By Dr Charlotte Archer, Research Fellow in Primary Care Mental Health, Centre for Academic Mental Health and Centre for Academic Primary Care, University of Bristol
Why did we do the research?
Research has shown that more people are now being prescribed beta-blockers, such as propranolol, by their GP for anxiety. This increase in prescriptions is particularly noticeable in young adults aged 18 to 34. Although beta-blockers can be used for anxiety, they are not recommended in clinical guidelines for the management of anxiety. It is possible that they are not recommended because, so far, the evidence is not clear for whether they work well in treating anxiety.
In addition, a recent report suggests that prescribing beta-blockers in patients with anxiety or depression could be problematic because there are concerns around what happens if too many are taken or when they are prescribed alongside antidepressants.
Despite the increases in prescribing of beta-blockers, we know little about when and why GPs prescribe them for anxiety. Knowing this might help us identify possible reasons for the increase in prescribing, and whether we need more research to understand how effective they can be in helping people with anxiety.
We conducted in-depth interviews with 17 GPs to explore their views on prescribing beta-blockers for anxiety disorders. GPs were recruited via GP practices in Bristol and the surrounding area. This research has been recently published in the British Journal of General Practice.
What we found
We found that many GPs think beta-blockers have a role to play in the management of anxiety. They view beta-blockers a ‘low-risk’ medication, particularly in young adults where they might have concerns about prescribing antidepressants because they can increase thoughts around suicide.
Some GPs also said they view beta-blockers as a potential alternative to benzodiazepines, as although both drugs can act quickly, beta-blockers do not lead to dependence (unlike benzodiazepines).
GPs reported that some patients appeared to want a quick ‘fix’ for their anxiety symptoms, which they thought beta-blockers could potentially offer, as they work quicker than antidepressants and waiting lists to access talking therapies were usually long.
GPs also described how some patients seemed more willing to try beta-blockers than antidepressants, as patients did not think of them as ‘mental health drugs’ and therefore were more acceptable and less stigmatising.
Finally, GPs described beta-blockers as a ‘patient-led’ treatment, with patients able to manage their own dose and frequency, with little need for GP input.
What does this mean for patients and GPs?
As GPs consider beta-blockers a safe and useful drug for the management of anxiety symptoms, and given the recent increases their prescribing of them, it would be timely to undertake research to assess the safety and effectiveness of beta-blockers in treating anxiety.
Future research could also aim to understand patients’ views of taking beta-blockers, considering GPs comments about patients wanting quick ‘fixes’ for their anxiety symptoms and viewing these drugs as more acceptable than antidepressants.
Evidence from this research would better inform GPs on when and how these drugs should be used to manage anxiety, and how best to discuss them with patients.
Read the full paper: GPs’ views of prescribing beta- blockers for people with anxiety disorders: a qualitative study. Charlotte Archer, David Kessler, Nicola Wiles, Carolyn A Chew-Graham and Katrina Turner. Published in British Journal of General Practice. September 2024.
See also: Is there value in GPs diagnosing and anxiety disorder?
Acknowledgements
Charlotte’s Launching Fellowship is funded by Bristol, North Somerset and South Gloucestershire Integrated Care Board.