Since a 1965 Lancet magazine article explored the use of Beta Blockers for anxiety and stage fright; there have been musicians, public speakers, surgeons needing to steady their hands, and people of all kinds who have used beta blockers like Propranolol, Atenolol and Metoprolol to help with their anxiety symptoms.
Blair Tindall, famous Oboist (a classical music instrument) and author of the book Mozart in the Jungle, put it best in a Guardian article :
Beta blockers are not recreational drugs. They do not affect cognitive abilities, but instead block adrenaline-like chemicals in the human system. For a violinist, this means performance can feel like practice, with no bouncing bow or slippery fingers.
Yet while beta blockers may provide performance anxiety relief for some, others may be hesitant to take pharmaceutical medications due to risk of side-effects or long-term dependence, and thus seek out more natural, over the counter substitutes.
Here we will explain a little more about how beta-blockers work, why some people are hesitant to use beta-blocker drugs for anxiety, and cover several over the counter beta blocker substitutes.
What are beta blockers?
Beta blockers, full name beta-adrenergic blocking agents or beta-adrenergic antagonists (since adrenaline is a beta-adrenergic substance), are drugs prescribed primarily to treat high blood pressure and heart related health issues like arrhythmia, angina, migraines and heart failure.
Beta blockers work by suppressing certain hormones, particularly epinephrine (adrenaline), that produce an elevated heart rate and trigger a fight-or-flight response when you’re in a stressful situation. As a result, beta-blockers reduce stress on the heart and lower blood pressure .
So beta blockers are relaxing the load on your cardiovascular system by blocking the effects of the adrenaline hormone, and adrenaline is a stress-related hormone. It binds itself to adrenergic receptors in the heart, also known as beta receptors . As a result, the heart has to pump blood with greater force, which causes your blood pressure and heart rate to go up.
Beta blockers then… block the effects of adrenaline and prevent it from binding to the beta receptors in the heart. Consequently, the heart can return to its regular workload, and your blood pressure can remain steady. This is why beta-blockers are prescribed for people with high blood pressure and hypertension.
As mentioned, many performers take beta-blockers “off-script” because it is too much adrenaline that is responsible for their anxiety symptoms.
When you are feeling anxious about something, it is to be expected that you’ll feel some level of stress. Naturally, you will feel a slight (or not) adrenaline rush as a part of that stress response. For many, that stress response is not a big deal, and they might even use it to their advantage to up the intensity of their performance.
For others who experience performance anxiety or social anxiety, that stress response goes too far. You experience a much greater effect of the adrenaline hormone, which causes your heart rate to skyrocket, along with other symptoms of stage fright and anxiety.
Since beta-blockers block the effects of adrenaline, they also prevent you from experiencing the physical symptoms of that same anxiety! Remaining physically calm has an overall calming effect, which then allows you to get through your engagement and keep your stress response at bay .
Which beta blocker is most popular for anxiety?
There are various beta-blockers available with a prescription, but here are some of the most common ones (and their common brand names):
- Inderal (Propranolol)
- Lopressor (Metoprolol)
- Sectral (Acebutolol)
- Coreg (Carvedilol)
- Tenormin (Atenolol)
- Zebeta (Bisoprolol)
Propranolol/Inderal is the most common beta blocker when it comes to people using them for anxiety symptoms. Propranolol is also the most commonly prescribed beta blocker in the US, overall.
Are Beta Blockers available Over The Counter (OTC)?
Assuming your doctor approves of you taking beta blockers for performance anxiety symptoms, and writes a prescription, you’ll have to refill that prescription every time you run out.
This will not be an issue if you only plan on using beta blockers occasionally. But if you start using them more often, then it could become a significant inconvenience.
Are there any over the counter substitutes for beta blockers?
If you are not too excited about becoming dependent on beta blockers every time you want to perform, or having to get a prescription whenever you run out, you may be wondering if there are substitutes to beta blockers available that can be purchased OTC/over-the-counter?
A good beta blocker substitute would achieve the same end-result as a beta-blocker (providing relief from symptoms of performance anxiety) but it would do so by supporting your mind and body in a way that, over time, makes you more resilient. You would become better equipped to handle any stress response and learn to think about your performances in a way that makes them less stressful to begin with.
Here are some of the most effective beta blocker substitutes that can be purchased at most stores/online over-the-counter and can significantly help with your performance anxiety symptoms:
GABA For Performance Anxiety
GABA, or Gamma-Aminobutyric Acid, is a naturally-occurring amino acid that acts as a neurotransmitter. GABA is widely recognized as having a calming effect, and GABA deficiency is believed to play a large part in anxiety disorders .
Studies performed on GABA supplementation have found it may have a positive effect on stress and anxiety , which would help block the symptoms associated with performance anxiety.
L-theanine For Anxiety
L-theanine is one of the ingredients that increase the availability of GABA in your brain. As previously mentioned, GABA helps you feel more relaxed by reducing excess activity in your brain .
Green, black, and oolong tea are all rich (and delicious) sources of L-theanine.
So, before a performance, use L-theanine to calm the nerves by reducing excessive mental chatter and helping you focus on your performance more constructively.
Magnesium For Anxiety
Magnesium is a vital mineral for the body, necessary for a wide range of natural functions. Magnesium deficiency is actually linked to cardiovascular diseases and hypertension . Magnesium is also essential in protecting and regulating the nervous system .
Several studies have found magnesium to have a positive effect on stress and anxiety , which shows us that it may be helpful in preventing or lessening the effects of performance anxiety. In short, Magnesium is an excellent over the counter beta blocker substitute.
Natural Brain-Boosting Supplements for Performers
Some dietary supplements contain a mixture of ingredients that support focus, calm and cognition, and may counteract the negative side-effects of performance anxiety and stage fright.
One such supplement that I personally like and recommend to clients is PerformZen, which contains GABA, L-theanine and Magnesium, as well as cognitive-enhancing ingredients Ginkgo Biloba, Vitamin B6 and Theacrine.
This specific combination of ingredients have been shown to help induce a calming effect on the body, as well as keeping the brain as sharp as it needs to be during your performance. I actually reviewed PerformZen in this article & interviewed the founder (as well as secured a limited-time discount for PerformanceAnxiety.com readers!). See the review here.
Note From The Author: I reached out to PerformZen, creators of the Calm Performance Formula supplement that I use and have recomended to many of my clients who struggle with anxiety, and they agreed to offer PerformanceAnxiety.com readers an exclusive discount of $7 off your first order!
Simply use the discount code PERFORMANCEANXIETY7 during checkout to claim your discount. This is valid until 31 Oct 2023 and is limited to the first 110 customers, so you should act fast:
Garlic For Stage Fright
Garlic can be a great beta blocker substitute, providing many of the same positive effects on cardiovascular health and blood pressure as beta blockers.
Studies have shown that garlic has significant beneficial effects on hypertension . Garlic works in much the same way as L-arginine, stimulating the production of nitric oxide and relaxing blood vessels .
Whether the antihypertensive benefits of garlic prove beneficial for performance anxiety is yet to be seen, however its ability to replicate the effects of prescription beta-blockers is very promising!
Conclusion: What’s the best Over The Counter substitute for beta blockers?
Stage fright, social anxiety and performance anxiety are not fun issues to deal with. It can be worse when you’re commonly asked to perform in high-pressure scenarios, and/or doing so is part of your profession.
Luckily there are many over the counter substitutes for beta blockers that you can try in order to treat the symptoms of performance anxiety, or even to prevent the cause itself. I would say that trying all the beta blocker alternatives mentioned in this article like amino acids such as GABA and L-theanine, cognitive-enhancing supplements like PerformZen or simple solutions like garlic, is the best way to find a OTC beta blocker substitute to fight off nerves and perform without anxiety.
Over The Counter Beta Blockers Frequently Asked Questions
I received some emails from readers who had more specific questions about OTC beta blocker substitutes. I’m publishing my responses here to refer people to in future. If you have your own questions, leave a comment down below or get in contact here.
- Q: Can you get over the counter beta-blockers?
- A: Beta blockers are strictly available as prescription-only medicines, typically in tablet form, which means they can only be prescribed by a qualified healthcare professional. This is the case for most popular beta blockers including Metoprolol, Propranolol and Atenolol.
- Q: Is garlic a natural beta blocker?
- A: Garlic can provide many of the same positive effects on cardiovascular health and blood pressure as beta blockers. Not enough study has been done into garlic’s full effects on anxiety symptoms, but studies have shown that garlic can reduce blood pressure in the same way as beta blockers, having consequential effects on some performance anxiety symptoms.
- Q: Are bananas natural beta-blockers?
- A: Bananas are natural beta-blockers. This means that when you eat a banana, it prevents adrenaline from binding to beta receptors. Your pulse rate and blood pressure both decrease, reducing your anxiety levels after eating 1-2 bananas. Bananas are also packed with Potassium, which is super important for calming stress levels. Potassium normalizes your heart beat, increases oxygen sent to the brain, and regulates water balance. Plus, when you’re stressed before a big performance, your potassium levels drop as your metabolic rate rises, so bananas help keep your head clear during a performance.
- ^ https://www.theguardian.com/music/2008/jun/05/classicalmusicandopera.news
- ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
- ^ https://uvitals.com/celebs-beta-blockers-anxiety/
- ^ https://performzen.com/propranolol-for-anxiety/#propranolol_requires_a_prescription
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836118/
- ^ https://pubmed.ncbi.nlm.nih.gov/12662130/
- ^ https://pubmed.ncbi.nlm.nih.gov/16971751/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024559/
- ^ https://www.sciencedirect.com/science/article/pii/S0028390811003054?via%3Dihub
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959081/
- ^ https://www.mdpi.com/2072-6643/9/5/429
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966103/
- ^ https://pubmed.ncbi.nlm.nih.gov/12052435/
- ^ https://pubmed.ncbi.nlm.nih.gov/24035939/