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SSRIs vs. Beta Blockers For Anxiety: Which One Should I Take?

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Benzodiazepines are the first-line treatment for anxiety but aren’t suitable for everyone. Muscle relaxants, while effective at calming people who are in agitated, excited, and nervous states, have certain short-term and long-term risks, including:

  • Substance abuse
  • Dependency
  • Car accidents
  • Workplace accidents
  • Cognitive impairments
  • Overdose

For people with a history of drug abuse or people who operate vehicles or heavy machinery or are physically active for work, benzodiazepines are not an effective treatment for anxiety. Luckily two alternative medications treat the symptoms of anxiety effectively:

SSRIs and Beta-Blockers.   

If you need an alternative anxiety treatment, an SSRI or Beta-Blocker might be the best course of action. In this article, Klarity will outline the primary differences between the two and discuss where one medication might be better than the other, depending on certain medical conditions.

Determining which medication is best for you takes time, patience, and help from experienced anxiety-trained mental health specialists. Luckily for you, we can speed that process up—

Klarity has already helped 30,000+ Americans find online treatments for anxiety, depression, ADHD, and insomnia. Our unique telehealth services are fast, affordable, and convenient, taking the wait, expense, and hassle out of finding the right anxiety treatment. 

Take our brief, 2-minute online mental health assessment and speak with an anxiety-trained mental health provider in as little as 48 hours

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.

SSRIs For Anxiety

SSRIs, or selective serotonin reuptake inhibitors, are a commonly prescribed class of antidepressants that help relieve anxiety symptoms. Specifically, SSRIs are 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
  • Upset stomach
  • 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; ex: 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. 

Low levels of serotonin and dopamine are associated with many of the symptoms of anxiety and depression. SSRIs work by elevating the number of these crucial neurotransmitters, which help your brain function better.  

What Do SSRIs Treat?

Depression

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

Anxiety

SSRIs can also treat a variety of 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 US to treat depression, anxiety, and other off-label conditions. These medications affect serotonin transporters in the brain and prevent serotonin reuptake. 

However, subtle differences between each SSRI produce slightly different side effect profiles. Discuss each SSRI with a trusted medical provider who can help you decide which SSRI is right for you.

Klarity will connect you with an anxiety specialist to help you determine if SSRIs are the right treatment plan for your anxiety disorder. Take our short online mental health assessment to talk to an anxiety specialist within 48 hours. 

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 – $30 range.

Common Side Effects

Some people do not 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 do not go away. 

If these side effects interfere with your life in a harmful way—causing stress, depression, or other negative feelings—then SSRIs might not be the best treatment option for that person.

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

SSRIs can interact with other medications. Before taking SSRIs, you must disclose other medications, vitamins, and supplements to your medical provider. 

SSRIs can increase the risk of bleeding. Patients who take blood thinners (Warfarin, Coumadin, Jantoven, etc.) or regularly take NSAIDs (ibuprofen, naproxen, aspirin, etc.) need to be aware of this increased risk when taking SSRIs.

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 two different drugs that affect serotonin, this rare—but potentially fatal—condition can develop.

It’s crucial to monitor for symptoms of serotonin syndrome within the first few hours of taking a new medication or increasing the dose.

  • 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 

People starting SSRIs need to not have taken MAOIs for two weeks leading up to the first SSRI dose. MAOIs are antidepressants that also elevate levels of serotonin in the brain.

Common MAOIs include:

  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Emsam)
  • Tranylcypromine (Parnate)

Drug Warnings

SSRIs are prescribed only after disclosing a black box suicidality warning. In 2004, placebo-controlled trials revealed a small increase in suicidal ideation and behaviors in children and adolescents who took antidepressants. These findings have not been replicated in adult populations. 

People taking antidepressants need to be monitored and to self-monitor for increases in suicidal thoughts and behaviors when taking antidepressants. Caregivers, guardians, and parents of children prescribed antidepressants must monitor for sudden changes in behavior that indicate an increased risk of suicide:

  • 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 For Anxiety

Beta-blockers 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. 

Beta-blockers block your body from using the hormone epinephrine (adrenaline) and have a calming effect on your nervous system. Because of this particular effect, beta-blockers are prescribed as an off-label treatment to manage symptoms of several anxiety disorders, including

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

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 your symptoms. 

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 three 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.

  • Cardiovascular Symptoms 
  • Anxiety Disorder Symptoms
  • Migraines
  • Essential Tremors
  • Glaucoma

What Are the Most Commonly Prescribed Beta-Blockers?

Here are the most commonly prescribed beta-blockers:

  • Sectral
  • Zebeta
  • Coreg
  • Inderal
  • Tenormin 
  • Lopressor

Costs

Beta-blockers have been on the market for several decades—being 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. 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)
  • OTC and Prescription Allergy Medications
  • Clonidine (prescribed for high blood pressure and migraines)
  • Mefloquine (prescribed to prevent or treat malaria)
  • NSAIDs like aspirin, ibuprofen, naproxen

For a complete list of drug interactions, see this resource page.

Warnings for Use

Beta-blockers are not 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 Reynauld’s Syndrome should avoid taking beta-blockers, as this medication can make circulation problems worse by lowering blood pressure and heart rate.

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

Which Anxiety Medication Is Best For You?

Your particular medical profile will determine what anxiety medication is best for you. 

If you experience strong physical symptoms of anxiety, including racing heartbeat, sweating, elevated blood pressure, and muscle tension, even when nothing identifiable prompts those symptoms, beta-blockers can help alleviate those physical symptoms.

However, beta-blockers will not treat the underlying causes of your anxiety symptoms. To treat the underlying causes of anxiety, you’ll likely need a different treatment plan that may include an SSRI and psychotherapy. 

If You Suffer from Anxiety or Depression, Klarity Can Help

Klarity connects everyday people with fast, affordable, and convenient online mental health treatments. We’ve already helped 30,000+ Americans find online anxiety, depression, ADHD, and insomnia medication, and we’re ready to help you. 

Klarity is fast! No more waiting months to be seen at a brick-and-mortar mental health facility. When you take our brief online mental health assessment, you can schedule a virtual appointment in as little as 48 hours.

Klarity is affordable! You don’t need health insurance to afford Klarity’s telehealth services. Though we accept insurance, you’ll never need insurance to find online anxiety, depression, ADHD, and insomnia treatment. Plus, there are no subscription fees or hidden fees.

Klarity is convenient! Take Klarity with you wherever you go. You have 24/7 messaging access to your mental health provider, so we are always within reach. Plus, you can meet with us anywhere you have internet access or cellular data. Klarity puts the office in your pocket. 

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

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