Anxiety disorders are common mental health conditions characterised by persistent and intense feelings of unease that are disproportionate to the situation (Craske et al., 2011). Generalised Anxiety Disorder (GAD) is the most common type of anxiety disorder, occurring in approximately 4-8% of people in UK primary care (NICE, 2024).
UK clinical guidelines for managing anxiety disorders recommend General Practitioners (GPs) refer people to counselling, typically cognitive behavioural therapy (CBT), and/or prescribe antidepressants like Fluoxetine or Sertraline (NICE, 2024). Given the long waiting lists for NHS Talking Therapies, and reports that only 50% of people with anxiety respond to antidepressants (Huh et al., 2011), GPs may look for alternatives to help people manage their symptoms.
One such alternative is the beta-blocker Propranolol, which is usually used to treat high blood pressure. This medication is believed to work by blocking the action of adrenaline and noradrenaline hormones, which can be responsible for the physical symptoms of anxiety like an increased heart rate, sweating, and shakiness (Archer et al., 2024a). The prescribing of beta-blockers for anxiety in adults has increased in the UK from 2.3/1000 to 4.1/1000 person-years-at-risk between 2003 and 2018 (Archer et al., 2022).
Despite this increase, beta-blockers are not mentioned in UK clinical guidelines (NICE, 2024). This could be due to the lack of high-quality evidence to support its routine use in this context (Steenen et al., 2025). As there is a discrepancy between increased prescribing of propranolol and an uncertain evidence base, understanding GPs rationale for prescribing is important.
This qualitative interview study by Archer et al. (2024b) aimed to “understand when and why GPs prescribe beta-blockers for people with anxiety.”
Despite a rise in prescribing for anxiety disorders, beta-blockers are not recommended in UK clinical guidelines, highlighting a key discrepancy in current practice.
Methods
GPs were purposively sampled from research-active practices across Southwest England to participate in a one-to-one semi-structured telephone or video interview. These interviews were conducted by an experienced qualitative and health services researcher, with questions focusing on GPs’ reasons for prescribing beta-blockers for anxiety, associated risk factors, and their knowledge of relevant guidelines. Questions were reviewed by two people with lived experience of an anxiety disorder prior to data collection.
After the interview recordings were transcribed verbatim, the data was analysed using reflexive thematic analysis (Braun et al., 2023). Throughout analysis, codes and researcher interpretations were regularly discussed and refined through team meetings that included a healthcare professional and people with lived experience of an anxiety disorder.
Results
Seventeen GPs from 10 practices were interviewed, who were predominantly female (n = 11), White (n = 14) and had a mean age of 47 years. GPs had been working in primary care between six months and 30 years, and nine were salaried. Based on the Index of Multiple Deprivation, five worked in practices in the most relatively deprived areas (deciles 1–3), four in moderately deprived areas (deciles 4–7), and eight in the least deprived areas (deciles 8–10).
Three themes were developed during analysis: (1) pragmatic prescribing, (2) safety-driven prescribing, and (3) patient-driven prescribing.
Theme 1: Pragmatic prescribing
A third of GPs were aware that guidelines do not recommend beta-blockers for anxiety. Some imagined this was due to low evidence or because the medication only addresses physical symptoms. Despite this, most GPs considered beta-blockers a pragmatic “tool in the toolbox” (GP11) for the physical symptoms of anxiety like heart palpitations and rapid breathing. Some also used viewed beta-blockers as a pragmatic tool for people on long waiting lists for counselling.
If their anxiety is quite mild … they are waiting for CBT [cognitive behavioural therapy] and particularly if those physical symptoms are particularly bad, I will say, ‘well this may help you cope with your anxiety attacks’ … that’s probably when I would go with them first-line.
Theme 2: Safety-driven prescribing
Most GPs prescribed beta-blockers for anxiety due to perceptions of the medication as low risk, particularly for young adults. They were often seen as a safer alternative to benzodiazepines and, in some cases, antidepressants, which can initially increase suicidal ideation. GPs were only cautious about prescribing beta-blockers in specific cases, such as for people with asthma, low blood pressure, or those who were pregnant. Due to this perception of beta-blockers being low risk, most GPs were comfortable with people using them long term. However, there were mixed views on the actual effectiveness of beta-blockers for anxiety, with GPs often leaving the decision to continue the medication up to the person.
[There can be] Early suicide risk on antidepressants … increasing impulsivity around self-harm, so I guess there is a bigger commitment as a GP to start someone on antidepressants, whereas a beta-blocker feels less risky.
Theme 3: Patient-driven prescribing
A final reason GPs prescribed beta-blockers for anxiety was when people said they wanted immediate symptom relief and they were on long waiting lists for counselling. GPs said that people preferred beta-blockers because they can help with the physical symptoms of anxiety quickly compared to antidepressants that can take weeks to work. Many people also wanted to avoid antidepressants due to a perception that they dulled emotions or because of the stigma associated with them. GPs found that people often saw beta-blockers as a more agreeable option for managing their anxiety and that some people were not in the headspace to sign up to counselling.
There is still this massive thing about taking an antidepressant is a sign of failure … whereas if you say … “this is propranolol and it physically stops your heart from racing, therefore may abate your panic attack” … that is far more understandable.
GPs reported pragmatic, safety-driven, and patient-driven reasons for prescribing beta-blockers for anxiety, like immediate symptom relief and avoiding the stigma associated with antidepressants.
Conclusions
This qualitative study highlights a gap between clinical guidelines for the use of beta-blockers for anxiety and GP prescribing practices. GPs explained using beta-blockers to provide immediate symptom relief while people are waiting for counselling, due to their perceived low risk profile in comparison to some other medications, and to accommodate some patient preferences to avoid antidepressants. As such, the researchers highlight the clear need to further investigate beta-blockers safety and effectiveness as a treatment for anxiety disorders.
GPs’ perceived benefits of beta-blockers for anxiety underscore a need for further research and updated clinical guidance to align practice with evidence.
Strengths and limitations
The use of interviews was a strength, as it provided more in-depth detail on why GPs prescribe beta-blockers for anxiety than possible with a survey. The involvement of people with lived experience of anxiety was a strength, as their input grounded the interview questions and analysis in what was most important to them. Another strength was the diverse sample of GPs, who varied by gender, age, role, and their practice’s Index of Multiple Deprivation decile. This diversity may have helped to capture a broader variation of experiences and perspectives than a convenience-only sample would have.
However, ethnic diversity was limited, with most GPs being White. Studies have found that taking medications for mental health is more stigmatising for Black people than for White people (Hunt et al., 2013). However, it is not yet understood if Black GPs’ prescribing of beta-blockers might be influenced by their own stigmatisation of the medication, or by a protective intention to mitigate people’s exposure to such stigma. A similar limitation is that GPs were recruited from Southwest England for convenience. Findings, therefore, may not be transferable to GPs in other regions of England or the wider UK. Maximum variation of GPs’ sociodemographics should be considered in future studies.
The findings may be susceptible to recall bias, where GPs misremember the details of their consultations or decision-making. There is also the possibility of social desirability bias. This is when participants share views they perceive to be more socially acceptable or what they believe the researcher wants to hear. However, because a researcher without clinical training conducted the interviews, GPs may have perceived there to be less judgment of their decision-making than if they were interviewed by a fellow healthcare professional.
Despite recommendations from the Consolidated Criteria for Reporting Qualitative Research (Booth et al., 2014), these observations about the power dynamics between the researcher and GP were not discussed. Such reporting can add to reflexivity on how the researcher’s positionality might have influenced data collection and analysis (Gill and Johns, 2019). However, this omission is a recognised challenge in qualitative health research because of the restrictive word limits (typically ~4,000 words) of many medical journals. These constraints can unfortunately limit the space available for in-depth description of the methods and findings, and the number of quotes reported.
While there was some diversity among the recruited GPs, recruitment was confined to Southwest England and there was limited ethnic diversity.
Implications for practice
Despite inconclusive evidence on the safety of prescribing beta-blockers for anxiety, the GPs interviewed in this study perceived them as ‘low risk,’ particularly for young adults, and viewed them as a safer alternative to benzodiazepines and antidepressants when the person presents with suicide ideation. Given this discrepancy between the evidence on safety and GPs’ views, I agree with the researchers’ point that:
There is a clear need for a definitive trial to assess the safety and effectiveness of beta-blockers in treating anxiety. Given the wide range of doses, durations of prescribing, and relevant anxiety presentations, more than one trial may be required.
Until such evidence is available, I recommend that GPs consider the uncertainty of the evidence and exercise caution when prescribing beta-blockers for anxiety. If prescribed, GPs may want to have a plan for ongoing review and consider appropriate time points for dose reduction or discontinuation. GPs may also find it helpful to explain to people the uncertainty of evidence for beta-blockers for anxiety and alternative medications like antidepressants that have more evidence for effectiveness and clearer side effect profiles. For example, one recent systematic review found that antidepressants were more effective than placebo in reducing anxiety (Kopcalic, 2025).
Until definitive evidence is available, GPs should exercise caution when prescribing beta-blockers for anxiety and have conversations with patients about their uncertainty of evidence for their effectiveness and alternative treatments.
Statements of interests
None.
Links
Primary paper
Archer, C., Kessler, D., Wiles, N., Chew-Graham, C. A., & Turner, K. (2024b). GPs’ views of prescribing beta-blockers for people with anxiety disorders: a qualitative study. British Journal of General Practice, 74(748).
Other references
Archer, C., MacNeill, S. J., Mars, B., Turner, K., Kessler, D., & Wiles, N. (2022). Rise in prescribing for anxiety in UK primary care between 2003 and 2018: a population-based cohort study using Clinical Practice Research Datalink. British Journal of General Practice, 72(720), e511-e518.
Archer, C., Wiles, N., Kessler, D., Turner, K., & Caldwell, D. M. (2024a). Beta-blockers for the treatment of anxiety disorders: a systematic review and meta-analysis. Journal of Affective Disorders.
Booth, A., Hannes, K., Harden, A., Noyes, J., Harris, J., & Tong, A. (2014). COREQ (consolidated criteria for reporting qualitative studies). Guidelines for reporting health research: a user’s manual, 214-226.
Braun, V., Clarke, V., Hayfield, N., Davey, L., & Jenkinson, E. (2023). Doing reflexive thematic analysis. In Supporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research (pp. 19-38). Springer International Publishing.
Craske, M. G., Rauch, S. L., Ursano, R., Prenoveau, J., Pine, D. S., & Zinbarg, R. E. (2011). What is an anxiety disorder?. Focus, 9(3), 369-388.
Huh, J., Goebert, D., Takeshita, J., Lu, B. Y., & Kang, M. (2011). Treatment of generalized anxiety disorder: a comprehensive review of the literature for psychopharmacologic alternatives to newer antidepressants and benzodiazepines. The Primary Care Companion for CNS Disorders, 13(2), 26955.
Hunt, J., Sullivan, G., Chavira, D. A., Stein, M. B., Craske, M. G., Golinelli, D., … & Sherbourne, C. D. (2013). Race and beliefs about mental health treatment among anxious primary care patients. The Journal of Nervous and Mental Disease, 201(3), 188-195. 10.1097/NMD.0b013e3182845ad8
Kopcalic, K., Arcaro, J., Pinto, A., Ali, S., Barbui, C., Curatoli, C., Guaiana, G. (2025). Antidepressants versus placebo for generalised anxiety disorder (GAD). Cochrane Database of Systematic Reviews, (1).
National Institute for Health and Care Excellence. (2024). Generalized anxiety disorder (GAD): Background information – Prevalence. CKS NICE.
