As someone who has used propranolol on and off over the past few years, the thing that intrigues me here is that propranolol works well in this instance due to crossing the blood/brain barrier as opposed to other beta blockers that do not.
The use of beta blockers in anxiety is commonly associated with reducing the effects of stress on heart rate and blood pressure, not necessarily on affecting the brain directly which appears to be happening here. That is, beta blockers are usually a band aid rather than a fix, so this discovery is exciting.
(As an aside, if you suffer from unusual levels of physical response to certain stimuli while intellectually remaining calm or indifferent, propranolol may be worth investigating for you as it has helped me a lot. At your own risk, of course.)
If you are out there and suffer daily 'stage fright' or serious social anxiety - propranolol is the drug for you. That weird fear that sweeps over you before a conversation - just doesn't happen. Need to talk in front of 50 people in 25 minutes? No problem. If you are crippled by social anxiety - this pill will turn you into Bradley Cooper in Limitless.
> this pill will turn you into Bradley Cooper in Limitless
That’s quite a sales pitch! Propranolol worked for me for occasional use for stage fright scenarios. It was an amazing feeling the first couple of times to be able to go into those situations without the anxiety. But far from the Limitless example, for me a couple of hours after taking it I would slow down mentally and a few hours after taking it I would be exhausted and absolutely done for the day.
Maybe I’m an outlier, but it had absolutely no effect on me for public speaking or social situations. I was prescribed a lot of it, tried for years and even still have some sitting around. I envy those who get the effects you describe.
Yeah it slows my heart rate and chills me out a little but it's no magic cure for generalized social anxiety in my case. I've had better outcomes from eliminating caffeine.
I do like that (for me) Propranolol has minimal side effects other than mild drowsiness.
Cutting out caffeine reduced social anxiety? I guess I can see the connection, but I don't think I've ever heard this mentioned before, or I just haven't heard about it.
Heavy caffeine consumption is so normalized in nerd culture that I didn't even think about my intake. A friend of mine who also has social anxiety quit caffeine and made me realize what a large effect it was having on my mood.
The physical withdrawal symptoms of cold turkey are pretty eye opening.
Yes of course because it makes one less jittery. But I think the positive side effects outweigh the negative: drinking coffee is social and so is staying awake long.
after heavily consuming caffeine for some time it no longer keeps you awake (I can drink a monster energy drink and immediately go to sleep). If you’re just drinking coffee socially I’d be willing to bet you’re not having any symptoms that affect your daily life
I don't know the reason, but my anecdata from talking to quite a few people about it is that some people react very poorly to it. But I guess that's true of a lot of medications that affect behavior.. antidepressants would be another great example of that.
> That is, beta blockers are usually a band aid rather than a fix,
Anxiety is complex and is not just the mental experience, which is why therapy for anxiety uses "hot cross bun diagrams" to describe the feedback loops that physical sensation contribute to.
I also thought before reading the article that it "just" relieves the person of the stress response happening elsewhere in the body, disconnecting it from the perceived danger.
Typically the fight or flight response. Racing heart, constricted blood vessels, shaking hands, shaky voice. Beta blockers will prevent adrenaline from taking effect. It's commonly prescribed off label for people who suffer from acute anxiety attacks with a known stimulus, like public speaking.
These effects are due to the fact that it readily crosses the BBB because of its high lipophilicity. It is also responsible for various other CNS side-effects such as: brain fog, sedation, vivid dreams, sleep disturbances, and rarely, depression and short-term memory issues. In contrast, low lipid solubility is associated with a lower incidence of CNS adverse effects due to the fact that it makes it difficult to cross the BBB.
Additionally, these effects may actually elicit anxiety in some individuals (especially those who get anxious over changes in their mental state and whatnot), which in turn also affects its effects on the heart rate. In such cases hydrophilic beta-blockers would do the job. I prefer labetalol as it has alpha-blocking properties and counters the catecholamine-induced (from anxiety) alpha stimulation which contributes to the increased heart rate as well.
Living with someone with crippling PTSD and anxiety disorders, I'm thrilled to hear about this study.
As someone who's dealt with an oppressive government (which is where the PTSD and anxiety came from), I wonder if this therapy can be weaponized by the powerful to oppress the powerless. The rise of the warrior cop is bad enough, but what about a crack squad that has been chemically desensitized to killing in cold blood, taking orders from corrupt officials? Great for the warrior cop's medical prognosis, not so great if you're his target.
I believe many people in prison got there through some form of fear. Fear they'd get found out, fear they'd lose something, fear for their life, fear from their childhood they lost the ability to deal with, fear they self-medicated leading to a crime. If this technology makes it out of the proverbial Petri dish, I'm hoping we as a society could substitute a session for 10+ years of incarceration. We'd end up safer, less poor, and more just.
That worry feels like a stretch, because right now, the many oppressive governments of the world are not in the least suffering logistical difficulties due to their stormtroopers getting PTSD.
There are I think 2 main reasons why not:
- Stormtroopers are people who have non functioning empathy, by nature or nurture, they don't experience killing in cold blood as horrific.
- Stormtroopers are a cheap commodity. The oppressive government doesn't mind using them up.
On the other hand the people who are subject to crippling PTSD are victims of stormtroopers, directly and via losing friends. And a few doses of this stuff smuggled in might effectively reignite the fire in a resistance movement.
A Black Mirror episode considers a flip side of that coin: the threat of PTSD as a blackmail device. Granted, alongside some other far-fetched circumstances.
I'm sorry you're living in a world where the first thing you think of when hearing about something that will help anxiety is that it will be used to turn police into remorseless killers.
> The rise of the warrior cop is bad enough, but what about a crack squad that has been chemically desensitized to killing in cold blood, taking orders from corrupt officials?
I read Eichmann in Jerusalem recently. One of the main arguments of the book is that people don't need to be extraordinary (i.e. lacking a conscience or particularly fanatical) in order to do terrible things.
The book is controversial but I think that argument is correct. The problem with Nazi Germany was not a generation of Germans who happened to be born without consciences. And, horrifyingly, we've seen this pattern repeat across time and space. It just isn't necessary to chemically alter people to get them to perform actions that we would describe as evil.
I expect weaponization of drugs from malicious governments will come in a far more effective fashion. There's no need for oppressive cops if you can simply drug your population. Not only wipe away their anxiety, but any concept of fight or flight (the root of anxiety disorders) whatsoever. Pair it with increasingly endless entertainment, plummeting testosterone levels, and a general effeminization of society and you'd never need concern yourself with losing your grasp on power.
In Brave New World, this was soma. "A gram is better than a damn."
Propranolol massively improved my quality of life. I used to get panicked at the prospect of public speaking, but with propranolol I feel like I could give a nationally televised State of the Union address with no problem.
I take it only before public speaking, not regularly. The only downside is it leaves me with dry eyes and exhaustion at the end of the day, but it’s a small price to pay for the huge QoL improvement.
That works if you can ever get to the "everything is fine" point. I was always able to get through speaking, but it was never fine. It was always a battle to keep the anxiety at bay, and occasionally I would lose that battle.
Beta blockers were the only thing that let me experience public speaking where everything was actually fine. Now I don't need them anymore, but I never would have gotten past it without them.
Honestly, there is a chance I’m dependent on it now. But I’m still okay with that being a trade off. So long as I always have at least 40 minutes notice before having to do public speaking, I should be fine.
What if you have poor speaking mannerisms or public speaking/story telling mechanics (e.g. applying emphasis to words, voice inflection, intonation, etc.) to engage a crowd or simply lack social awareness from being on the spectrum, will the drug make you confidently make a fool of yourself in front of a crowd if you haven't practiced the art of public speaking?
This does not surprise me one bit. I was prescribed beta blockers for "heart problems" that turned out to be panic attacks and I noticed the same effects. On beta blockers you're able to talk about unpleasant memories as casually as one would note the weather. It's a surreal experience, but a useful one.
Before this it was easy to shut down and avoid confronting bad memories. Now I can just brush away everything. Another great property to propranolol is it reduces the jitteriness from caffeine. Granted, if your anxiety is bad enough to need beta blockers that's definitely not a good thing, but at least the medication works well for what it does.
This kind of medication is far superior to benzos for anxiety disorders. It was pure luck to have been prescribed this instead of getting put on some horrible downer, developing a tolerance in a few months, and then having to detox with rebound symptoms that are worse than the illness being treated. There seems to be a lot of promising developments in psychiatry recently.
If caffeine makes you jittery, try out those time-release caffeine pills and a tall glass of water. I've replaced morning coffee this way, and it's great.
Why not just cut out caffeine? You'll be in a slump for a month but once you're past that energy levels and alertness will be back to normal. I used to drink caffeinated water after I gave up soda until I realized it was kind of ridiculous. Taking a caffeine pill strikes me similarly.
If you really like the effects of caffeine, with a pill you don't have to worry about the carcinogens (acrylamide) in toasted coffee. Also, pills can be cheaper than any bought or made-at-home coffee It's not ridiculous.
L-Theanine + Caffeine is a great combo and mitigates the jittery effect. Better still, both occur naturally in green tea, so taking supplements is not needed.
This is also pictured in NOVA: memory hackers on Netflix (last accessed in Brazil, in case it is region locked). It documents the process of treating arachnophobia in a patient that clearly has an extreme aversion to spiders and it is incredible.
sorry I was late to answer. Yep, it just shows one tarantula by itself and the participant is asked to try to touch the spider, and that is it. I guess if you are triggered that easily you could skip the scene, but the spider scene is very mild
I have been taking low dosage Propranolol for about a year now. It was prescribed for me for my hemiplegic migraines. Combined with exercise and occasional CBD oil it has completely eliminated migraines from my life.
This medication is absolutely brilliant and harmless. Also keeps my resting heart rate around 55.
If you struggle with migraines, talk to your neurologist, for me it was a life changer.
The same thing happened to me, and it unexpectedly was a huge relief for my anxiety. I went off of the propanolol about two years ago after losing a considerable amount of weight, thinking that I no longer needed it. My work performance suffered and I was having considerable difficulty finding a job and was getting the same sorts of crippling anxiety I'd had in my 20s.
It took about a year and a half to finally have a light bulb moment that the Propanolol was the major difference between the most successful and prosperous years of my life and the parts of my life where I've been an anxious hot mess. I'm so glad I stumbled upon this medicine as it's truly made my life more meaningful in allowing me to achieve what I'm really capable of as a software developer.
My resting heart rate is about 55, and I don't do a lot (arguably not any) of cardio. I'm probably in the group of people who shouldn't take propranolol.
my resting heart rate was high 30s-low 40s. I was put on propranolol and now my resting heart rate is in the mid 40s. I am the exact opposite of an athlete.
I'm really curious where social anxiety comes from. I get it though not crippling most of the time. But for example public speaking I can logically see that I publicly speak any time I'm at dinner with friends or voice my thoughts in a meeting so it's strange to me that officially speaking would have so different a feeling but it does.
For me it's the anticipation of putting myself on the line. I can speak up in meetings where I know i'm an authority, but struggle to do so when I don't have that role. Social situations with people I don't know well will nearly always have me looking for ways to avoid it, even though I've been told repeatedly that I'm very personable. I've done group salsa performances in front of hundreds (possibly thousands) of people, but I need to get very drunk to do regular club (not salsa) dancing.
My best guess as to the origin is the environment at home when growing up. Without going into too much detail, it was very stressful and I felt like I didn't have a voice.
I'm curious if it affects emotional reconsolidation of other emotions and not just fear. If someone takes a dose before reminiscing about, say, their wedding day, will it remove or flatten those emotional associations as well?
I take propranolol with ADHD medication to help negate some of the anxiety/raised heart rate effects.
I'm not sure if I've noticed a difference with anxiety while on it, other than the mitigation of anxiety from ADHD medication.
I guess I should try taking it alone.
That being said, a large part of my psychological issues are due to anxiety, but I haven't seen any treatments that have been compelling enough for me to try (SSRI's/benzos mainly).
I do exercise, try to be good about sleep, try to force myself to get out with friends or family every other week or so.
Additionally, I've noticed meditation to be a large help for me with anxiety. It took me a while to where I really notice the difference, but I've reached a point where I can say I notice if I've meditated the night before or not.
(I'm not advocating for or against any medication, individual situations vary, and people should consider treatment in the context of their situation with their doctor)
> I take propranolol with ADHD medication to help negate some of the anxiety/raised heart rate effects.
Happy to hear someone else does this as well. It's really done wonders and has helped me think more clearly in stressful situations — whereas, with stimulants alone, things can become a little more stressful when you're stressed due to increased heart rate and blood pressure.
“In a 1987 study by the International Conference of Symphony and Opera Musicians, it was shown that 27% of interviewed members admitted to using beta blockers such as propranolol for musical performances.[70] For about 10–16% of performers, their degree of stage fright is considered pathological.[70][71] Propranolol is used by musicians, actors, and public speakers for its ability to treat anxiety symptoms activated by the sympathetic nervous system.[72] It has also been used as a performance-enhancing drug in sports where high accuracy is required, including archery, shooting, golf[73] and snooker.[73] In the 2008 Summer Olympics, 50-metre pistol silver medalist and 10-metre air pistol bronze medalist Kim Jong-su tested positive for propranolol and was stripped of his medals.[74]”
> “The effects are pretty amazing,” Dr. Soeter said. “Everything is treatable. It’s almost too good to be true, but these are our findings.”
Honestly yes. And it even sounds a bit scary, to me, that a drug that is very un-selective produces such a selective effect (erasing a specific kind of memory under very specific conditions). It sounds a little bit like striking a welding arc a couple times in just the right way next to a computer to flip a few specific bits in it's main memory -- absolutely astounding that it works, but who knows what else happened in there?
That being said I very much hope that this turns out to not produce {short,long}-term damage, because anxiety orders are very difficult to treat and are a huge waste of human ability.
> Propranolol achieves selective erasure: It targets the emotional component, but knowledge is intact. They know what happened, but they aren’t scared anymore. The fear association is affected, but not the innate fear response to a threat stimulus [...] This single-session therapy addressing what psychologists call fear memory reconsolidation
emotional/fear association sounds like a type of memory to me.
I've used it about once every other week to chill myself out in the morning when I am too worried about other things to focus on what I need to. Side effect of nausea though can hit me like 1 in 4 times, so I am really selective about when I take it. Its helpful as an adjunct (for me), but not curative, and not something I feel like I could take every day long term.
> The propranolol must be given within roughly an hour before to 1 hour after therapeutic reactivation of the fear memory to be effective.
[...]
when subjects were rechallenged 12 hours after taking propranolol the previous day – that is, after a night’s sleep – the fear memory was gone
Yeah, but that just makes one careful. On the other hand, not being able to climb a ladder, be too close to a window on the 3rd floor, or other such things would suck. You can then keep the knowledge that some heights are dangerous without actually having the fear.
I believe normal people like me are still wary of danger, and even have physical responses (tensing up, moving gingerly, holding your breath) when under the illusion of danger even when logically knowing there's very little danger, such as when standing on a transparent balcony floor or walkway of a very very tall building, or preparing for a drop from a tall roller coaster. I think that's all the physiological response one needs without getting psychologically crippled, paralyzed, making rash decisions, or just generally having a bad time when presented with these situations.
Same, I lost many many fears over the years (I now help spiders go back to safe places instead of screaming in terror). But vertigo is still one that blanks my mind entirely
Or just go back to the 90s and tell yourself that, no matter how cool Hypercolor shirts are in advertisements, they won't actually make YOU cool, and nobody needs a garment that draws additional attention to their sweaty armpits.
A lot of people are saying it's "erasing" the memory. I actually think the way it works is much simpler. I've read that when you relive any memory your brain essentially unloads it, then rewrites it (sometimes in a modified form).
So like think loading a block of memory then rewriting it, but this time you rewrite the memory without the associated anxiety.
As a person with depression and anxiety, I've definitely noticed my memories change based on my mood whenever I recall them. I'd remember professors having harsh tones and cold body language, but then see them acting completely different in a class a year or two later. They hadn't changed; it was that, during my depressive episodes, I'd always obsess over classes I skipped or failed.
I took it as a product of not having a photographic memory. When my mind recalled the memory, there were a lot of parts missing: hand gestures, voice volume, other students, etc. So my brain filled in those gaps with "reasonable" guesses. And, during a depressive episode, it was reasonable to assume other people didn't like me. These additions became part of the memory.
Even with the depression and anxiety under control, I keep in mind that memories can be emotionally altered. So I'm more willing to believe my memories are wrong. And I don't let myself obsess over a memory, which was never productive, anyway.
> Fifteen received 40 mg of propranolol after spending 2 minutes in proximity to a large tarantula, 15 got placebo, and another 15 received propranolol without exposure to a tarantula.
What about a group who was exposed to the tarantula without the propranolol?
from the punctuation and sentence structure, it is saying that "15 got placebo" meaning in the same situation as the previous statement (with tarantula). Also, what purpose would there be to having people take a placebo and be in a normal situation?
Coincidentally, I recently listened to an interesting Revisionist History episode that covered the importance and controversy of a semicolon in the interpretation of a section of the constitution
Use in anxiety disorders is not really a new phenomenon. It's a non-selective beta blocker that's been used in performance anxiety for decades. I have to give a talk in 6 months and I'm going to prescribe myself propranolol so I can give the talk without feeling adrenergic sympathetic activation/fight or flight. So if I can't feel a sympathetic response centrally or peripherally, I'm going to have minimal performance anxiety and therefore no fearful memories of the event. Hopefully it goes smoothly. I would hate to be calm and give a pathetic shitshow of a talk and then not feel bad about it later..
This sounds extremely similar to results discovered a while back about the antibiotic D-cycloserine. The referenced paper does briefly mention D-cycloserine, but indicates that the effect is different without going into much detail.
I've read a lot of comments about taking propranolol before an anxiety inducing event. I agree it is incredibly useful there. But for me, it is also useful afterwards. It causes amnesia of fear memories. Instead of having my mind race and thinking of all the small mistakes I may have made, I can think normally and actually focus on things after a tough event.
I bet this discovery is related to another recent discovery: "Blocking IgSF9b in pathologically anxious mice has an anxiolytic effect and normalises anxiety behaviour in these animals." (see https://www.mpg.de/12620765/anxiety-protein-amygdala)
I was temporally prescribed metoprolol for some palpitations but also discovered it does helps with anxiety symptoms, so I still use it sometimes. At first it gave me nightmares but they stopped. I wanted to try propranolol (probably better) but I read the side effects are worse than those of metoprolol so I didn’t.
Edit: I read the side effects are basically the same, including ED.
As described at the link above, it would be inappropriate/harmful for a physician to prescribe more than a single dose of propranolol for this purpose — to be taken in concert with a therapeutic session and likely never again — but absolutely not as a take-home prescription of more than a single pill. This is the same type of prescribing regimen that we’re finding out psilocybin works with too, and you wouldn’t get a take-home supply of that either.
That you can acquire the drug readily for other medical reasons is not in any way a reason to start self-prescribing it for anxiety. Without the trauma-inducing psych session, the anti-PTSD benefit they describe has no chance to occur. And it’s a bad plan to give yourself traumatic recall flashbacks - a bad trip by any definition - without some sort of competent mental support from competent human beings.
I've taken this before for anxiety and while I do think it helps massively, it certainly isn't a single dose silver bullet. IMO you need to take it every time before the thing that causes you anxiety.
I take propranolol for migraine prevention - I found it really did have a fear and anxiety erasing effect at first - however eventually I became "accustomed" to it. It still seems to help some though.
> The researchers next conducted a randomized, double-blind clinical trial in 45 individuals with arachnophobia. Fifteen received 40 mg of propranolol after spending 2 minutes in proximity to a large tarantula, 15 got placebo, and another 15 received propranolol without exposure to a tarantula. One week later, all patients who received propranolol with spider exposure were able to approach and actually pet the tarantula.
Please refrain from simply quoting the article, adding nothing to the conversation. It’s a blatant attempt at upvote harvesting from the TLDR crowd, and doesn’t belong on HN
HN Guidelines:
Be civil. Don't say things you wouldn't say face-to-face. Don't be snarky. Comments should get more civil and substantive, not less, as a topic gets more divisive.
Don't some people who have, say, a social anxiety disorder already take a dose of propranolol one hour before a social event? So isn't this discovery already widely known among propranolol users?
Yes, but this research (even though similar research occurred prior) is about "guided therapy" where the therapist is trying to specifically trigger a memory but also help the patient figure out new coping strategies and turning those new coping strategies into habits so the automatic anxiety induced habit is not the only coping mechanism.
Taking a dose of propranolol prior to a stressful situation is a different type of environment with different goals for how will interact with the environment.
----
This is not new research for we had replication research of the connection with specific Beta receptors in the amygdala and the hippocampus in 2004 with fear and Yadda, Yadda, Yadda... with prior breakthrough research happening even earlier. But there are so many interactions with so many systems that research after 2004 is about learning the "best practices and best applications" of how to treat patients. Science and Medicine is a continuous undertaken process. This researcher M Soeter has a dozen important scientific papers on the detail of this process from 2009 to 2018.
Is there some way to see this without the paywall?
I realize I’m just one data point, but as someone with anxiety, I studied up on the use of propranolol in fear extinction and was able to get my doctor to prescribe it around 5 years ago. It had absolutely no positive effect on me. I may as well have been taking aspirin. It did, however seem to have some negative effects on my memory. If I met someone while on it, I would often not recognize them if we met again. It’s like it prevented my brain from recording their face to my long term memory.
I was on nothing else but blood pressure medication, by the way.
Even though the discussion is not valid in the context of the article that clearly limitates the use of memory reconstruction to basic forms of emotional memory, we could very well picture entities abusing higher forms of memory manipulation to political ends.
You gain retention by assimilating facts at the same time you have some emotional experience, this is one of the reasons why professors who are entertaining can sometimes also be much better teachers. Laughing while assimilating works better than simply trying to memorize stuff.
Even looking at rote memorization, most experts in memorization tell you to associate places and emotions with whatever you're currently trying to memorize.
So by removing the emotional payload from the memory, you're effectively also removing the memory itself, even if superficially the facts remain. What will happen over time is that since there's less emotion associated with the facts, the facts will be forgotten -- like all the other facts in your life day-to-day are forgotten.
I knew all of that and thought others did too. Next time I'll try assuming that is not the case.
The use of beta blockers in anxiety is commonly associated with reducing the effects of stress on heart rate and blood pressure, not necessarily on affecting the brain directly which appears to be happening here. That is, beta blockers are usually a band aid rather than a fix, so this discovery is exciting.
(As an aside, if you suffer from unusual levels of physical response to certain stimuli while intellectually remaining calm or indifferent, propranolol may be worth investigating for you as it has helped me a lot. At your own risk, of course.)