Propranolol Is All the Rage for Anxiety – But Not Risk-Free

But first, Huntington’s disease, the rapidly progressing genetic disorder resembling a combo of dementia, Parkinson’s, and motor neuron disease, has been successfully treated for the first time. Doctors say a new gene therapy, administered via brain surgery, was shown to slow progression in recipients by a remarkable 75%. Jack May-Davis, who has the gene that causes the disease, says discovery of the breakthrough has left him overwhelmed – in a good way. At 30 years old, he told the BBC he hadn’t been expecting to live much longer, having watched his father’s rapid decline and death at age 54. But now, he says, the future “seems a little bit brighter; it does allow me to think my life could be that much longer.” 

Popping propranolol for anxiety isn’t a big deal in today’s pop culture – but maybe it should be

As someone who has close loved ones living with chronic heart disease, I’d long assumed beta blockers were restricted to the treatment of cardiovascular conditions. So imagine my shock when Robert Downey, Jr. joked about how having taken one would make his moment in the spotlight at last year’s Golden Globes “a breeze.” Sara Ashley O’Brien references the moment in her recent write up for the Wall Street Journal, which describes the frequency – and ease – with which propranolol is prescribed these days, not for heart disease, but for anxiety. 

Most beta blockers target specific parts of the body, but propranolol “affects beta receptors in the heart and everywhere else in the body, including the brain,” says academic psychiatrist Nassir Ghaemi, which is why it can quell anxiety. It’s clear why propranolol is so attractive: Compared to benzodiazepines, like Xanax or Valium, propranolol is considered mild and nonaddictive, especially in low doses. But it’s not without risk, Ghaemi adds. Propranolol works to reduce blood pressure and heart rate, and reducing it too much could cause an emergency. 

While off-label prescriptions of propranolol for anxiety aren’t necessarily cause for alarm, increasingly cavalier approaches to prescription and use might be, experts told the Journal.. Research and evidence on the drug’s effectiveness in treating chronic anxiety is limited, and there’s some concern over whether people understand when and how to use it properly – and which drugs it could have dangerous interactions with, potentially leading to accidental overdose or death. 

In 2021, musician and model Delilah Belle Hamlin was hospitalized with an accidental overdose after taking the drug with Benadryl, and also admitted to taking propranolol multiple times per day and being dependent on Xanax. Two years ago, a 17-year-old girl died from a propranolol overdose in England, where the medication is approved for anxiety. Also in her system were a prescribed amount of an antidepressant and a pain-relieving medication.

Nonetheless, influencers have popularized taking the drug for everything from a first date to a walk down the aisle. And, once you want one, it is “so easy to get a prescription,” Alta Bloom told the WSJ. The 25-year-old Googled how to get one after seeing an ad on social media. It only took filling out a questionnaire and sharing her blood pressure to get one from telehealth company Hers. “You could kind of fudge that, if you wanted to, which was a little bit scary,” Bloom says. “There was really no verification to prove that was your blood pressure.”

It’s why Ghaemi bristles at prescribing propranolol through telehealth. “If you’re not physically in the room to touch the patient and check the pulse, there’s no way you can really know (if it’s right).” Besides, he added, the drug is hazardous for people with asthma or diabetes because it can mask early signs of acute trouble in those conditions. But it does seem to be helping people who struggle with anxiety, some of whom might otherwise be unable to get other help. The trouble is, there’s not enough evidence to support the use of beta blockers for disrupting long-held anxiety patterns, says Charlotte Archer, a UK-based researcher who studies anxiety disorders and the medications that treat them. 

The bottom line: People who want to try propranolol for anxiety should discuss it with their doctor – preferably in person. It’s important to check up on pre-existing conditions, drug interactions and warning signs of an overdose or adverse reactions to the beta blocker. It’s great to be able to quell anxiety, and it’s good that stars are more open about experiencing it, but it’s important not to take risks with one’s safety. 

Limerence: when an unrequited crush becomes an unhealthy obsession

Limerence, a term coined by psychologist Dorothy Tennov in the 1970s, describes the all-consuming state of romantic obsession many of us experience from time to time, characterized by intense emotional highs and lows. To this layperson, it’s a fancy word for “super supreme crushing.” 

“Limerence is a state that many of us go into in the early stages of love: a profound romantic infatuation with another person,” neuroscientist Tom Bellamy told NPR’s Life Kit. “They give you an extraordinary natural high, so you feel a powerful desire to bond with that person.” But unlike a crush that, nurtured by both parties, organically blossoms, (or, unrequited, sputters out like the flame on my old oven broiler), one-sided limerence that goes on too long “can shift from happiness and euphoria into anxiety and craving,” Bellamy says, and might need a little help to fade away.

He knows the experience personally. Ten years ago, Bellamy developed limerence for a colleague, despite being happily married. “When that happened, I obviously had a bit of a problem to solve,” he says. “So that was when I started investigating it. Because of my background as a neuroscientist, my first thought was, what’s going on in the brain? How can I make sense of this experience?” His anonymous musings grew into an online community where people shared their experiences. The group became a massive repository of data, helping him learn that limerence often manifests as intrusive thoughts, heartache during uncertainty, and a tendency to idealize the other person.

According to Bellamy, limerence is not always harmful. In fact, it can lead to a wonderful experience of love, if feelings are mutual, and the pair is capable of forming a healthy bond. But when the object of limerence is unavailable, incompatible or unreliable, the brain’s reward wires get all crossed in tangles of uncertainty and mixed signals, creating an addictive cycle of craving and anxiety. That’s sometimes why people become fixated on those who give them inconsistent attention. Whatever little interactions they do get reignite the intoxication that accompanies limerence – but that obsession is, ultimately, destabilizing.

Breaking free from limerence is definitely possible, but takes considerable effort. You have to work to disrupt the patterns. “The mindset shift is to realize: ‘This is happening in my head. So that’s where I need to fix it,’” Bellamy says. On the practical side, try to keep them out of your life, and try not to indulge in fantasy thinking. Replacing the urge to focus on them with new goals can help you recognize limerence as a mental process rather than an inevitable fate, returning agency into your hands – and placing you back on track toward less obsessive, more fulfilling, mutual relationships. (You can read more about limerence in Bellamy’s book, Smitten, which was published in 2024 by St. Martin’s Press.)

In other news…

We might be overestimating AI therapy because too many human therapists have abandoned their professional responsibilities, therapist and author Jonathan Alpert argues in an op-ed in  the Los Angeles Times. “Instead of challenging illusions, telling hard truths and helping build resilience,” he writes, “modern therapy drifted into nods, empty reassurances and endless validation. Into the void stepped chatbots, automating bad therapy practices, sometimes with deadly consequences.” 

One such story is that of Sophie Rottenberg, who confessed the intention to end her life to ChatGPT, and was met with comfort – not intervention or warning. Her tragic death underscores how AI has honed the worst hallmarks of modern therapy, and now offers them with none of true therapy’s traditional safeguards.  This week, OpenAI thankfully took some limited steps to regulate the wildly popular tool. 

A caution: Alpert speaks largely from his own experience as a therapist; he reports good results changing patients’ outlooks and helping them solve problems in just a handful of sessions. (One of his books is called “Be Fearless: Change Your Life in 28 Days.”) For patients interested in the ‘why’ behind their actions, which traditional psychotherapy would examine, Albert’s approach might also prove unsatisfactory. But AI chatbots seem to model the worst in both approaches – a quick-fix mentality as well as incurious validation.

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Fostering mental wellness through community and faith: The Muslim American Society (MAS) Youth Center in Bensonhurst, Brooklyn is destigmatizing mental health by making it an integral part of its programming. The organization’s Social Services Department, launched in 2020, has rapidly evolved from facilitating education and referrals into a wellness hub offering community grief circles, Mental Health Mondays, and regular pop-up resource tables.  The goal is to meet young people where they are and connect faith with personal care. The center meets a critical need facing New York and the United States, as factors including discrimination, stigma, and poor access to care exacerbate Muslims’ risk for mental distress. 

“When we talk about breaking the stigma, that looks like creating a community. People need to be able to connect, to hug each other, make plans with each other, celebrate each other,” Ayah Issa, a licensed clinical social worker and trauma therapist told HealthBeat New York. “Those are the things that are incredibly important in helping manage and navigate mental health gaps.”