The Science Helps You Get Settled

(Photo by Sergiy Barchuk/WSJ)

In our there's-a-pill-for-everything culture there are worse medications than propranolol:

Approved by the Food and Drug Administration in 1967 to treat symptoms of cardiovascular disease, propranolol has become the go-to pill for dealing with all sorts of stressful situations, from public speaking to first dates. Prescriptions are on the rise, up 28 percent from 2020, according to the most recent data from IQVIA, making propranolol—a generic drug that is relatively inexpensive—the fastest-growing pill in the category. By slowing down heart rate and lowering blood pressure, the drug can reduce the physical symptoms of anxiety, though it has not been approved by the FDA to treat the condition. Most people take it situationally; musicians and actors, for instance, have long relied on beta blockers like propranolol before performing (“I took a beta blocker, so this is going to be a breeze,” the actor Robert Downey Jr. said during his 2024 Golden Globes acceptance speech). Now a new generation of stars is spreading the gospel.

I have never taken the drug but can't be too judgmental: if my livelihood depended on being cool in stressful situations I may well be using propranolol all the time.

Where other beta blockers focus on specific parts of the body, propranolol “affects beta receptors in the heart and everywhere else in the body, including the brain,” according to Dr. Nassir Ghaemi, an academic psychiatrist and professor of psychiatry at Tufts University School of Medicine.

“The effects on the brain are the effects that cause the decrease of anxiety,” Ghaemi says.

Compared to benzodiazepines, such as Xanax or Valium, propranolol is considered nonaddictive and is among the “mildest variety of anti-anxiety medication,” he says, but it is not without risk. Because propranolol works to reduce blood pressure and heart rate, if you reduce it too much, the person could faint.

The Mayo Clinic lists the "more common" side effects:

Chest tightness

cough producing mucus

difficulty with breathing

Anxiety

dry mouth

hyperventilation

irritability

restlessness

shaking

sleepiness or unusual drowsiness

trouble sleeping

unusual dreams

None of the above side effects appear particularly dangerous, so users are probably not gambling with their long-term health by taking propranolol or other beta blockers. Speaking as a baby boomer who witnessed some work colleagues taking prescriptions and illegal drugs (cocaine, marijuana) 40 to 50 years ago without apparent ill effect into their golden years, the rewards outweigh the risks, so you won't hear tsk-tsks from me.