Nervousness problems are frequent psychological well being circumstances characterised by persistent and intense emotions of unease which are disproportionate to the scenario (Craske et al., 2011). Generalised Nervousness Dysfunction (GAD) is the most typical kind of tension dysfunction, occurring in roughly 4-8% of individuals in UK major care (NICE, 2024).
UK scientific pointers for managing anxiousness problems suggest Basic Practitioners (GPs) refer individuals 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 stories that solely 50% of individuals with anxiousness reply to antidepressants (Huh et al., 2011), GPs could search for alternate options to assist individuals handle their signs.
One such various is the beta-blocker Propranolol, which is often used to deal with hypertension. This treatment is believed to work by blocking the motion of adrenaline and noradrenaline hormones, which might be accountable for the bodily signs of tension like an elevated coronary heart charge, 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 enhance, beta-blockers aren’t talked about in UK scientific pointers (NICE, 2024). This may very well be because of the lack of high-quality proof to help 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 individuals with anxiousness.”
Regardless of an increase in prescribing for anxiousness problems, beta-blockers aren’t advisable in UK scientific pointers, highlighting a key discrepancy in present observe.
Strategies
GPs had 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 had been carried out by an skilled qualitative and well being providers researcher, with questions specializing in GPs’ causes for prescribing beta-blockers for anxiousness, related danger elements, and their data of related pointers. Questions had been reviewed by two individuals with lived expertise of an anxiousness dysfunction previous to knowledge assortment.
After the interview recordings had been transcribed verbatim, the information was analysed utilizing reflexive thematic evaluation (Braun et al., 2023). All through evaluation, codes and researcher interpretations had been repeatedly mentioned and refined by crew conferences that included a healthcare skilled and folks with lived expertise of an anxiousness dysfunction.
Outcomes
Seventeen GPs from 10 practices had been interviewed, who had 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 had been salaried. Based mostly on the Index of A number of Deprivation, 5 labored in practices in essentially 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 had been developed throughout evaluation: (1) pragmatic prescribing, (2) safety-driven prescribing, and (3) patient-driven prescribing.
Theme 1: Pragmatic prescribing
A 3rd of GPs had been conscious that pointers don’t suggest beta-blockers for anxiousness. Some imagined this was resulting from low proof or as a result of the treatment solely addresses bodily signs. Regardless of this, most GPs thought-about beta-blockers a realistic “instrument within the toolbox” (GP11) for the bodily signs of tension like coronary heart palpitations and speedy respiratory. Some additionally used seen beta-blockers as a pragmatic instrument for individuals on lengthy ready lists for counselling.
If their anxiousness is sort of delicate … they’re ready for CBT [cognitive behavioural therapy] and significantly if these bodily signs are significantly dangerous, I’ll say, ‘nicely this will likely make it easier to cope along with your anxiousness assaults’ … that’s in all probability once I would go together with them first-line.
Theme 2: Security-driven prescribing
Most GPs prescribed beta-blockers for anxiousness resulting from perceptions of the treatment as low danger, significantly for younger adults. They had been typically seen as a safer various to benzodiazepines and, in some circumstances, antidepressants, which might initially enhance suicidal ideation. GPs had been solely cautious about prescribing beta-blockers in particular circumstances, akin to for individuals with bronchial asthma, low blood strain, or those that had been pregnant. Resulting from this notion of beta-blockers being low danger, most GPs had been snug with individuals utilizing them long run. Nevertheless, there have been blended views on the precise effectiveness of beta-blockers for anxiousness, with GPs typically leaving the choice to proceed the treatment as much as the individual.
[There can be] Early suicide danger on antidepressants … rising impulsivity round self-harm, so I assume there’s a greater dedication as a GP to begin somebody on antidepressants, whereas a beta-blocker feels much less dangerous.
Theme 3: Affected person-driven prescribing
A last purpose GPs prescribed beta-blockers for anxiousness was when individuals mentioned they wished speedy symptom reduction and so they had been on lengthy ready lists for counselling. GPs mentioned that individuals most well-liked beta-blockers as a result of they may help with the bodily signs of tension shortly in comparison with antidepressants that may take weeks to work. Many individuals additionally wished to keep away from antidepressants resulting from a notion that they dulled feelings or due to the stigma related to them. GPs discovered that individuals typically noticed beta-blockers as a extra agreeable choice for managing their anxiousness and that some individuals weren’t within the headspace to enroll to counselling.
There may be nonetheless this huge factor about taking an antidepressant is an indication of failure … whereas for those who say … “that is propranolol and it bodily stops your coronary heart from racing, subsequently 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 reduction and avoiding the stigma related to antidepressants.
Conclusions
This qualitative research highlights a niche between scientific pointers for using beta-blockers for anxiousness and GP prescribing practices. GPs defined utilizing beta-blockers to offer speedy symptom reduction whereas individuals are ready for counselling, resulting from their perceived low danger 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 therapy for anxiousness problems.
GPs’ perceived advantages of beta-blockers for anxiousness underscore a necessity for additional analysis and up to date scientific steering to align observe 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 attainable with a survey. The involvement of individuals with lived expertise of tension was a power, as their enter grounded the interview questions and evaluation in what was most vital to them. One other power was the various pattern of GPs, who various by gender, age, function, and their observe’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 individuals than for White individuals (Hunt et al., 2013). Nevertheless, it isn’t but understood if Black GPs’ prescribing of beta-blockers is perhaps influenced by their very own stigmatisation of the treatment, or by a protecting intention to mitigate individuals’s publicity to such stigma. An analogous limitation is that GPs had been recruited from Southwest England for comfort. Findings, subsequently, is probably not 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 prone to recall bias, the place GPs misremember the small print of their consultations or decision-making. There may be additionally the potential of social desirability bias. That is when members share views they understand to be extra socially acceptable or what they imagine the researcher needs to listen to. Nevertheless, as a result of a researcher with out scientific coaching carried out the interviews, GPs could have perceived there to be much less judgment of their decision-making than in the event that they had 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 in regards to 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 out there 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 observe
Regardless of inconclusive proof on the security of prescribing beta-blockers for anxiousness, the GPs interviewed on this research perceived them as ‘low danger,’ significantly for younger adults, and seen them as a safer various to benzodiazepines and antidepressants when the individual 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 big selection of doses, durations of prescribing, and related anxiousness shows, multiple trial could also be required.
Till such proof is offered, 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 assessment and contemplate acceptable time factors for dose discount or discontinuation. GPs may additionally discover it useful to clarify to individuals the uncertainty of proof for beta-blockers for anxiousness and various drugs like antidepressants which have extra proof for effectiveness and clearer aspect impact profiles. For instance, one current systematic assessment discovered that antidepressants had been simpler than placebo in lowering anxiousness (Kopcalic, 2025).
Till definitive proof is offered, 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 therapies.
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 individuals with anxiousness problems: 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 Scientific 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 therapy of tension problems: a scientific assessment and meta-analysis. Journal of Affective Issues.
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 guide, 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 blended 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). Therapy of generalized anxiousness dysfunction: a complete assessment of the literature for psychopharmacologic alternate options to newer antidepressants and benzodiazepines. The Main Care Companion for CNS Issues, 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 therapy 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 Opinions, (1).
Nationwide Institute for Well being and Care Excellence. (2024). Generalized anxiousness dysfunction (GAD): Background data – Prevalence. CKS NICE.
