When performing onstage, Dania Hallak, a singer and songwriter, sometimes found she couldn't hit lower notes. Her vocal coach suggested it was performance anxiety. Hallak saw her doctor, who prescribed a beta blocker, a class of drugs more commonly used to treat heart issues.
After taking a beta blocker for a show in April, Hallak said: "I felt like a different person. I was able to very easily hit the notes again."
Now, Hallak said she takes a beta blocker before every performance and work presentation. (She even took one before doing this interview, she told us.)
"I just want to nip it in the bud," Hallak said about the physical symptoms of her stage fright, "so I can just focus on having a pleasant interaction."
For decades, physicians have written off-label prescriptions for beta blockers to help people overcome the physical manifestation of performance anxiety, which is usually caused by a fear of failing at a stress-inducing task.
Movie stars take beta blockers before they give speeches at award ceremonies. Brides talk about using them for their wedding day. And, professional musicians sometimes rely on the medication so their hands won't shake when they perform.
But how do beta blockers work? And should you take one for your anxiety symptoms?
Mental health experts say beta blockers, such as atenolol and propranolol, can be used occasionally to manage the physical symptoms of performance anxiety.
When you're in a stressful situation, your body releases adrenaline and noradrenaline, which increases your heart rate, and causes flushed cheeks, a shaky voice and trembling hands, said Nina Kraguljac, chair of the council on research for the American Psychiatric Association.
Beta blockers block the receptors for these hormones in different parts of your body, helping to regulate the physical response. Because of this, your heart rate and blood pressure don't rise as much as they otherwise would, said Kraguljac, who's also the executive vice chair of psychiatry and behavioral health at Ohio State University.
A beta blocker can help someone give an annual toast at a public event, said Paul Nestadt, an associate professor of psychiatry and director of the McGlasson Anxiety Disorders Clinic at Johns Hopkins School of Medicine.
But, if you're consistently struggling with performance anxiety because you're running a weekly meeting at work, you may need a treatment that'll provide a long-term benefit instead, Nestadt said.
Beta blockers carry risks and won't address the underlying cause of anxiety.
Musicians can take a beta blocker before they go onstage, and the effects will last for a couple of hours, Nestadt said. But beta blockers only address the physical response to anxiety -- not the ruminating or worrying.
"When I prescribe a beta blocker, I explain it's not an antianxiety pill; it's not going to stop the worry itself," Nestadt said. "It just helps the body stay calm so you can perform."
Beta blockers are not an effective treatment for clinically diagnosed anxiety disorders or phobias, said Martin Antony, chair of the psychology department at Toronto Metropolitan University.
A 2025 review found "a lack of robust evidence of effectiveness" in placebo-controlled trials for beta blockers to treat an anxiety disorder -- a clinical diagnosis that's made when fear and worrying interfere with a person's life, work and relationships.
Charlotte Archer, the lead author of the review and a research fellow at the University of Bristol, said more research is needed to better understand whether beta blockers could be effective in treating anxiety disorders.
"We're very limited in terms of the conclusions we can draw based on the quality of evidence," she said.
For anxiety disorders, physicians recommend cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors, or SSRIs, because both can help alleviate the worrying over time, Kraguljac said.
CBT helps you identify the catastrophic thoughts that are exaggerating the reality of a situation so you can learn to "make those thoughts smaller and put them aside," Kraguljac said.
SSRIs provide long-term, steady relief from anxiety disorders. But, SSRIs can take weeks before patients feel a difference in their symptoms, said Jeff Huffman, the director of the cardiac psychiatry research program at Mass General Hospital.
No one should take a beta blocker unless it has been prescribed by their doctor, said Charles Marmar, chair of the psychiatry department at NYU Langone Health.
"Beta blockers are not drugs you want to put people on regularly because they can dramatically reduce your exercise tolerance and make you tired," Marmar said, adding that they are "not good for chronic anxiety for that reason -- too many side effects."
Beta blockers "are serious medications" that can interact with other prescriptions a person may be taking, Kraguljac said.
Beta blockers are not recommended for performance anxiety for people who have asthma, low blood pressure or cardiovascular diseases, experts say. Some people report headaches or fatigue after taking the medication, Kraguljac said. Because they lower blood pressure, they can make you feel dizzy or lightheaded.
Anxiety can also be a symptom of depression -- which is another reason someone dealing with feelings of anxiety should consult with a mental health professional, Nestadt said.
"Anxiety is just a symptom," Kraguljac said. "Anxiety is not a diagnosis."