Systematic reviews of beta blockers for anxiety disorders describe the evidence as lacking, sparse or insufficient. A 2016 systematic review and meta-analysis of propranolol concluded that the quality of evidence for efficacy is insufficient to support the routine use of propranolol in any of the anxiety disorders. The trials below tested other drugs, other conditions or other schedules, so each is described on its own terms.
What the reviews conclude
| Review | What its abstract says |
|---|---|
| 2008 systematic review of placebo-controlled randomized trials of drugs for social anxiety disorder | Evidence for the efficacy of beta-blockers in treating performance anxiety was lacking. |
| 2016 meta-analysis of propranolol for anxiety disorders | The quality of evidence for the efficacy of propranolol is insufficient to support its routine use in any of the anxiety disorders. |
| 2018 review in a Danish journal on exam-related anxiety | Propranolol is often prescribed to younger people with exam-related performance anxiety, but evidence for effect and safety is sparse for this non-approved indication. |
| 2025 meta-analysis of beta blockers for anxiety disorders | No evidence for a beneficial effect compared with placebo or benzodiazepines in patients with social phobia or panic disorder with or without agoraphobia (p-value for all meta-analyses ≥0.54). |
Their scopes differ. The 2008 review covered drug trials in social anxiety disorder, the 2018 review concerns exam-related anxiety, and the 2025 review covers anxiety disorders. The 2025 abstract also says many of the included studies had small sample sizes, missing data and high or unclear risk of bias. It concludes there is a lack of robust evidence of effectiveness and a need for a large randomized controlled trial to provide definitive evidence of whether beta blockers are an effective and safe treatment for anxiety.
Atenolol trials in social phobia
Two older trials tested atenolol, which is a different drug from propranolol. In a 1994 trial, seventy-two people with social phobia were randomly assigned to behavioral treatment (flooding), atenolol or placebo, with treatment over a 3-month period. The abstract says flooding was consistently superior to placebo, whereas atenolol was not.
A 1992 placebo-controlled comparison of phenelzine and atenolol in social phobia reported overall response rates of 64% for phenelzine, 30% for atenolol and 23% for placebo. It reported no significant differences between atenolol and placebo. The summaries used here do not state the atenolol doses.
PTSD trials and a public speaking pilot
These studies tested propranolol, but in other settings. A 2018 trial was a 6-week, double-blind, placebo-controlled, randomized clinical trial in 60 adults with long-standing PTSD. A 2021 trial was a double blind, placebo-controlled, randomised trial in 66 adults with longstanding PTSD. In both, propranolol or placebo was given 90 minutes before a brief memory reactivation session, once a week for 6 consecutive weeks, and the abstracts do not state the propranolol dose. The 2021 abstract concludes that the efficacy of propranolol was not greater than that of placebo 1 week post treatment. The summary used here does not report the 2018 trial's result.
A 2020 pilot study of propranolol for fear of public speaking, described as a reconsolidation-based treatment, had participants do a stress-inducing speech task and then receive 40 mg of propranolol (n = 40) or placebo (n = 20), double-blind. Its abstract reports clear reductions in self-reported speech distress and in questionnaire measures of public speaking anxiety following treatment, but says propranolol did not reliably outperform placebo, regardless of speech duration at treatment. The PubMed record's conflict of interest statement says a person it names is the co-founder of Kindt Clinics, a private clinic that provides reconsolidation-based treatments.
What this does not tell you
These are summaries of abstracts. They are not averaged or ranked here, and they do not show whether propranolol does or does not work for performance anxiety in any one person. The reviews describe the evidence they found as lacking, sparse or insufficient, and the 2025 review asks for a large trial on whether beta blockers are effective and safe for anxiety. The atenolol trials say nothing direct about propranolol. The PTSD trials enrolled adults with PTSD and used a weekly schedule with a memory reactivation session, so they describe a different use. A licensed provider decides whether propranolol is appropriate for a person.