Propranolol for Anxiety: How a Beta Blocker Calms the Body, Not the Mind
Propranolol for anxiety eases a racing heart and shaky hands before stressful events. Learn how it works, who should avoid it and how it compares to SSRIs.
Maybe your anxiety hits like a wave out of nowhere, with a racing heart and a feeling that something terrible is happening. Or maybe it's more like a low hum of worry that never quite switches off. Understanding panic disorder vs. generalized anxiety disorder can help you make sense of what you're feeling and find the treatment that fits.
Key takeaways
- Panic disorder centers on sudden, intense panic attacks and the fear of having more. Generalized anxiety disorder (GAD) centers on ongoing, hard-to-control worry about many things.
- Both can cause physical symptoms, and you can have both at the same time.
- New or unexplained chest pain should be checked by a medical team first. Don't assume it's panic.
- SSRIs and SNRIs are first-line medications for both conditions. Benzodiazepines are used cautiously, if at all, and usually for a limited time.
- Skills-based treatment with a trained mental health professional works well for both, often alongside medication.
If you're having chest pain or a medical emergency: Call 911. If you're in emotional crisis or having thoughts of harming yourself, call or text 988, or text HOME to 741741. You can find more options on our crisis resources page.
What a panic attack feels like
A panic attack is a sudden surge of intense fear or discomfort that builds quickly, usually peaking within minutes. It can include:
- A pounding or racing heart
- Chest pain or tightness
- Shortness of breath or a choking feeling
- Sweating, trembling or shaking
- Dizziness, lightheadedness or nausea
- Numbness or tingling
- Feeling detached from yourself or your surroundings
- Fear of losing control, "going crazy" or dying
Panic attacks are frightening, but on their own they aren't a diagnosis, and many people have one during a stressful time. They can also happen with other conditions, including GAD, depression and PTSD.
What panic disorder is
Panic disorder is diagnosed when panic attacks keep happening unexpectedly, without a clear trigger, and the fear of them starts to change your life. According to the DSM-5, at least one attack is followed by a month or more of ongoing worry about having another one, or by changes in behavior to avoid them.
Anticipatory anxiety
For many people, the fear of the next attack becomes as hard as the attacks themselves. This is called anticipatory anxiety. You might constantly scan your body for signs of a racing heart or feel on edge before leaving the house.
Avoidance
Over time, people often start avoiding places or situations where an attack happened or where escape might feel hard, such as driving, crowded stores, public transit or being alone. When avoidance becomes widespread, it may be a related condition called agoraphobia. Avoidance brings short-term relief but tends to make the fear grow.
What generalized anxiety disorder is
GAD is ongoing, excessive worry that is hard to control. The worry usually spans many areas, like work, health, money, family and everyday tasks, and often jumps from one topic to the next. The DSM-5 describes it as happening more days than not for at least six months.
GAD also tends to bring physical and mental symptoms, such as:
- Restlessness or feeling keyed up
- Getting tired easily
- Trouble concentrating or a mind that goes blank
- Irritability
- Muscle tension
- Trouble falling or staying asleep
Some people with GAD look calm and capable on the outside. If that sounds familiar, you may relate to our post on high-functioning anxiety.
Panic disorder vs. generalized anxiety disorder at a glance
| Panic disorder | Generalized anxiety disorder | |
|---|---|---|
| Main experience | Sudden, intense panic attacks | Ongoing, hard-to-control worry |
| Timing | Attacks peak within minutes | Worry is present more days than not over months |
| Focus of fear | The attacks themselves and their physical sensations | Many everyday topics, often shifting |
| Physical symptoms | Strong and sudden, such as racing heart or chest tightness | Steady, such as muscle tension, fatigue and poor sleep |
| Common behavior | Avoiding places or situations linked to attacks | Seeking reassurance, over-planning, procrastinating |
| First-line medications | SSRIs and SNRIs | SSRIs and SNRIs |
When chest pain needs emergency care
Panic attacks can feel exactly like a heart problem, and the reverse is also true. Call 911 or get emergency care right away if you have:
- Chest pain, pressure or squeezing, especially for the first time
- Pain that spreads to your arm, jaw, neck or back
- Shortness of breath that doesn't ease
- Fainting, severe dizziness or a cold sweat
- Symptoms that feel different from your usual panic attacks
It's always okay to get checked, even if you've had panic attacks before.
How each is diagnosed
There's no lab test for panic disorder or GAD. A psychiatric provider diagnoses them through a careful conversation about your symptoms, when they started, how often they happen and how they affect your life. Questionnaires can help track symptoms over time. The National Institute of Mental Health has a helpful overview of both conditions.
Part of the evaluation is ruling out other causes. Thyroid problems, heart rhythm issues, caffeine, some medications, stimulants, and alcohol or substance withdrawal can all mimic anxiety. Your provider may order lab work or coordinate with your primary care doctor for tests such as an EKG.
Treatment for panic disorder and GAD
Both conditions are very treatable. Many people do best with a combination of medication and skills-based treatment.
SSRIs and SNRIs
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and escitalopram, and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine and duloxetine, are first-line medications for both panic disorder and GAD. Our guide to SSRIs vs. SNRIs explains how they differ.
These medications take several weeks to work. People with panic disorder can be sensitive to early side effects like jitteriness, so prescribers often start low and increase slowly. Antidepressants carry an FDA boxed warning about a possible increase in suicidal thoughts in children, teens and young adults, so close follow-up in the first weeks matters.
Benzodiazepines
Benzodiazepines, such as alprazolam, lorazepam and clonazepam, work quickly, which can make them appealing. But they carry real risks, including drowsiness, memory problems, falls, physical dependence and withdrawal. The FDA requires a boxed warning about misuse, addiction and dependence, and they can be dangerous when combined with opioids or alcohol.
For these reasons, prescribers usually use them cautiously, for a limited time or in specific situations, often while an SSRI or SNRI starts working. Never stop a benzodiazepine suddenly without guidance.
Other options
Buspirone is sometimes used for GAD. Propranolol, a beta blocker, can ease physical symptoms like a racing heart in specific situations, though it isn't a first-line treatment for panic disorder or GAD. Learn more in our post on propranolol for anxiety.
Skills-based treatment
Evidence-based, skills-based treatment with a trained mental health professional is highly effective for both conditions. It can help you understand panic sensations, reduce avoidance and manage worry. Our team focuses on evaluation, diagnosis and medication management, and we can help coordinate this kind of care.
Always talk with your prescriber before starting, stopping or changing any medication.
Frequently asked questions
Can a panic attack hurt me?
A panic attack feels terrifying, but it isn't dangerous on its own and passes with time. Still, if you have chest pain or symptoms that feel new or different, get emergency care to rule out a medical cause.
Can you have panic disorder and GAD at the same time?
Yes. They often occur together, and each can make the other worse. The good news is that many of the same treatments help both.
Should I cut back on caffeine?
Caffeine can trigger or worsen anxiety and panic in some people. Cutting back gradually can help, along with steady sleep and limiting alcohol.
How long does treatment take to work?
SSRIs and SNRIs usually take several weeks to reach their full effect. Skills-based treatment also builds over time.
Get help for panic and worry
You don't have to keep bracing for the next wave. At Musec Medical, our psychiatrist and psychiatric physician assistants diagnose and treat panic disorder and GAD, in person in Chicago and by telehealth anywhere in Illinois. Request an appointment to get started.
