TREATMENTS FOR ANXIETY

Drugs known as ANXIOLYTICS

DRUG GROUP:- THE BETA-BLOCKERS

Some other beta-blockers may have similar effects.

What are beta-blockers used for ?

In lower dose, beta-blockers can be used to help treat the symptoms of anxiety e.g. palpitations, sweating, shakiness etc. They are more usually used to help heart conditions such as hypertension (high blood pressure), angina, arrhythmias etc.

How do beta-blockers work for anxiety ?

When you are anxious, your brain becomes more active and alert. Your brain may then make more of the chemical messengers called noradrenaline and adrenaline. These will then cause your body to have a faster heart rate, shake, sweat etc. and make you feel more anxious. The beta-blockers reduce the effect of these transmitters and so reduce the physical symptoms of anxiety. There are other drug treatments for anxiety e.g. the benzodiazepines (diazepam etc.).

How should I take them ?

Tablets and capsules:

Tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. The capsules should be swallowed whole with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in the throat. The capsules are a "sustained-release" preparation and should not be sucked or chewed.

Liquid:

Your pharmacist should give you a medicine spoon. Use it carefully to make sure you measure the correct amount. Ask your pharmacist for a medicine spoon if you do not have one.

Shake the bottle well before use

When should I take my beta-blocker ?

Take your medication as directed on the medicine label. Try to take them at regular times each day. Taking them at meal times may make it easier to remember as there is no problem about taking either of these drugs with or after food.

How long will the beta-blocker take to work ?

They should start to work on your symptoms fairly soon after you start to take them e.g. within a few hours. After that your doctor may need to change the dose to suit you.

How long will I need to keep taking them for ?

This should be discussed with your doctor as different people respond differently. The beta-blockers are best taken in a fairly low a dose as a "first aid" measure.

Are the beta-blockers addictive ?

The beta-blockers are not addictive. They only act on the physical symptoms of anxiety. It is not a good idea to stop them suddenly though (see next question). For further discussion, click here.

Can I stop taking the beta-blocker suddenly ?

It is best not to stop taking a beta-blocker suddenly if you have been taking them regularly every day for more than about 4 to 6 weeks, although there probably would be no great problem. A gradual reduction in your dose is probably best.

What should I do if I forget to take a dose ?

Start again as soon as you remember unless it is almost time for your next dose. Do not try to catch up by taking two or more doses at once as you may get more side-effects. If you miss several doses start again when you remember. Tell your doctor about this next time you meet.

What sort of side-effects might occur ?

Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk )

Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet.

Will the beta-blocker make me drowsy ?

Some people do feel a little drowsy, particularly at the start of treatment, but this should wear off. If you do feel drowsy, you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times.

Will the beta-blocker cause me to put on weight ?

It is not thought that the beta-blockers cause any great changes in weight although it has been reported that a few people put on a small amount of weight over several years. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.

Will the beta-blocker affect my sex life?

Beta-blockers do not have any known significant effects. Higher doses may reduce blood pressure in some people (which is often why they are prescribed), which may have a detrimental effect in some men’s ability to achieve an erection. In some people, reduced anxiety may be an advantage.

Can I drink alcohol while I am taking a beta-blocker ?

Alcohol may slightly reduce the effect of your beta-blocker, but this is unlikely to be a problem.

Are there any foods or drinks that I should avoid ?

You should have no problems with any food or drink other than alcohol (see above).

Will the beta-blocker affect my other medication ?

You should have no problems if you take other medications although a few problems can occur. Make sure your doctor knows about any other medicines you are taking. Make sure your doctor knows about any heart, breathing, thyroid or diabetic problems you have had in the past e.g. you should not normally take a beta-blocker if you have asthma.

The beta-blockers can "interact" with some other drugs e.g. for high blood pressure, glaucoma and some antidepressants. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctors instructions very carefully. You should tell your doctor before starting or stopping these or any other drugs.

If I am taking a contraceptive pill, will this be affected ?

It is not thought that the contraceptive pill is affected by either of these drugs.

What if I want to start a family or discover I'm pregnant?

It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:

The beta-blockers propranolol and oxprenolol are classified as "C". There is no proven evidence of a teratogenic effect, and animal tests show a low risk of danger. Some problems have been reported, especially later in pregnancy, and so you should seek personal advice from your GP, who may then if necessary seek further specialist advice. Reducing your dose a few weeks before your due date may also be possible.

Will I need a blood test ?

You should not need to have a blood test to check on your beta-blocker, although your doctor may want to check your blood for other reasons.

Can I drive while I am taking a beta-blocker ?

The beta-blockers can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy when you start to take them. Until these effects wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times.

It is against the law to drive, attempt to drive or be in charge of a vehicle when unfit, either through illness or from the side effects of medication. Under UK law, it is the drivers responsibility to let the DVLA and insurance company know if you may be "unfit" to drive. If you do not, and you have an accident, it could effect your insurance cover. Your doctor will be able to advise you, and may wish to access the UK Driver and Vehicle Licensing Agency (DVLA) guidelines website, which has the current DVLA guidelines on anxiety/depression, psychotic disorders, mania and other conditions. If your doctor advises you not to drive, and you continue to do so, the doctor can inform the DVLA directly, as he or she would be lawfully responsible were you to have an accident. Once told, the DVLA may wish to carry out an enquiry, but you are entitled to drive until there a decision is made.

Email your comments or feedback.
Many developments have been as a result of feedback from visitors.

No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support.

Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site.