Anxiousness issues are widespread psychological well being situations characterised by persistent and intense emotions of unease which are disproportionate to the scenario (Craske et al., 2011). Generalised Anxiousness Dysfunction (GAD) is the most typical sort of hysteria dysfunction, occurring in roughly 4-8% of individuals in UK major care (NICE, 2024).
UK medical pointers for managing anxiousness issues suggest Basic Practitioners (GPs) refer folks to counselling, usually cognitive behavioural remedy (CBT), and/or prescribe antidepressants like Fluoxetine or Sertraline (NICE, 2024). Given the lengthy ready lists for NHS Speaking Therapies, and experiences that solely 50% of individuals with anxiousness reply to antidepressants (Huh et al., 2011), GPs could search for alternate options to assist folks handle their signs.
One such various is the beta-blocker Propranolol, which is normally used to deal with hypertension. This medicine is believed to work by blocking the motion of adrenaline and noradrenaline hormones, which will be liable for the bodily signs of hysteria like an elevated coronary heart fee, sweating, and shakiness (Archer et al., 2024a). The prescribing of beta-blockers for anxiousness in adults has elevated within the UK from 2.3/1000 to 4.1/1000 person-years-at-risk between 2003 and 2018 (Archer et al., 2022).
Regardless of this improve, beta-blockers should not talked about in UK medical pointers (NICE, 2024). This might be because of the lack of high-quality proof to assist its routine use on this context (Steenen et al., 2025). As there’s a discrepancy between elevated prescribing of propranolol and an unsure proof base, understanding GPs rationale for prescribing is vital.
This qualitative interview research by Archer et al. (2024b) aimed to “perceive when and why GPs prescribe beta-blockers for folks with anxiousness.”
Regardless of an increase in prescribing for anxiousness issues, beta-blockers should not really useful in UK medical pointers, highlighting a key discrepancy in present follow.
Strategies
GPs have been purposively sampled from research-active practices throughout Southwest England to take part in a one-to-one semi-structured phone or video interview. These interviews have been performed by an skilled qualitative and well being companies researcher, with questions specializing in GPs’ causes for prescribing beta-blockers for anxiousness, related threat elements, and their data of related pointers. Questions have been reviewed by two folks with lived expertise of an anxiousness dysfunction previous to knowledge assortment.
After the interview recordings have been transcribed verbatim, the information was analysed utilizing reflexive thematic evaluation (Braun et al., 2023). All through evaluation, codes and researcher interpretations have been frequently mentioned and refined via group conferences that included a healthcare skilled and folks with lived expertise of an anxiousness dysfunction.
Outcomes
Seventeen GPs from 10 practices have been interviewed, who have been predominantly feminine (n = 11), White (n = 14) and had a imply age of 47 years. GPs had been working in major care between six months and 30 years, and 9 have been salaried. Primarily based on the Index of A number of Deprivation, 5 labored in practices in probably the most comparatively disadvantaged areas (deciles 1–3), 4 in reasonably disadvantaged areas (deciles 4–7), and eight within the least disadvantaged areas (deciles 8–10).
Three themes have been developed throughout evaluation: (1) pragmatic prescribing, (2) safety-driven prescribing, and (3) patient-driven prescribing.
Theme 1: Pragmatic prescribing
A 3rd of GPs have been conscious that pointers don’t suggest beta-blockers for anxiousness. Some imagined this was because of low proof or as a result of the medicine solely addresses bodily signs. Regardless of this, most GPs thought-about beta-blockers a practical “instrument within the toolbox” (GP11) for the bodily signs of hysteria like coronary heart palpitations and fast respiration. Some additionally used seen beta-blockers as a pragmatic instrument for folks on lengthy ready lists for counselling.
If their anxiousness is kind of delicate … they’re ready for CBT [cognitive behavioural therapy] and significantly if these bodily signs are significantly unhealthy, I’ll say, ‘effectively this may increasingly make it easier to cope together with your anxiousness assaults’ … that’s in all probability once I would go along with them first-line.
Theme 2: Security-driven prescribing
Most GPs prescribed beta-blockers for anxiousness because of perceptions of the medicine as low threat, significantly for younger adults. They have been usually seen as a safer various to benzodiazepines and, in some circumstances, antidepressants, which may initially improve suicidal ideation. GPs have been solely cautious about prescribing beta-blockers in particular circumstances, akin to for folks with bronchial asthma, low blood strain, or those that have been pregnant. As a result of this notion of beta-blockers being low threat, most GPs have been comfy with folks utilizing them long run. Nevertheless, there have been combined views on the precise effectiveness of beta-blockers for anxiousness, with GPs usually leaving the choice to proceed the medicine as much as the particular person.
[There can be] Early suicide threat on antidepressants … growing impulsivity round self-harm, so I assume there’s a larger dedication as a GP to begin somebody on antidepressants, whereas a beta-blocker feels much less dangerous.
Theme 3: Affected person-driven prescribing
A closing motive GPs prescribed beta-blockers for anxiousness was when folks mentioned they wished speedy symptom aid and so they have been on lengthy ready lists for counselling. GPs mentioned that folks most popular beta-blockers as a result of they may also help with the bodily signs of hysteria shortly in comparison with antidepressants that may take weeks to work. Many individuals additionally wished to keep away from antidepressants because of a notion that they dulled feelings or due to the stigma related to them. GPs discovered that folks usually noticed beta-blockers as a extra agreeable possibility for managing their anxiousness and that some folks weren’t within the headspace to enroll to counselling.
There’s nonetheless this large factor about taking an antidepressant is an indication of failure … whereas in case you say … “that is propranolol and it bodily stops your coronary heart from racing, due to this fact could abate your panic assault” … that’s way more comprehensible.
GPs reported pragmatic, safety-driven, and patient-driven causes for prescribing beta-blockers for anxiousness, like speedy symptom aid and avoiding the stigma related to antidepressants.
Conclusions
This qualitative research highlights a spot between medical pointers for the usage of beta-blockers for anxiousness and GP prescribing practices. GPs defined utilizing beta-blockers to offer speedy symptom aid whereas individuals are ready for counselling, because of their perceived low threat profile compared to another drugs, and to accommodate some affected person preferences to keep away from antidepressants. As such, the researchers spotlight the clear have to additional examine beta-blockers security and effectiveness as a remedy for anxiousness issues.
GPs’ perceived advantages of beta-blockers for anxiousness underscore a necessity for additional analysis and up to date medical steering to align follow with proof.
Strengths and limitations
The use of interviews was a power, because it offered extra in-depth element on why GPs prescribe beta-blockers for anxiousness than doable with a survey. The involvement of individuals with lived expertise of hysteria was a power, as their enter grounded the interview questions and evaluation in what was most vital to them. One other power was the numerous pattern of GPs, who different by gender, age, position, and their follow’s Index of A number of Deprivation decile. This variety could have helped to seize a broader variation of experiences and views than a convenience-only pattern would have.
Nevertheless, ethnic variety was restricted, with most GPs being White. Research have discovered that taking drugs for psychological well being is extra stigmatising for Black folks than for White folks (Hunt et al., 2013). Nevertheless, it isn’t but understood if Black GPs’ prescribing of beta-blockers may be influenced by their very own stigmatisation of the medicine, or by a protecting intention to mitigate folks’s publicity to such stigma. An identical limitation is that GPs have been recruited from Southwest England for comfort. Findings, due to this fact, will not be transferable to GPs in different areas of England or the broader UK. Most variation of GPs’ sociodemographics ought to be thought-about in future research.
The findings could also be inclined to recall bias, the place GPs misremember the small print of their consultations or decision-making. There’s additionally the potential for social desirability bias. That is when individuals share views they understand to be extra socially acceptable or what they consider the researcher desires to listen to. Nevertheless, as a result of a researcher with out medical coaching performed the interviews, GPs could have perceived there to be much less judgment of their decision-making than in the event that they have been interviewed by a fellow healthcare skilled.
Regardless of suggestions from the Consolidated Standards for Reporting Qualitative Analysis (Sales space et al., 2014), these observations concerning the energy dynamics between the researcher and GP weren’t mentioned. Such reporting can add to reflexivity on how the researcher’s positionality may need influenced knowledge assortment and evaluation (Gill and Johns, 2019). Nevertheless, this omission is a recognised problem in qualitative well being analysis due to the restrictive phrase limits (usually ~4,000 phrases) of many medical journals. These constraints can sadly restrict the house obtainable for in-depth description of the strategies and findings, and the variety of quotes reported.
Whereas there was some variety among the many recruited GPs, recruitment was confined to Southwest England and there was restricted ethnic variety.
Implications for follow
Regardless of inconclusive proof on the security of prescribing beta-blockers for anxiousness, the GPs interviewed on this research perceived them as ‘low threat,’ significantly for younger adults, and seen them as a safer various to benzodiazepines and antidepressants when the particular person presents with suicide ideation. Given this discrepancy between the proof on security and GPs’ views, I agree with the researchers’ level that:
There’s a clear want for a definitive trial to evaluate the security and effectiveness of beta-blockers in treating anxiousness. Given the wide selection of doses, durations of prescribing, and related anxiousness shows, multiple trial could also be required.
Till such proof is on the market, I like to recommend that GPs contemplate the uncertainty of the proof and train warning when prescribing beta-blockers for anxiousness. If prescribed, GPs could need to have a plan for ongoing overview and contemplate applicable time factors for dose discount or discontinuation. GPs might also discover it useful to clarify to folks the uncertainty of proof for beta-blockers for anxiousness and various drugs like antidepressants which have extra proof for effectiveness and clearer facet impact profiles. For instance, one current systematic overview discovered that antidepressants have been simpler than placebo in lowering anxiousness (Kopcalic, 2025).
Till definitive proof is on the market, GPs ought to train warning when prescribing beta-blockers for anxiousness and have conversations with sufferers about their uncertainty of proof for his or her effectiveness and various remedies.
Statements of pursuits
None.
Hyperlinks
Main paper
Archer, C., Kessler, D., Wiles, N., Chew-Graham, C. A., & Turner, Okay. (2024b). GPs’ views of prescribing beta-blockers for folks with anxiousness issues: a qualitative research. British Journal of Basic Observe, 74(748).
Different references
Archer, C., MacNeill, S. J., Mars, B., Turner, Okay., Kessler, D., & Wiles, N. (2022). Rise in prescribing for anxiousness in UK major care between 2003 and 2018: a population-based cohort research utilizing Medical Observe Analysis Datalink. British Journal of Basic Observe, 72(720), e511-e518.
Archer, C., Wiles, N., Kessler, D., Turner, Okay., & Caldwell, D. M. (2024a). Beta-blockers for the remedy of hysteria issues: a scientific overview and meta-analysis. Journal of Affective Problems.
Sales space, A., Hannes, Okay., Harden, A., Noyes, J., Harris, J., & Tong, A. (2014). COREQ (consolidated standards for reporting qualitative research). Tips for reporting well being analysis: a person’s handbook, 214-226.
Braun, V., Clarke, V., Hayfield, N., Davey, L., & Jenkinson, E. (2023). Doing reflexive thematic evaluation. In Supporting analysis in counselling and psychotherapy: Qualitative, quantitative, and combined strategies analysis (pp. 19-38). Springer Worldwide Publishing.
Craske, M. G., Rauch, S. L., Ursano, R., Prenoveau, J., Pine, D. S., & Zinbarg, R. E. (2011). What’s an anxiousness dysfunction?. Focus, 9(3), 369-388.
Huh, J., Goebert, D., Takeshita, J., Lu, B. Y., & Kang, M. (2011). Remedy of generalized anxiousness dysfunction: a complete overview of the literature for psychopharmacologic alternate options to newer antidepressants and benzodiazepines. The Main Care Companion for CNS Problems, 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 psychological well being remedy amongst anxious major care sufferers. The Journal of Nervous and Psychological Illness, 201(3), 188-195. 10.1097/NMD.0b013e3182845ad8
Kopcalic, Okay., Arcaro, J., Pinto, A., Ali, S., Barbui, C., Curatoli, C., Guaiana, G. (2025). Antidepressants versus placebo for generalised anxiousness dysfunction (GAD). Cochrane Database of Systematic Evaluations, (1).
Nationwide Institute for Well being and Care Excellence. (2024). Generalized anxiousness dysfunction (GAD): Background data – Prevalence. CKS NICE.
