SSRIs vs beta blockers for anxiety: Which one should I take?

Navigating the world of anxiety treatment can be overwhelming, especially when you’re faced with an array of medication options.  When deciding between SSRIs vs beta blockers, which one is better for anxiety disorders?

In this article, we outline the primary differences between SSRIs and beta-blockers for anxiety and discuss how one medication might be better than the other depending on your need and certain medical conditions.

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Beta-blockers vs. SSRIs

When comparing beta blockers and SSRIs for anxiety treatment, each class of medication offers distinct benefits and mechanisms of action. Beta-blockers are primarily used for managing physical symptoms of anxiety, such as palpitations and tremors, by blocking adrenaline’s effects on the body. 

SSRIs, on the other hand, focus on increasing serotonin levels in the brain, which can improve mood and reduce feelings of anxiety. 

Choosing between beta blockers and SSRIs depends on the specific symptoms and needs of the individual. While beta-blockers might be preferable for those facing immediate, physical manifestations of anxiety, SSRIs offer a long-term solution to address underlying psychological factors.

Consult a healthcare professional who will review your medical history and overall health to determine the most appropriate treatment plan.

Beta blockers for anxiety

Beta-blocker drugs block epinephrine (adrenaline) and have a calming effect on your nervous system. Because of this particular effect, beta-blockers are prescribed off-label to treat chronic anxiety disorders, including:

• Generalized anxiety disorder (GAD)
• Panic disorder (PD)
• Post-traumatic stress disorder (PTSD)

Beta-blockers, or beta-adrenergic blocking agents, are most often prescribed to treat cardiovascular symptoms, including:

• Irregular heart rhythm (arrhythmia)
• Heart failure
• Chest pain (angina)
• High blood pressure

This medication reduces how hard your heart has to work to pump blood by reducing the strain on smooth muscle tissue, such as those found in blood vessels and the respiratory system.

If you experience severe physical symptoms of anxiety, such as a racing heartbeat, intense sweating, feelings of impending doom or sudden danger, high blood pressure, or trembling, then beta-blockers may be an effective tool for managing the physical symptoms of anxiety or situational anxiety like performance anxiety or social anxiety. 

However, it’s important to note that beta-blockers don’t address the underlying reasons a person has anxiety symptoms and don’t directly treat psychological symptoms of anxiety disorders.

How do beta blockers work?

Beta-blockers work by blocking beta receptors, which are found on the surface of your body’s cells. These beta receptors respond to epinephrine — also known as adrenaline — and control certain types of cellular activity. 

When these receptors are blocked, this cellular activity is lessened or prevented entirely. There are 3 types of beta receptors — B1, B2, and B3 receptors. 

Beta-1 receptors

B1 receptors are found in the heart and kidneys. When activated, they:

• Increase heart rate
• Increase the force of heartbeats

Beta-2 receptors

B2 receptors are found in the nervous system, respiratory system, and in blood vessels. When activated, they:

• Relax smooth muscles in the respiratory system (helping people breathe better)
• Relax smooth muscles and lowers blood pressure in the circulatory system
• Can cause muscle tremors
• Cause the heart to work harder and beat faster

Beta-3 receptors

B3 receptors are found in fat cells and the bladder. When activated, they:

• Trigger fat cells to break down
• Relax the bladder

Some beta-blocker medications only work on certain types of beta receptors, while others work on all beta receptors. Most beta blockers prescribed for heart conditions and other off-label treatments are “cardioselective,” meaning they only work on B1 receptors found in the heart and kidneys.

What do beta blockers treat?

Though mostly prescribed for cardiovascular conditions, beta-blockers have other medical applications. 

• Anxiety disorder symptoms
• Cardiovascular symptoms
• Migraines
• Essential tremors
• Glaucoma

What are the most commonly prescribed beta-blockers?

Here are the most commonly prescribed beta-blockers:

• Sectral / Acebutolol
• Zebeta / Bisoprolol
• Coreg / Carvedilol
• Inderal / Propranolol
• Tenormin / Atenolol
• Lopressor / Metoprolol tartrate

Costs

Beta-blockers were first prescribed in the 1960s. Because they’ve been around for a while, their costs are generally low. Most beta-blockers range between $6 and $32. 

Beta-blocker side effects

Beta receptors are located all over your body. Even with cardioselective beta-blockers, the heart has a direct effect on the circulatory system, which, in turn, affects other systems. As a result, beta-blockers are associated with several side effects.

• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Arrhythmias (irregular heart rhythms)
• Fatigue
• Nightmares
• Dry mouth
• Dry eyes
• Dizziness
• Nausea
• Insomnia

Each beta-blocker has a slightly different chemical structure and produces a different side effect profile. It’s best to talk with a trained medical provider when discussing anxiety treatment options.

Drug interactions

Beta-blockers can interact with many different types of medications and other anxiety medications. It’s important to fully disclose to your medical provider which medications, supplements, and vitamins you take with your healthcare provider. 

Some drugs/drug classes that have known interactions with beta-blockers are:

• Antiarrhythmics (prescribed for irregular heartbeats)
• Antihypertensives (prescribed to lower blood pressure)
• Antipsychotics (used to treat severe mental illness)
• Over-the-counter (OTC) and prescription allergy medications
• Clonidine (prescribed for high blood pressure and migraines)
• Mefloquine (prescribed to prevent or treat malaria)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen

For a complete list of interactions with other drugs, see the beta-blockers. Drug interactions of clinical significance article on PubMed.

Warnings for use

Beta-blockers aren’t right for everyone. Depending on your medical history, your medical provider may prescribe one type of beta-blocker over another or choose a different treatment altogether.

For example, people with moderate to severe asthma should only be prescribed cardioselective beta-blockers that block B1 receptors. Non-selective beta-blockers can affect B2 receptors and trigger an asthma attack when blocked.

Beta-blockers lower blood pressure and heart rate by design. If a person has hypotension (low blood pressure) to begin with, then taking beta-blockers is not the best course of action.

People with Raynaud’s Syndrome should avoid taking beta-blockers, as this medication can make circulation problems worse by lowering blood pressure and heart rate. Raynaud’s Syndrome is a condition in which small blood vessels in the extremities, such as fingers and toes, narrow, leading to reduced blood flow and causing areas to turn white and blue. It is often triggered by cold temperatures or stress.

People who have diabetes need to check their blood sugar more regularly because beta-blockers can mask certain symptoms of hypoglycemia, like sweating. 

SSRIs for anxiety

SSRIs, or selective serotonin reuptake inhibitors, are commonly prescribed antidepressants that help relieve anxiety symptoms. Regarding anxiety disorders, SSRIs are most effective at treating GAD or generalized anxiety disorder. 

Symptoms of GAD include:

• Restlessness
• Feeling on-edge
• Intrusive thoughts 
• Unable to stop worrying or thinking
• Racing thoughts
• Tiredness
• Poor concentration
• Irritability
• Headaches
• Muscle aches
• Stomach pain
• Unexplained pains

In addition to GAD, SSRIs can help treat the symptoms of other anxiety disorders, such as:

• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Severe phobias, for example agoraphobia or social phobia 

How do SSRIs work?

SSRIs help your brain cells (called neurons) communicate more effectively by increasing the usable number of chemical messengers (called neurotransmitters) in the brain. Specifically, SSRIs help elevate levels of serotonin and dopamine. 

This is where the reuptake inhibitor part of the name comes from. SSRIs block the channels that would normally reabsorb serotonin and dopamine after being used in a chemical exchange between neurons.

By preventing the reuptake of these chemical messengers, the total number available builds up over time, improving the ability of your brain cells to communicate effectively with one another.

What do SSRIs treat?

Depression

SSRIs are often the first choice when treating persistent or severe depression because they have fewer side effects than older antidepressants like tricyclics.

Anxiety

SSRIs can also treat anxiety disorders. Additionally, some people have co-occurring anxiety and depression. In cases like this, an SSRI is an effective treatment option because it helps alleviate symptoms of anxiety and depression.

Off-label uses for SSRIs

Some healthcare providers may prescribe SSRIs as an off-label treatment for the following conditions.

• Vasomotor symptoms (associated with menopause) 
• Neurocardiogenic syncope (fainting spells)
• Fibromyalgia
• Diabetic neuropathy (nerve damage mostly in legs and feet)
• Migraine headaches (prophylaxis)
• Premature ejaculation

What are the most commonly prescribed SSRIs?

Several SSRIs are commonly prescribed in the U.S. to treat depression, anxiety, and other off-label conditions. 

Here are the most common SSRIs:

• Prozac (Fluoxetine)
• Celexa (Citalopram)
• Zoloft ((Sertraline)
• Paxil (Paroxetine)
• Lexapro (Escitalopram)

Costs

Generic SSRIs are usually priced below $10 for a 30-day supply. Brand names may be more expensive, but not much more expensive. Certain extended-release forms might push prices into the $20 to $30 range.

Common side effects

Some people don’t experience noticeable side effects while taking SSRIs, and those who initially experience side effects report that they lessen over time. However, for others, certain side effects don’t go away. 

Here are the most common SSRI side effects:

• Nausea
• Vomiting
• Diarrhea
• Headaches
• Drowsiness
• Dry mouth
• Insomnia
• Nervousness
• Agitation
• Restlessness
• Dizziness
• Sexual problems: reduced sexual desire, difficulty reaching orgasm, or inability to maintain an erection (erectile dysfunction)
• Overeating or Undereating  

Drug interactions

While SSRIs are generally considered safe and effective, they can interact with other medications, including prescription drugs, OTC medicines, and herbal supplements.

Some general drug interactions for SSRIs include:

• Monoamine oxidase inhibitors (MAOIs)
• Blood thinners
• NSAIDsAntiplatelet drugs
• Triptans
• St. John’s Wort
• Other antidepressants

Serotonin syndrome

Though serotonin is a necessary neurotransmitter, the hormone can reach toxic levels in the human body. When people increase their dosage of serotonin-elevating medication, start a new serotonin-elevating medication, or mix different drugs that affect serotonin, this rare — but potentially fatal — condition can develop.

• Agitation
• Restlessness
• Insomnia
• Loss of muscle coordination or twitching muscles
• High blood pressure
• High fever
• Tremor
• Seizures
• Irregular heartbeat
• Unconsciousness
• Muscle rigidity
• Heavy sweating
• Diarrhea
• Headache
• Shivering
• Confusion
• Rapid heart rate and high blood pressure
• Dilated pupils

Drug warnings

People taking antidepressants need to be monitored and self-monitor for increases in suicidal thoughts and behaviors when taking antidepressants. 

• Changes in personality and appearance
• Social withdrawal
• Hopelessness
• Threatening or talking about suicide/harming oneself
• Severe sadness or moodiness
• Making preparations
• Severe trauma or life crisis 

Beta-blockers vs. SSRIs

When comparing beta blockers and SSRIs for anxiety treatment, each class of medication offers distinct benefits and mechanisms of action. Beta-blockers are primarily used for managing physical symptoms of anxiety, such as palpitations and tremors, by blocking adrenaline’s effects on the body. 

SSRIs, on the other hand, focus on increasing serotonin levels in the brain, which can improve mood and reduce feelings of anxiety. 

Choosing between beta blockers and SSRIs depends on the specific symptoms and needs of the individual. While beta-blockers might be preferable for those facing immediate, physical manifestations of anxiety, SSRIs offer a long-term solution to address underlying psychological factors.

Consult a healthcare professional who will review your medical history and overall health to determine the most appropriate treatment plan.

If you suffer from anxiety or depression, a provider on Klarity can help

Klarity connects you with a board-certified mental health professional who can diagnose and prescribe beta-blockers, SSRIs, and other anxiety treatments, if needed, and in 48 hours or less.

To get started, find a provider on Klarity.

Sources

Angela Gomez. “SSRIs and Benzodiazepines for General Anxiety Disorders (GAD).” Anxiety and Depression Association of America. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/ssris-and-benzodiazepines-general-anxiety

“Do Beta Blockers Work For Anxiety?” Cleveland Clinic. https://health.clevelandclinic.org/beta-blockers-for-anxiety/

Lo Styx. “Beta Blockers Are the Buzziest New Anti-Anxiety Medicine—Here’s What to Know.” Very Well Mind. https://www.verywellmind.com/beta-blockers-are-the-buzzy-new-anti-anxiety-medicine-heres-what-you-need-to-know-5271756

Mayo Clinic Staff. “Selective Serotonin Reuptake Inhibitors (SSRIs).” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

Megan Brown. “Can Beta Blockers Help Your Anxiety.” Healthline. https://www.healthline.com/health/beta-blockers-for-anxiety