Beta blockers can help ease stage fright
Prescribing for anxiety is a legal but off-label use of beta blockers — that is, not Federal Drug Administrationapproved for that purpose. Beta blockers were approved for and are still primarily used to treat heart disease and high blood pressure. A 2006 study at the University of Illinois-Chicago College of Pharmacy found that off-label administration of beta blockers was higher than previously reported, but didn’t pinpoint the prevalence of particular uses.
Unlike anti-anxiety drugs such as diazepam (best known as Valium) or alprazolam (Xanax) or even alcohol, which work on neurotransmitters in the brain to cause sedation and muscle relaxation, beta blockers prevent the body’s natural adrenaline and noradrenaline from stimulating their target receptors. This slows the heart rate.
Beta blockers have few side effects, especially for people who only take them occasionally. Still, Walton cautioned against sharing drugs without a prescription. People with asthma, depression, low blood pressure, cardiac issues and other problems or who are on certain medications should not take beta blockers. And beta blockers will not help anyone with severe anxiety.
The drugs seem designed for stage fright. They inhibit the harrowing effects of the adrenaline-laced fight or flight response that make a nervous performer even more nervous: pounding heart, quavering voice, trembling and sweaty hands.
It’s no wonder then that performers turned to them shortly after their invention nearly four decades ago.
Of the several beta blockers developed since, the most effective for performance anxiety remains the first: propranolol (brand name Inderal). Its use among actors and musicians is commonplace, if somewhat underground.
“There was a time I couldn’t go on stage without beta blockers,” said James Hampton, a former tenor who is now artistic services manager at the Dallas Opera. “There is a degree of ‘good nerves’ that you want, but that can go too far.”
Hampton used propranolol for one stressful year, when he was overwhelmed by a shift from singing to stage direction and completing a doctorate. Before ending his singing career, he sang for four years without them, encouraged after he had a successful performance despite forgetting his pills at home.
Musicians and actors have quit the stage because of performance fright. Yet some doctors and musicians resist beta blockers as treatment.
Many performers value that very rush of adrenaline that sparks anxiety. “It makes us aware of ourselves at a time when we need to be aware,” said Sally Nystuen Vahle of the Dallas Theater Center and acting and voice instructor at the University of North Texas.
Beta blockers can introduce a dullness that interferes with that, according to Dr. Bernard Rubin, a professor at the UNT Health Science Center at Fort Worth and a physician who treats many musicians. For anyone facing even heart-pounding nerves, Rubin advocates “a little bit of time, a little bit of forethought and much less pharmacology.”
Regardless of their stance on beta blockers for stage fright, every physician and performer interviewed said alternative relaxation techniques are also essential. And the No. 1 antidote to anxiety advocated by everyone is preparation.
“Practice, practice, practice,” said Kris Chesky, director of UNT’s Texas Center for Music and Medicine. “And put everything in perspective. If you falter, your life is not going to end.”
Daphne Howland is a freelance writer in Portland, Maine.