Nearly a third of all Americans will experience an anxiety disorder at some point in their lives. When symptoms are severe, medication can help. Beta blockers are a class of drugs that works on your body’s fight-or-flight response—blocking the effects of adrenaline. If you’ve ever experienced anxiety symptoms like sweating palms, racing heartbeat, or difficulty breathing, it may sound like a welcome respite. Because they slow your heart rate and relax your blood vessels, these medications are typically prescribed for hypertension (high blood pressure) or heart conditions. However, those same effects make these medications an effective off-label treatment for anxiety. Metoprolol, also sold under the brand names Lopressor and Toprol XL, is one of the available options. Here’s what you need to know about metoprolol for anxiety.
Does metoprolol help with anxiety?
The first-line medications for anxiety are antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). However, some people don’t like the idea of taking any psychiatric or psychotropic medication, notes Aida Mihaljovic, MD, a psychiatrist in Chicago, Illinois. In those cases, metoprolol can help treat the physical symptoms of anxiety. Although it won’t alleviate the psychological cause of the condition, this medication can help manage a racing heart, sweaty palms, or shakiness.
Metoprolol is a beta blocker, most commonly prescribed to treat heart conditions such as chest pain (angina), heart attack, or heart failure. Beta blockers work by relaxing your blood vessels and slowing your heart rate, which can help improve blood flow and decrease blood pressure. These medications are not approved by the U.S. Food and Drug Administration (FDA) for anxiety, but they have long been proven effective in helping some people with anxiety.
“Beta blockers such as metoprolol can be used for certain kinds of anxiety, particularly if having a racing heart or tremors is an issue,” says Katherine Rizzo, DO, a psychiatrist with Advantage TMS in Clearwater, Florida. For example, if you suffer from stage fright or performance anxiety (think: public speaking), metoprolol might help you. It can block the effects of the hormone epinephrine, also known as adrenaline, which is sometimes called the fight-or-flight hormone. As a result, it slows down your heart rate and helps you feel calmer.
There’s another benefit of using metoprolol instead of some other medications that are sometimes used to treat anxiety. It’s not a controlled substance. “Although it is used off-label, it can be beneficial in managing symptoms of anxiety and help avoid the use of stronger, more addictive drugs, like benzodiazepines,” explains Zishan Khan, MD, a psychiatrist with MindPath Health in Frisco, Texas. “These medications, which include Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam), are controlled substances for a reason. They are habit-forming and can lead to tolerance, meaning a person will need more of the medication to achieve the highest dose.”
However, that doesn’t mean your healthcare provider will automatically recommend metoprolol. “They are by no means the first line of defense that I would introduce to a patient, but they can be useful in specific situations, such as performance anxiety, where the major focus falls on managing the patient’s physical response to stress,” says Dr. Rizzo.
How long does it take for metoprolol to work for anxiety?
One advantage of metoprolol is that it starts working fairly quickly—unlike SSRIs and SNRIs, which can take several weeks to reach a therapeutic level. It takes about an hour or two to go into effect and about 16 hours for the medication to leave your system. You should take it situationally, such as before giving a big presentation or flying, about 60 to 90 minutes before the stressful event.
How much metoprolol should I take for anxiety?
The initial daily dose of metoprolol for heart and circulatory system issues can range from 25 mg to 100 mg. For anxiety treatment, your provider may suggest a lower starting dose, taken as needed when you expect a stress-inducing situation. Dr. Mihajlovic recommends beginning with 25 mg.
“If the starting dose is well tolerated and effective, a healthcare provider may gradually increase the dosage, but the goal is generally to use the smallest effective dose possible,” says Dr. Khan. “For managing physical symptoms of anxiety, such as heart palpitations, a lower dose can be helpful, especially to avoid potential side effects.”
As with any medication, side effects are possible with metoprolol. The most common side effects of metoprolol include:
- Sleepiness or drowsiness
- Chest pain or discomfort
- Confusion
- Blurred vision
- Dizziness or lightheadedness
- Irregular heartbeat or slow heartbeat
- Sweating
- Unusual fatigue or weakness
More serious side effects are also possible, such as shortness of breath, difficulty breathing, wheezing, a rapid or pounding heartbeat, weight gain, and swelling of the extremities. Another potentially serious adverse effect of metoprolol is bradycardia, which is when the heart beats slower than normal. The risk is usually higher with short-acting or immediate-release formulations (metoprolol tartrate) than extended-release formulations of metoprolol (metoprolol succinate), according to research.
“For the most part, it’s well tolerated,” says Dr. Mihajlovic. However, if you are concerned about potential side effects or you do develop side effects after beginning treatment with metoprolol, let your healthcare provider know.
Alternatives to metoprolol for anxiety
Metoprolol is generally considered safe for most people, with the caveat that it’s not recommended for people with the following medical conditions:
- Hypotension, or low blood pressure
- Slow heart rate
- Certain liver conditions
- Lung diseases like severe asthma
- Overactive thyroid
- Some kinds of blood circulation problems, such as Raynaud’s
A 2017 study also found that it seemed to worsen depression symptoms in some patients with chronic heart failure, although it did help with anxiety symptoms.
If metoprolol isn’t right for you, other beta blockers can help with anxiety. Inderal (propranolol) is the most commonly prescribed beta blocker for anxiety. And it does the job pretty well, according to Dr. Mihajlovic. “It’s a great medication for social anxiety and social phobia, which I treat regularly,” she says, adding that it tends to be “patient-friendly” and has minimal side effects. Tenormin (atenolol) is also generally well-tolerated and effective for anxiety.
The bottom line
The good news is that there are many treatment options for anxiety. If the first-line medications aren’t right for you, a beta blocker like metoprolol could provide relief from symptoms like a racing heart or shakiness. Your healthcare provider will create an individualized treatment plan that can help get your symptoms under control when you need relief.
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