part. It also does not sedate you or make you feel 'out of it,' which is why many people prefer it to calming medicines for work events.

It is a tool for occasional, predictable situations. If anxiety affects many areas of your life, such as meetings, phone calls or social events, a fuller assessment and treatment plan makes more sense than an as-needed tablet.

Practice run before the real thing

Your clinician will usually suggest taking a test dose on an ordinary day before you rely on it for something that matters. This shows you how you feel, whether you notice lightheadedness or tiredness, and how long the effect lasts for you. Your clinician sets the dose and timing based on your health and the event.

On the day itself, stick to the plan your clinician gave you. Avoid adding alcohol, which MedlinePlus notes can increase the amount of propranolol in your body, and do not double up if you feel nervous.

Who should not use it

Beta blockers are not right for everyone. MedlinePlus advises that your doctor may tell you not to take propranolol if you have a slow or irregular heartbeat, heart failure, or asthma or other lung disease. NIMH notes they generally are not recommended for people with asthma or diabetes. Propranolol can also mask the warning signs of low blood sugar.

Tell your clinician about every medicine and supplement you take, including other blood pressure medicines, and whether you are pregnant or breastfeeding. Your online assessment covers these questions in detail.

Musicians, athletes and other performers

Public speaking is not the only setting where tremor and a racing heart get in the way. Musicians, people giving wedding toasts, and professionals facing job interviews or high-stakes negotiations describe the same physical surge. The same screening and test-dose approach applies.

One caution: beta blockers are prohibited in competition in some precision sports, such as archery and shooting, under anti-doping rules. If you compete in a tested sport, check your sport's rules before using one.

Pairing medication with skills

NIMH describes cognitive behavioral therapy as the gold-standard psychotherapy for social anxiety. Skills such as slow breathing, rehearsing out loud, and gradually practicing in front of bigger audiences build confidence that lasts. Many people use a beta blocker for a few high-stakes events while they build those skills, and find they need it less over time.

• Rehearse the opening minute until it feels automatic
• Practice in front of one or two people, then a small group
• Use slow exhalations before you start to steady your breathing
• Arrive early to get familiar with the room and equipment
• Keep water nearby for a dry mouth

Getting a prescription through HealifyMD

Your online assessment covers your heart, lung and blood sugar history, current medicines and the situations that trigger your symptoms. A licensed clinician reviews it and prescribes only if appropriate. The medication is filled by a licensed U.S. pharmacy and shipped to you. Beta blockers cost $149 one-time with no membership fee, and your price is confirmed at the eligibility review.