If you can’t take benzodiazepines to treat anxiety because their side effects prevent you from functioning effectively at your job or in your day-to-day activities, you’ll likely have explored other anxiety treatment options.
Tricyclics and beta blockers are two classes of medications clinicians can prescribe to treat anxiety when SSRIs and benzodiazepines (also known as muscle relaxants) like Xanax, Klonopin, Valium, and Ativan, are not viable options for treating anxiety.
Not only are tricyclics and beta blockers quite different from muscle relaxants, but they are different from one another, too. In this article, we explore tricyclics and beta blockers to help you decide which of the anti-anxiety medications is best for your body chemistry, medical history, and individual needs.
- What tricyclics and beta blockers are
- How each medication works for managing anxiety
- Essential information regarding drug warnings, interactions, and potential side effects
- How to determine which anti-anxiety medication is best for you.
Klarity connects people with mental health professionals who can diagnose and prescribe tricyclics and beta blockers for anxiety. However, we’re unlike your traditional, in-person psychiatric health care service—you don’t have to wait weeks to get seen by a mental health professional.
Book an appointment on Klarity, and you’ll be able to meet with a mental healthcare provider in 48 hours or less.
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
|Drug Class||Tricyclic antidepressants (TCAs)||Beta Blockers|
|Brand/Generic Status||Brand-names and generics available|
Most common TCAs:
• Tofranil (imipramine hydrochloride)
• Pamelor (nortriptyline)
• Asendin (amoxapine)
• Elavil (amitriptyline)
• Surmontil (trimipramine)
• Vivactil (protriptyline)
• Silenor (doxepin)
• Zonalong or Prudoxin (doxepin)
• Norpramin (desipramine)
|Brand names and generics available
Most common beta blockers:
• Sectral (acebutolol)
• Zebeta (bisoprolol)
• Coreg (carvedilol)
• Inderal (propranolol)
• Tenormin (atenolol)
• Lopressor (metoprolol)
|Form(s) of the Drug||Common forms of TCAs include: |
• Flavored liquid suspensions
|Common forms of beta blockers include:
|Standard Dosage||Varies, depending on TCA and condition being treated||Varies, depending on type of beta blocker and condition being treated|
|Conditions Treated||Conditions most often treated: |
• Migraine headaches
Other conditions treated:
• Obsessive-compulsive disorder (OCD)
• Anxiety disorders
• Chronic pain
• Neuropathic pain
• Nerve pain
• Itching and eczema
Different TCAs are FDA-approved for different uses
Many TCAs are prescribed off-label to treat certain conditions
|Conditions most often treated:
• Irregular heart rhythm (arrhythmia)
• Heart failure
• Chest pain (angina)
• High blood pressure
Other conditions treated:
• Generalized anxiety disorder (GAD)
• Panic disorder (PD)
• Post-traumatic stress disorder (PTSD)
|Cost||Average cost of a 30-day supply: |
• $20 for a 30-day supply of:
• $120 or more for most other tricyclics*
*Most TCAs are covered under insurance
|Average cost of a 30-day supply:
• $6 to $32 for generic formulas*
• $111 to $$468 for brand-name formulas**
*Some beta blockers don’t have a generic formula available for Rx.
**Cost of brand-name beta blockers may be offset by coupons and insurance
|Side-Effects||Common side effects: |
• Dry mouth
• Blurred vision
• Orthostatic hypotension
• Urine retention
• Increased sweating
• Increased or decreased appetite
• Sexual dysfunction
|Common side effects:
• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Arrhythmias (irregular heart rhythms)
• Dry mouth
• Dry eyes
|Warnings For Use||• Combination with other medications may cause serotonin syndrome|
• Symptoms of serotonin syndrome include:
• Anxiety or agitation
• Fever, sweating
• Lack of coordination
• Blood pressure and heart rate changes
• May cause seizures or falls in those prone to them
• Do not mix with alcohol
• Rarely, TCAs cause suicidal thoughts or behaviors
• Contact your doctor immediately if this occurs
|Adverse drug interactions:
• OTC and Rx allergy medications
What Are Tricyclics?
Tricyclic antidepressants are one of the first antidepressants to see widespread use in the US. The first patents came from the 1950s, meaning this powerful medication class has a long and studied clinical history.
Though initially designed to treat mood disorders like depression, certain tricyclics have also been shown to effectively treat anxiety disorders and certain neurological conditions.
Tricyclics are usually not the first line of defense against depression and anxiety symptoms because they generally tend to cause more side effects than newer antidepressants.
However, they are often prescribed when newer medications fail to treat underlying symptoms or pose a greater risk to the patient. In the case of anxiety treatments, tricyclics might be a safer choice than benzodiazepines for a person who must operate heavy machinery for work, for example.
How Do Tricyclics Work?
Tricyclics are named after their unique molecular structures, which contain three interconnected rings of atoms. These molecules directly affect specific receptors in the brain, which block the “reuptake” of certain chemical messengers—called neurotransmitters.
Low levels of serotonin and norepinephrine are associated with certain moods, anxiety, personality, and neurological disorders. By preventing the circulating supply of these chemical messengers from being reabsorbed back into the neurons, more are available for use in the brain’s synapses.
These drugs effectively boost serotonin and norepinephrine so your brain can work as intended.
Primarily, tricyclics block the reuptake of serotonin and norepinephrine. However, being an older form of antidepressant, they are less targeted and therefore affect other chemical systems in the brain. This is why tricyclics often have more side effects than newer medications.
What Do Tricyclics Treat?
Having a long history of use in psychiatry, these medications are widely used to treat other conditions beyond depression.
Here is a list of conditions that tricyclic antidepressants treat:
Tricyclics are prescribed to treat major depressive disorder (MDD) and dysthymia, which is mild depression that lasts a long time—usually a period of years. Additionally, some tricyclics are used to treat bipolar disorder.
Tricyclics are often prescribed to treat certain anxiety disorders like generalized anxiety disorder (GAD), panic disorder (PD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). Additionally, clinicians prescribe tricyclics to help treat body-dysmorphic disorder and associated conditions like bulimia and anorexia nervosa.
Clinicians sometimes prescribe tricyclics to treat neurological conditions such as ADHD, fibromyalgia, Parkinson’s disease, migraine, neuropathic pain, and chronic pain.
What Are the Most Commonly Prescribed Tricyclics?
Tricyclics have been on the market for a while. Though they are not the first-line treatment for anxiety, a medical provider may determine that tricyclics are an appropriate choice. In this case, there are some that medical providers turn to first.
Many types of tricyclics are available, so the price can vary depending on name-brand or generic options. However, because these medications have been around for so long, they tend to be less expensive than other treatment options.
Most tricyclics range between $6 and $20 for a 30-day supply, but this price depends on the specific tricyclic medication and whether or not it is generic or name-brand.
Common Side Effects
Tricyclics come with many side effects. This is because they are less targeted. In other words, they affect more brain systems than newer, more targeted medications do.
The most common side effects include:
- Weight gain
- Blurred vision
- Increased appetite
- Muscle twitches
- Nausea and vomiting
- Rapid or irregular heart rate
- Sexual dysfunction
The intensity of side effects can often be reduced by starting out on a lower dose of medication and gradually increasing the strength up to the desired amount. Also, many less-invasive side effects tend to go away with continued use as your body adjusts to the medication.
Certain side effects of tricyclics can be made worse when taken in combination with other medications and drugs. Talk to your medical provider and let them know the full extent of medicines you already take or if you recreationally use substances like alcohol.
You should also inform them of any herbal substances or supplements you take, as these can also affect how tricyclics work in your body.
Do not use tricyclics if you are already on MAO inhibitors like Isocarboxazid (Marplan),
Phenelzine (Nardil), Selegiline (Emsam), or Tranylcypromine (Parnate).
Do not use tricyclics if you are on medication for high blood pressure or urinary incontinence or if you need to use epinephrine to treat severe allergic reactions.
Warnings for Use
There are several warnings that everyone taking antidepressants of any kind needs to know about. Most prominently are black box warnings and serotonin syndrome warnings.
Black Box Warning
In short-term studies, the use of antidepressants in children and adolescents was associated with an increase in suicidal thoughts and ideation when compared to a placebo. This increase in suicidal thoughts and ideation hasn’t been clinically established in adult populations.
Children and adolescents taking antidepressants need to not only self-monitor but be proactively monitored by adults for sudden changes in behavior, social withdrawal, mood swings, and depressive symptoms.
When first taking a new medication that increases serotonin levels in the brain, patients need to monitor for symptoms of serotonin syndrome, which is a rare but potentially fatal condition.
Symptoms usually occur within a few hours of taking a medication that elevates serotonin levels. These symptoms include:
- Muscle stiffness and rigidity
- Irritability, agitation, or restlessness
- Trouble Sleeping
- Rapid heart rate
- Dilated pupils
- Twitching muscles and loss of muscle control
- High blood pressure
What Are Beta Blockers?
Beta-blockers, which are also called beta-adrenergic blocking agents, are a class of drugs that reduces the amount of stress placed on the circulatory system. Some beta-blockers only affect the heart, while others may affect the heart and blood vessels.
These drugs are primarily used to manage heart conditions like hypertension, arrhythmias, and angina. However, because of their effect on the autonomous nervous system, beta-blockers are also used for other medical applications, like treating anxiety.
Beta-blockers were first developed in the 1960s as a treatment for angina. In the 60 years since their introduction, they’ve now been approved to treat various conditions related to adrenaline production, heart disease, and autonomous nervous system disorders.
How Do Beta Blockers Work?
Beta-blockers prevent the adrenaline from activating beta receptors throughout your body. In essence, they “block” the receptors by occupying the channel that would otherwise allow the neurotransmitter adrenaline to elevate blood pressure and induce the fight-or-flight response.
Beta-blockers reduce the strain and stress on the cardiovascular and circulatory systems by preventing adrenaline from making your heart work harder and dilating your blood vessels. Adrenaline and other stress hormones prepare the body to respond to danger and take immediate action.
However, for people with hypertension, angina, arrhythmia, congestive heart failure, or people with panic disorder and other anxiety disorders, the fight or flight response is a detriment to their health and well-being.
Therefore, beta-blockers are an effective treatment for these conditions because they prevent agitated states.
The Three Types of Beta receptors
There are three types of beta receptors that regulate slightly different functions.
- B1 Receptors: Found in the heart and kidneys. They regulate heart rate and pumping force.
- B2 Receptors: Found in smooth muscle tissue all over the body. They increase heart rate and pumping force but also cause certain smooth muscle tissues to relax, such as respiratory and circulatory muscles.
- B3 Receptors: Found in fat cells and the bladder. They trigger the breakdown of fat and relax the bladder.
Most beta blockers only affect B1 beta receptors found mostly in the heart. Because of this, they are called cardioselective beta blockers. B2 beta receptors are called non-selective beta blockers because they affect beta receptors all over the body.
What Do Beta Blockers Treat?
Beta-blockers mute the body’s fight-or-flight response, reducing both the physical reactions associated with anxiety and the additional strain on the circulatory system. Because of these effects, beta-blockers are used to treat several circulatory system disorders, anxiety disorders, and other conditions caused by too much adrenaline.
Here is a list of the conditions and symptoms that beta-blockers treat:
The primary use of beta-blockers is to manage cardiovascular health and reduce the strain and stress placed on the heart and blood vessels.
Specifically, beta-blockers treat the following heart conditions.
- Hypertension (high blood pressure)
- Congestive heart failure
- Myocardial infarction (heart attack)
- Tachycardia (rapid heartbeat)
- Arrhythmia (irregular heartbeat)
- Coronary heart disease
By blocking adrenaline and other hormones, beta-blockers reduce how much force the heart generates, reducing its overall stress. Additionally, beta-blockers that target blood vessels help improve blood flow and help reduce the pressure in the circulatory system.
Anxiety Disorder Symptoms
Because beta-blockers work reduce the intensity of the flight-or-fight response, they help manage the physical symptoms of anxiety. They reduce the severity of physical panic—reducing heart rate, sweating, etc.
Therefore, they are a helpful tool for helping people who have panic disorder (PD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD) manage the certain symptoms of their conditions.
Note that beta blockers do not treat the underlying causes of anxiety but help manage its physical symptoms.
Beta-blockers that relax blood vessels can help treat migraines and tension headaches caused by constricted blood vessels in the head muscles.
Beta-blockers can reduce the intensity of tremors. Though the exact mechanism is not fully understood, doctors theorize that the drugs block nerve impulses to the affected muscles.
Glaucoma is an eye condition affecting older adults that leads to partial or full blindness. It is caused by a build-up of fluid pressure in the eye and can be treated with eye drops that contain beta blockers. Certain beta-blockers reduce the production of eye fluid that causes the disease.
What Are the Most Commonly Prescribed Beta Blockers?
There are a wide variety of beta-blockers available on the market. It’s important to distinguish between B1 and B2 beta blockers, as B2 beta blockers will affect more than just the heart and kidneys.
B1 Beta Blockers (Cardioselective)
B2 Beta Blockers (Nonselective)
Many beta-blockers are inexpensive, as they’ve been around since the 1960s and have generic options available. Though prices vary from beta-blocker to beta-blocker, patients can expect to pay between $6 and $20 for a 30-day supply of most generic beta-blockers.
Common Side Effects
Though primarily used to treat heart conditions, beta-blockers affect beta receptors all over the body and can cause several side effects.
- Slow heartbeat (bradycardia)
- Low blood pressure
- Abdominal discomfort
- Nausea and vomiting
- Weakness and dizziness
- Sleeping difficulties, insomnia
- Erectile dysfunction
- Edema (fluid retention)
- Cold feet and hands
- Memory loss
If you experience severe side effects, do not stop taking your beta-blockers as prescribed. Talk with your medical provider about how to safely stop taking your medication. Abruptly stopping beta-blockers can cause the initial symptoms you were trying to treat to come back worse.
Warnings for Use
There are a few warnings that people considering beta-blockers as a treatment for anxiety or other conditions ought to know.
Beta-blockers can make the following conditions worse. People with the following conditions should seek medical alternatives:
- Certain types of asthma
- Raynaud’s disease and other arterial diseases
- Slow heart rate
- Uncontrolled heart failure
Beta-blockers reduce a person’s heart rate and can mask specific symptoms of low blood sugar. People with hypoglycemia and diabetes should monitor more frequently for low blood sugar because beta-blockers will prevent increased heart rate, which is one of the tell-tale signs of low blood sugar.
Some beta-blockers are safe to use while pregnant, while others are not. Consult with your healthcare provider if you are pregnant and considering beta-blockers or are already on beta-blockers and considering becoming pregnant.
Which Anxiety Medication Is Best For You?
Tricyclics and Beta-blockers both help manage anxiety symptoms, but each drug class works from a different angle to relieve those anxiety symptoms. If you cannot take SSRIs and benzodiazepines, which are the first line of treatment for anxiety. Then you need to consider other treatment options.
Tricyclics help elevate serotonin and norepinephrine levels in the brain, which help stabilize mood and can reduce anxiety. Therefore, tricyclics can address anxiety directly by addressing chemical imbalances in the brain.
Beta-blockers do not treat anxiety directly by addressing chemical imbalances. Instead, beta-blockers reduce the physical symptoms of anxiety by muting the body’s stress response. Physical symptoms associated with anxiety—heavy sweating, increased heart rate, heart palpitations, etc., are all reduced while on beta-blockers.
If you are trying to decide which anxiety medication is right for you, you must first consider the root cause of your anxiety and then determine which symptoms are most negatively affecting your day-to-day life.
Beta-blockers can help people who have strong physiological reactions to anxiety, but they won’t treat the underlying causes of anxiety, which are often attributed to other factors that traditional antidepressants, like SSRIs, SNRIs, and tricyclics, are proven to treat.
If you need help determining which of the anxiety medications is best for you, then Klarity can help.
If You Suffer from Anxiety, Klarity Can Help Fast
Can’t take benzodiazepines or SSRIs for your anxiety but don’t want to wait weeks for in-person treatment?
Book an appointment on Klarity, and you’ll be able to connect with licensed medical providers who can diagnose and prescribe tricyclics and beta-blockers for anxiety in 48 hours or less.
Our telemedicine service is fast, convenient, and affordable.
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Kate Bettino. “What to Know About Beta-Blockers for Anxiety.” PsychCentral. https://psychcentral.com/anxiety/beta-blockers-for-anxiety
Laura Wheatman Hill. “Can Beta Blockers Help With Anxiety?” The Checkup. SingleCare. https://www.singlecare.com/blog/beta-blockers-for-anxiety/
Lo Styx. “Beta Blockers Are the Buzziest New Anti-Anxiety Medications.” Very Well Mind. https://www.verywellmind.com/beta-blockers-are-the-buzzy-new-anti-anxiety-medicine-heres-what-you-need-to-know-5271756
Marcia Purse. “Overview of Tricyclic Antidepressants.” Very Well Mind. https://www.verywellmind.com/tricyclic-antidepressants-379652
Mayo Clinic Staff. “Tricyclic antidepressants and tetracyclic antidepressants.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983