Posts Tagged ‘propranolol’

One of the most fascinating intervals during a  placebo-controlled clinical trial is the days or weeks between baseline (no intervention) and treatment onset because almost everyone improves regardless of which group they’ve been assigned to.  There is something about simply committing to a protocol and believing the pill/activity/program will work that results in measurable change for the better.  And from an outcome point of view does it really matter how you get there if you like the destination?   Sometimes.

Musicians and actors have been using propranolol (beta blocker with a good safety record) to manage performance anxiety for years with reported success.  Although data may be inconclusive (off-label use makes clinical trials an unnecessary expense for big pharma) why not go ahead and take it if you feel better when you do?  For a success story read Carl Swanson’s 2001 Harp Column article about his experience managing stage fright under the supervision of a physician.  We know it works well enough that two Korean shooters were banned from Olympic competition for using propranolol to reduce hand tremors and kill butterflies.

However, Steve Silberman wrote a fun piece for Wired (24-Aug-2009) that offers another way to look how at drugs work.   It’s not that easy for pharmaceutical companies to prove statistical significance in drug studies because of positive placebo response.  So on the one hand you could say a drug is effective because it works 10% more often in people taking the active compound.  However you could equally well argue that only 10% fewer people respond to placebo than the drug.  Hmmmmm.   Makes the risk benefit calculation much trickier than marketing will ever let on.  How much are you willing to spend for a 10% chance over placebo?  And what side effects are you willing to put up with based on those odds?

In the balance it seems as though professional musicians who are debilitated by physical symptoms like shaky cold hands, rapid heartbeat, breathlessness and sweating (but feel confident of their command of the repertoire) do well with beta blockers.  When performance anxiety arises from self-consciousness, shyness or lack of preparation they will be less effective.   Believing that beta blockers work increases the likelihood that they will.   So before you give propranolol a try consider that beta blockers are associated with nuisance issues such as gastro-intestinal problems (try that onstage), diminished or absent sexual performance with regular use and rare deadly events such as bronchospasm and anaphylactic shock.  Someone’s got to be the outlier, right?  Best to take propranolol on a test run when you’re not alone and nothing is at stake before assuming it will provide poise and calm during a performance.


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