Misc Are beta-blockers safer than benzos for anxiety relief, sedation, and combination with stimulants?

[ninjapirateroberts]

I read that beta-blockers are sometimes used as "performance-enabling drugs" which help reduce anxiety since they block epinephrine and norepinephrine on adrenergic beta receptors in the heart.

Beta-blockers for anxiety: Uses, benefits, and side effects

Beta-blockers are a type of medication that can treat heart conditions. Some doctors also prescribe them to ease the symptoms of anxiety. Learn more in this article.

www.medicalnewstoday.com

How Are Beta-Blockers Different Than Other Anxiety Medications?

Beta-blockers act differently than many other anxiety medications by relieving the physiological symptoms of performance anxiety like a racing heart.

www.gokick.com

The effect of propranolol versus placebo on resident surgical performance.

PURPOSE: To determine whether propranolol can decrease surgical tremor and anxiety in residents performing ocular microsurgery without impairing patient or physician safety. METHODS: In this randomized, double-masked, crossover study, 5 third-year ophthalmology ...

www.ncbi.nlm.nih.gov

Propranolol For Anxiety: How To Ease Performance Nerves

Primarily used to treat blood pressure and heart conditions, beta-blockers are known to lessen the physical effects of anxiety conditions and social phobias.

www.gokick.com

I found a study that reports that beta blockers are safer in combination with active stimulant use:

Avoidance of β-blockers in patients who use stimulants is not supported by good evidence

www.ncbi.nlm.nih.gov

Has anyone had experience with beta blockers (Propranolol, or other drugs) for anxiety relief, sedation, or combination with stimulants as opposed to benzos? (I know benzos are indicated for all of those symptoms including insomnia but I don't know if doctors recommend benzos in combination with stimulants as they do with beta blockers). I've never tried beta blockers, and some sources state beta blockers may cause insomnia (so they can't be used like benzos or Z-drugs).

Since beta blockers are not psychoactive and only act on the sympathetic nervous system, is it a safer alternative to benzos? (given benzo's notorious withdrawals, dependence, etc.)

 

[ninjapirateroberts]

I think it is worth mentioning that since beta blockers aren't psychoactive, they tend not to cause mental side effects such as drowsiness (unlike benzos which will cause memory impairments and sleepiness) therefore people can still perform at the optimal level without feeling like they're drunk when they're on beta blockers.

Based on the limited understanding, my theory (rough idea) is that stimulants act as ligands on both PNS and CNS norepinephrine and epinephrine receptors, but although some of the substances managed to escape through the blood-brain-barrier and bind to drug target sides (neurons), some of the "left over" drugs come back to the systemic circulation and bind to PNS receptors.

So if we still take a psychoactive stimulant that will act on both CNS and PNS, and beta blockers that will only act on PNS adrenergic beta receptors and is not psychoactive, we basically "eliminate" the unwanted PNS stimulation that comes for free with psychoactive stimulants.

That's my basic idea.

 

[CFC]

So, the kind of performance-enablement they're referring to is usually with regards to activities like (opera) singing, public speaking, or shooting guns or arrows to Olympic gold-medal level standard, where reducing fine motor physical tremor, or relaxing the muscles around the trachea, can help.

Regarding the CNS/PNS thing, there are so many different classes of beta-blockers, and many of the most common (like propranolol) cross the BBB with ease, acting directly in the CNS (hence propranolol tends to be more useful for some forms of anxiety, whereas atenolol is more specific to the heart, and so on).

It's worth bearing in mind that neither peripheral nor centrally-acting forms of exogenous stimulation or depression can be isolated to compartments in quite the way you seem to be thinking: they're still all connected and anything you do to one arm will modify the other to a certain degree, even if the drug in question is itself selective. Which is my roundabout way of saying that you have not found the holy grail for having only good effects without the bad, I'm afraid, though certainly a small dose of something like nebivolol can limit the worst of the typical stimulant cardiovascular effects without entirely crippling the positives as well.

More generally, beta blockers are 'safer' than benzos in treating stimulant ODs because they help to block the root cause of the biggest problem directly (cardiovascular effects, aggravation etc). Benzos take a comparatively long time to act, are less predictable in their outcome (often completely useless lol), and have a whole bunch of side-effects that have the potential to be really unhelpful.

 

[SpiralusSancti]

Such drugs really interest me. Drugs that work on mental level too but without getting you high. Like ibuprofen works for depression, and actually pretty great at toxic doses. And when it comes to really curing some mental issues, surprisingly often stuff that doesn’t get you high work the best or is safest at least but most users are so wired to expect you need to get at least a bit high to know something works. Almost opposite of when it comes to pain not connected with brain issues when stuff that does get you at least a bit high works the best and most pain-relief that can’t get you high is shitty option for serious pain.

I considered trying beta-blcokers for anxiety. In fact I’ll try it soon. Propranolol here I come.

 

[ninjapirateroberts]

So, the kind of performance-enablement they're referring to is usually with regards to activities like (opera) singing, public speaking, or shooting guns or arrows to Olympic gold-medal level standard, where reducing fine motor physical tremor, or relaxing the muscles around the trachea, can help.

Regarding the CNS/PNS thing, there are so many different classes of beta-blockers, and many of the most common (like propranolol) cross the BBB with ease, acting directly in the CNS (hence propranolol tends to be more useful for some forms of anxiety, whereas atenolol is more specific to the heart, and so on).

It's worth bearing in mind that neither peripheral nor centrally-acting forms of exogenous stimulation or depression can be isolated to compartments in quite the way you seem to be thinking: they're still all connected and anything you do to one arm will modify the other to a certain degree, even if the drug in question is itself selective. Which is my roundabout way of saying that you have not found the holy grail for having only good effects without the bad, I'm afraid, though certainly a small dose of something like nebivolol can limit the worst of the typical stimulant cardiovascular effects without entirely crippling the positives as well.

More generally, beta blockers are 'safer' than benzos in treating stimulant ODs because they help to block the root cause of the biggest problem directly (cardiovascular effects, aggravation etc). Benzos take a comparatively long time to act, are less predictable in their outcome (often completely useless lol), and have a whole bunch of side-effects that have the potential to be really unhelpful.

Interesting, thank you for clearing that up!

I take stimulants pretty much every single day for ADHD but sometimes I get tachycardia due to anxiety, or when I'm walking around my school campus, or any activity that raises my HR and anxiety. Benzos are my go-to drugs in such cases, I carry a blister pack on my pocket literally everywhere I go and I pop a pill when I feel like my HR is kinda high or that I feel anxiety. But I don't like being dependent on benzos for those purposes and was looking for "safer" alternatives, that's when I came across beta blockers.

Anyway, I bought Propranolol 40mg pills and I guess I can pop one of those when I get anxiety or tachycardia instead of alprazolam 1mg.

 

[ninjapirateroberts]

It also seems like benzos also slow down mental activity (so long-term use seem to lead to memory impairment, inability to form new memory/skills, amnesia, etc.) but it seems like beta blockers are more peripheral and don't mess with the brain a whole lot. So I guess I don't get the mental intoxication like drowsiness with beta blockers while still benefiting from anxiety relief and slowing down HR effects while retaining mental capabilities.

 

[CFC]

Interesting, thank you for clearing that up!

I take stimulants pretty much every single day for ADHD but sometimes I get tachycardia due to anxiety, or when I'm walking around my school campus, or any activity that raises my HR and anxiety. Benzos are my go-to drugs in such cases, I carry a blister pack on my pocket literally everywhere I go and I pop a pill when I feel like my HR is kinda high or that I feel anxiety. But I don't like being dependent on benzos for those purposes and was looking for "safer" alternatives, that's when I came across beta blockers.

Anyway, I bought Propranolol 40mg pills and I guess I can pop one of those when I get anxiety or tachycardia instead of alprazolam 1mg.

I'd go for nebivolol rather than propranolol to manage specificaly your heart related issues while using your ADHD meds. It'll cause less interference to the stimulant, yet also has a more potent effect on heart rhythm (and also enhances peripheral vasodilation).

But if you get a lot of anxiety, maybe there's a different ADHD med you could try (or a different dose)? Anxiety's horrible, but I suspect beta-blocking it away may not be that effective. Either way, it would be interesting to hear down the line if you felt the propranolol was helpful.

 

[CFC]

It also seems like benzos also slow down mental activity (so long-term use seem to lead to memory impairment, inability to form new memory/skills, amnesia, etc.) but it seems like beta blockers are more peripheral and don't mess with the brain a whole lot. So I guess I don't get the mental intoxication like drowsiness with beta blockers while still benefiting from anxiety relief and slowing down HR effects while retaining mental capabilities.

Benzos and beta-blockers are such different classes of drugs, and really don't share a lot in common. Beta blockers can have an effect on memory formation, particularly (they believe) in relation to dampening night-time adrenergic pulses during sleep phases, but it's nothing like the amnesiac effect from benzos. But generally benzos are a much worse option - if you can avoid them - for a whole bunch of reasons but mostly because messing with the GABA system so directly is harmful and tends to backfire long-term.

 

[ninjapirateroberts]

I'd go for nebivolol rather than propranolol to manage specificaly your heart related issues while using your ADHD meds. It'll cause less interference to the stimulant, yet also has a more potent effect on heart rhythm (and also enhances peripheral vasodilation).

But if you get a lot of anxiety, maybe there's a different ADHD med you could try (or a different dose)? Anxiety's horrible, but I suspect beta-blocking it away may not be that effective. Either way, it would be interesting to hear down the line if you felt the propranolol was helpful.

I'm on Vyvanse 40mg right now and it's immensely helpful in suppressing my ADD symptoms (I would've dropped out without stimulants). Anxiety is not a major issue and usually isn't triggered by stimulants. I usually get increased HR if I am either sleep deprived (or even didn't had a decent night sleep) or do some physical activity like walking around my college campus; I don't do regular exercise or stress my heart (I never even go outside the house, and the only time I get to do some physical activity is when I wanted to walk to my collage for a lecture, so that's when my heart gets decently "stressed").

Also, the very fact of thinking about my HR increases my anxiety. I'd start to think worst things might happen to me, and the anxiety is usually triggered by the feeling of impending doom. For example, if I feel like my HR is rising or I feel a little dizzy, I start to think that I might collapse due to "sudden cardiac death", and that induces a cascading effect and I get full-blown anxiety after that; when that happens, I go for the benzos to supposedly save myself from "sudden cardiac death" due to the stimulant I'm taking.

My anxiety is for the most part psychosomatic ("feeling of impending doom") due to me simply thinking that I would suddenly get a heart attack or a seizure (it all starts in my head).

The fact of knowing that I have benzos on my pocket (within "reachable distance" in case I get a "sudden heart attack") eases my psychosomatic anxiety.

I also get stimulant-induced tics so that also increases my paranoia that I might get a seizure. This is the reason I'm prepared for the "worst" (I have lorazepam, alprazolam, propranolol in my home and always keep them at a reachable distance; and if I go out, I'd carry at least 3 pills of alprazolam, lorazepam, and now I'll also be carrying propranolol).

The feeling of impending doom and psychosomatic effects are my major issue (and it's usually not directly triggered my stimulants, it mostly starts in my head. If I get a tic, I'd start to think I'd get a seizure; if I feel like my HR is rising, I'd start to think I'd get a sudden heart attack or go into a cardiac collapse).

I think by now you could kinda get a sense of what goes into my head... (sharing this here really helps )

 

[ninjapirateroberts]

Just noticed, I meant to write “I also get”, not “I have to get” lol.

 

[Dextro .45]

For what it’s worth…I have taken many prescription stimulants and the only one to even give me heart palpitations was Vyvanse (Lisdexamfetamine) 40mg capsules (equal to 12mg of d-amph) with a 3h onset and 10-12h duration

A friend of mine who regularly uses cocaine & alcohol also tried Vyvanse and said it gave him chest pains…..weird ah? From a guy who regularly blasts biker rails

Biphetamine & Ritalin IR (Methylphenidate) is FAR more euphoric and pleasurable for me
Generic dextro-amphetamine 5mg IR tablets and Shire Adderall 30mg XR capsules I’ve taken and were GREAT ….but Vyvanse, heart palpitations and concerning cardiovascular side effects …..sudden death syndrome & cardiac/heart problems are very real and all these meds carry a “Black Box Warning” stating just that

Clonidine 0.1mg tablets is what I’ve been using for over 10 years and is great for reducing norepinephrine in the CNS, while reducing cardiac output/stress. Reducing blood pressure & heart rate. An Excellent anxiolytic on par with benzodiazepines, mild sedative and great before bed for sleep

Clonidine is rapid acting 15min full onset, in half hour you’re at peak serum levels, calm & relaxed, HR & BP reduced to a comfortable level

Beta-Blockers are also very effective and definitely a useful drug to have in ones inventory

 

[sekio]

My anxiety is for the most part psychosomatic ("feeling of impending doom") due to me simply thinking that I would suddenly get a heart attack or a seizure (it all starts in my head).

Anxiety will not cause you to have a sheer heart attack. The number of users of (meth)amphetamine that engage in activities that raise heart rate and blood pressure more than anxiety (sports, sexual activity, screaming tantrums, etc)... and relatively few if any just drop dead.

 

[soulwentmia]

So, the kind of performance-enablement they're referring to is usually with regards to activities like (opera) singing, public speaking, or shooting guns or arrows to Olympic gold-medal level standard, where reducing fine motor physical tremor, or relaxing the muscles around the trachea, can help.

Regarding the CNS/PNS thing, there are so many different classes of beta-blockers, and many of the most common (like propranolol) cross the BBB with ease, acting directly in the CNS (hence propranolol tends to be more useful for some forms of anxiety, whereas atenolol is more specific to the heart, and so on).

It's worth bearing in mind that neither peripheral nor centrally-acting forms of exogenous stimulation or depression can be isolated to compartments in quite the way you seem to be thinking: they're still all connected and anything you do to one arm will modify the other to a certain degree, even if the drug in question is itself selective. Which is my roundabout way of saying that you have not found the holy grail for having only good effects without the bad, I'm afraid, though certainly a small dose of something like nebivolol can limit the worst of the typical stimulant cardiovascular effects without entirely crippling the positives as well.

More generally, beta blockers are 'safer' than benzos in treating stimulant ODs because they help to block the root cause of the biggest problem directly (cardiovascular effects, aggravation etc). Benzos take a comparatively long time to act, are less predictable in their outcome (often completely useless lol), and have a whole bunch of side-effects that have the potential to be really unhelpful.

For me benzos are a no no first because i'm a downer fiend but also because they not only calm me down, they make me go "nuts" and ready for another round, i stop giving a fuck about tomorrow or my future.

 

[paranoid android]

I was on beta blockers for migraines (forget which one) when i was a kid. It was fucking awful i couldnt even do a lap around the gym without almost passing out. Also it gave me lethary and depression as well.

Id much rather a benzo for anxiety, insomnia or coming down off stims. Really the only side effect with benzos anyway is addiction

 

[Mycophile]

Well, I take Klonopin (even though I'm slowly weaning off), and I asked my psychiatrist about his opinion on beta blockers for anxiety (performance or generalized) and he basically said:

"that's fine if you maybe have something you do once a week that causes performance anxiety and you're going to take a beta blocker before that, but otherwise, these are generally heart medications that have significant effects on heart rate and blood pressure, and they are not to be taken lightly. So if you have generalized anxiety and/or OCD that affects you every day or most days, then taking beta blockers is not going to be practical or a good idea."

He didn't use those EXACT words, but that's pretty much what he said. They also may not work for MENTAL/EMOTIONAL anxiety in the same way. Like if you have racing thoughts in relation to very specific things you worry about, benzos may work for that, but beta blockers are not likely to, as they have their primary effects by slowing down bodily processes, reducing things like racing heart, trembling, sweating, etc.

They are not intended to treat most MENTAL/EMOTIONAL anxiety. But they can be great if you happen to have something you occasionally do that causes you performance anxiety, just not as a regular anxiety medication.

As for how they'd work to combat the negative side effects of stimulants or for sedation, they might work better for that. I didn't ask him those questions.

 

[soulwentmia]

Well, I take Klonopin (even though I'm slowly weaning off), and I asked my psychiatrist about his opinion on beta blockers for anxiety (performance or generalized) and he basically said:

"that's fine if you maybe have something you do once a week that causes performance anxiety and you're going to take a beta blocker before that, but otherwise, these are generally heart medications that have significant effects on heart rate and blood pressure, and they are not to be taken lightly. So if you have generalized anxiety and/or OCD that affects you every day or most days, then taking beta blockers is not going to be practical or a good idea."

He didn't use those EXACT words, but that's pretty much what he said. They also may not work for MENTAL/EMOTIONAL anxiety in the same way. Like if you have racing thoughts in relation to very specific things you worry about, benzos may work for that, but beta blockers are not likely to, as they have their primary effects by slowing down bodily processes, reducing things like racing heart, trembling, sweating, etc.

They are not intended to treat most MENTAL/EMOTIONAL anxiety. But they can be great if you happen to have something you occasionally do that causes you performance anxiety, just not as a regular anxiety medication.

As for how they'd work to combat the negative side effects of stimulants or for sedation, they might work better for that. I didn't ask him those questions.

Personally, i get emotionally and mentally fucked moreso bcs of heart rate, tremors and bp. While on propranolol it's almost no anxiety. It's a feedback loop, a chill body chills the mind.

 

[ninjapirateroberts]

Well, I take Klonopin (even though I'm slowly weaning off), and I asked my psychiatrist about his opinion on beta blockers for anxiety (performance or generalized) and he basically said:

"that's fine if you maybe have something you do once a week that causes performance anxiety and you're going to take a beta blocker before that, but otherwise, these are generally heart medications that have significant effects on heart rate and blood pressure, and they are not to be taken lightly. So if you have generalized anxiety and/or OCD that affects you every day or most days, then taking beta blockers is not going to be practical or a good idea."

He didn't use those EXACT words, but that's pretty much what he said. They also may not work for MENTAL/EMOTIONAL anxiety in the same way. Like if you have racing thoughts in relation to very specific things you worry about, benzos may work for that, but beta blockers are not likely to, as they have their primary effects by slowing down bodily processes, reducing things like racing heart, trembling, sweating, etc.

They are not intended to treat most MENTAL/EMOTIONAL anxiety. But they can be great if you happen to have something you occasionally do that causes you performance anxiety, just not as a regular anxiety medication.

As for how they'd work to combat the negative side effects of stimulants or for sedation, they might work better for that. I didn't ask him those questions.

I've been taking propranolol 20mg after about 3-4 hours into my daily Vyvanse stimulant dose for several days and it's been really great. It takes the edge off and makes me more "calm" due to reduced heart rate (most of my anxiety is due to me noticing my heart is going little fast, or that I could literally "hear" my heart, like when you sip coffee for example). It doesn't seem to cause any mental effects (I got drowsiness only the first day, but it's gone after the 2nd time).

Tbh, stimulants use to raise my HR when I'm about to go out, talk to someone on phone, need to give a presentation (or ask a question in class), take an exam, etc. but this beta-blocker takes away the physical anxiety part, in result making me calm. I'd say it's definitely better than benzos (at least for me) especially when combined with a stimulant (meaning not to take the edge off during stimulant comedown, rather during drug effect). I also don't feel any anxiety or heart palpitation during Vyvanse comedown (I always get heart palpitation after eating dinner, but when I'm on propranolol, I get zero heart palpitation or comedown anxiety).

I found this really, really helpful for anxiety, in combination with the stimulant (without messing up with the mental alertness/ADHD-suppressant effects of stimulants). I guess even if propranolol is mostly physically (heart) active, I'd developed tolerance... but I guess since I'm taking a small dose (20mg a day) compared to what a heart patient would take, I guess I can still withdraw and not have life-threatening or really fucked up side effects unlike benzos (which btw I'm CURRENTLY withdrawing from).

 

[soulwentmia]

I've been taking propranolol 20mg after about 3-4 hours into my daily Vyvanse stimulant dose for several days and it's been really great. It takes the edge off and makes me more "calm" due to reduced heart rate (most of my anxiety is due to me noticing my heart is going little fast, or that I could literally "hear" my heart, like when you sip coffee for example). It doesn't seem to cause any mental effects (I got drowsiness only the first day, but it's gone after the 2nd time).

Tbh, stimulants use to raise my HR when I'm about to go out, talk to someone on phone, need to give a presentation (or ask a question in class), take an exam, etc. but this beta-blocker takes away the physical anxiety part, in result making me calm. I'd say it's definitely better than benzos (at least for me) especially when combined with a stimulant (meaning not to take the edge off during stimulant comedown, rather during drug effect). I also don't feel any anxiety or heart palpitation during Vyvanse comedown (I always get heart palpitation after eating dinner, but when I'm on propranolol, I get zero heart palpitation or comedown anxiety).

I found this really, really helpful for anxiety, in combination with the stimulant (without messing up with the mental alertness/ADHD-suppressant effects of stimulants). I guess even if propranolol is mostly physically (heart) active, I'd developed tolerance... but I guess since I'm taking a small dose (20mg a day) compared to what a heart patient would take, I guess I can still withdraw and not have life-threatening or really fucked up side effects unlike benzos (which btw I'm CURRENTLY withdrawing from).

I am 100% on board with what you say. It takes away the bad aspects of stims without bartarding you. Really great shit.

 

[ninjapirateroberts]

Oh, and this must be mentioned, I also feel almost no rebound anxiety, heart palpitation, or increased HR after the propranolol has worn off (which is totally opposite compared to what I feel on benzos; I almost always get rebound anxiety with alprazolam once it wears off (lorazepam is worst), and when I combine it with a stimulant like I'm doing with propranolol (which I normally not do with benzos since combination would just cancel out stimulants due to being highly centrally active) the rebound effects would be additive).

 

[Skorpio]

I'd be careful mixing beta blockers with stimulants. They are contraindicated in treatment of stimulant overdose.

Beta2 adrenergic receptors help increase the heart rate when norepinephrine binds, but they also dilate veins, lowering blood pressure.

This opposes alpha 1 adrenergic receptors, which also bind norepinephrine, and cause vasoconstriction and raise blood pressure.

When on stimulants that produce norepinephrine release, I would worry about the unopposed alpha agonism causing a dangerous blood pressure spike.

Clonidine is a much better choice, as it decreases the release of norepinephrine rather than by changing the balance of its binding sites.