Post-Gazette: Lights, camera, beta blockers? Online companies offer stage fright cure, as PCPs cast caution

Using a class of heart drugs known as beta blockers to stem the sweaty, shaky effects of stage fright isn’t new.

It’s an old and “off-label” use, and one not approved by the FDA. But it’s also well-established, as medical practitioners are also taught during training about using beta blockers in this way, classically for certain niche populations such as musicians or politicians.

But those seeking help with stage fright are niche no more. Now, direct-to-consumer online companies, and their targeted ads on social media, have begun advertising their ability to supply nearly anyone with sweaty palms, a shaky voice or a pounding heart with beta blockers.

After a brief online intake form, consumers choose how much of the medication they’d like to purchase. The provided answers — on medical and psychological history and other medications the patient is taking — are then reviewed by a medical practitioner.

The process allows patients to skip the appointment-making process, the wait to be seen and the process of explaining their needs, but as with nearly any “easy” alternative, there are caveats.

Nina Fatigati, primary care physician and doctor of internal medicine at St. Clair Health, drives home the idea of a “medical home,” a place where the medical provider knows your story personally, not as a series of checked boxes.

“Even the most basic things we do in the office, like vital signs, are vital,” she said. “There’s a reason why we do those every time, because it provides a framework for how we talk about medical problems and types of treatment.”

Because beta blockers are known to decrease heart rate and blood pressure, obtaining accurate vital signs — including heart rate and blood pressure — are essential to prescribing these medications safely, she said.

While beta blocker-providing companies do ask consumers to supply a blood pressure reading from the past six months, it is self-reported and unverified.

“If you give a beta blocker to a young, thin woman whose systolic blood pressure is 90, they may have performance anxiety, but you could also cause that person harm,” she said. “You could bottom out their blood pressure, for sure.”

The idea of self-reported “performance anxiety” — which can accompany work presentations, for instance — also raises flags for her.

“If somebody is coming in with any kind of anxiety, we need to be screening for depression and other mental health problems that could warrant more urgent and different treatment,” she said.

Christopher Pray, a St. Clair Health cardiologist, raises additional concerns.

“If you have someone with asthma, beta blockers can trigger an asthma exacerbation,” he said. “If you’ve got someone who has underlying heart or vascular disease, there may be reasons to avoid using these classes of medicines. Anyone with underlying depression, there are examples of when beta blockers can really worsen depressive symptoms. That’s where patients and consumers have to be really careful when choosing their providers.”

But Fatigati and Pray’s objections are only to the limited nature of these transactions, as they see it, not patients’ desire to treat performance anxiety.

“We talk about stage fright as a vicious cycle,” Pray said. “Your stress hormones are secreted by your adrenal glands into your bloodstream. Those work on your heart and blood vessels. Your heart beats faster. Your blood pressure goes up. Then you feel it. And then you start getting nervous. More hormones are released into the body.”

Rather than working on the brain’s response to stress, as anti-anxiety medications do, beta blockers prevent the heart and blood vessels from responding to the body’s stress hormones, keeping heart rates low and palms and armpits cool.

In general, Fatigati sings the praises of telehealth mental health resources. When it comes to performance anxiety, she thinks these companies may serve to draw awareness, alerting those who suffer with possible ways to alleviate their symptoms.

But she also hopes that patients continue to view the care provided by their primary care physicians as superior.

“There are so many issues with access to health care right now in this post-pandemic world. It makes me sad that a patient’s first thought wouldn’t be to talk to their primary care doctor,” she said. “We have the capability to perform mental health screenings, which are so important overall, and can tailor our treatment plan to you … because we know you.”

Resource: https://www.post-gazette.com/news/health/2024/09/01/beta-blockers-anxiety/stories/202409010035

First Published September 1, 2024, at 5:30 a.m.