Beta-blockers decrease the symptoms of acute anxiety by reducing heartbeat, blood pressure, breathing rate, and tremors. Herbal extracts can also be used to produce these effects, as shown by human clinical trials. Passionflower, Lemon Balm, and Kava seem to be the best natural alternatives to beta-blockers in fighting acute anxiety.
Beta-blockers (β-blockers) are a class of pharmaceutical drugs primarily used in the management of cardiac arrhythmias, hypertension, and cardioprotection after myocardial infarction. Beta-blockers include, for example, the drugs propranolol (Inderal) and atenolol (Tenormin).
Beta-blockers act by blocking the action of the catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) on beta-adrenergic receptors (β1, β2 and β3) of the sympathetic nervous system. β1-adrenergic receptors are located mainly in the heart and kidneys; β2-adrenergic receptors are located mainly in smooth muscle (found in blood vessels, lungs, and the gastrointestinal tract, for example) and in skeletal muscle; β3-adrenergic receptors are found in adipose cells.
Beta-blockers can either block all beta-adrenergic receptors non-selectively, or they can have a selective action on a specific type of beta-adrenergic receptor. Due to their location and actions, β1 and β2 are the main clinical targets of beta-adrenergic drugs.
The sympathetic nervous system, through adrenaline and noradrenaline, mediates the “fight-or-flight” response (also known as the acute stress response), which is a physiological reaction to an event or stimulus perceived as threatening or harmful. Through stimulation of β1 receptors, epinephrine and norepinephrine increase the heart rate and the strength of the heartbeat; they also increase the release of renin by the kidneys, which in turn increases blood pressure. Through stimulation of β2 receptors, adrenaline and noradrenaline induce smooth muscle relaxation in several tissues, including blood vessels and bronchi (lungs), thereby causing vasodilation and intensifying the respiratory rate, leading to increased blood flow and oxygen delivery to target tissues; they also activate motor nerve terminals to increase muscle contraction. By inhibiting these sympathetic actions of adrenaline and noradrenaline, beta-blockers are able to reduce heartbeat, heart contractility, and blood pressure.
Why do beta-blockers have anxiolytic effects?
Beta-blockers are frequently used to reduce or prevent the occasional episodes of acute anxiety associated with public speaking or public performances, for example. Beta-blockers are effective in fighting acute anxiety because, by inhibiting the sympathetic actions of adrenaline and noradrenaline, they block a number of autonomic responses to acute stress that are also symptoms of a state of anxiety: they can decrease tachycardia (rapid heartbeat), palpitations, tachypnea (rapid breathing), tremors, gastrointestinal disorders, sweating, and dizziness.(1)
The anxiolytic actions of beta-blockers have been studied in several clinical trials that demonstrated their efficacy in managing not only acute stress reactions, but also generalized anxiety or panic disorders, for example. In general, beta-blockers are most effective when the autonomic symptoms are prominent but not severe. However, it is important to note that despite being effective in managing the symptoms of anxiety, it is not clear whether or not they have an actual anxiolytic effect; in other words, although they block the manifestations of anxiety, they may not block anxiety itself.(1)
Evidence-based natural alternatives to beta-blockers
Anxiety therapy is one of the most extensively researched applications of herbal products in mood disorders. Scientific studies have shown that there are several herbal extracts with relevant scientific evidence of anxiolytic effects in human clinical trials. There are robust clinical trials (double-blind, randomized, placebo-controlled trials) showing a positive anxiolytic effect following a continued use of Ashwagandha (Withania somnifera), Brahmi (Bacopa monnieri), Chamomile (Matricaria recutita), Galphimia (Galphimia glauca), Ginkgo (Ginkgo Biloba), Gotu Kola (Centella asiatica), Kava (Piper methysticum), Lemon Balm (Melissa officinalis), Passionflower (Passiflora incarnata), and Roseroot (Rhodiola Rosea).(2, 3)
Among these herbs, a few have also shown acute anxiolytic effects in human clinical trials following just a single administration, which is the type of anti-anxiety benefit people usually look for in beta-blockers. However, this does not mean that they have the same mechanism of action — although some of these herbs may have acute anxiolytic effects similar to those of beta-blockers, these are not necessarily due to the blockade of beta-adrenergic receptors. But based on the outcome that best reproduces the effects of beta-blockers — the ability to reduce acute anxiety — there are three herbal extracts that stand out as the best natural alternatives to beta-blockers.
Passionflower (Passiflora incarnata)
Passionflower has been used traditionally as a relaxant and there are several clinical trials that verified Passionflower’s anxiolytic effects. For example, a clinical trial using Passionflower extract in subjects with generalized anxiety disorder demonstrated that it was safer and as effective as the anxiolytic drug oxazepam in reducing anxiety.(4)
Several clinical trials have examined Passionflower’s acute effects on preoperative anxiety, having shown that Passionflower suppresses the increase in anxiety observed before surgical interventions.(5) One study showed that Passionflower could reduce subjective anxiety before dental surgery to the same extent as the anxiolytic drug midazolam, but with fewer side effects. Furthermore, it was shown that Passionflower reduced blood pressure and heart rate.(6)
Given the fact that there are several studies demonstrating an acute effect in lowering anxiety, accompanied by a decrease in blood pressure and heart rate, Passionflower seems to be the best natural alternative to the use of beta-blockers in acute anxiety.
Lemon Balm (Melissa officinalis)
Lemon balm is a common herb used traditionally for its mild sedative effects. In a clinical trial, it was shown that single doses of Lemon Balm were able to increase calmness. The sedative effects only became noticeable with increasing doses, showing that Lemon Balm can be used to decrease anxiety without causing sedation.(7) A similar study also showed that a single dose of Lemon Balm extract can have a significant effect in improving calmness in response to stimulation by a stressor.(8) Lemon balm has also been shown to be effective in decreasing heart palpitations, with this effect being associated with the decrease in anxiety.(9)
The existence of studies demonstrating an acute effect of Lemon Balm in lowering anxiety, along with its effects in decreasing heart palpitation, indicate that Lemon Balm is a good alternative to beta-blockers.
Piper methysticum (Kava)
Kava is a medicinal plant that has been used traditionally as a relaxant. Kava is probably the herb with most clinical evidence of efficacy as a treatment for anxiety.
A 2003 review of clinical trials assessing the anxiolytic effect of Kava showed that it is an effective short-term (1 to 24 weeks) treatment for anxiety.(10) A 2018 review confirmed the assertion that Kava appears to be effective as a short-term treatment for anxiety, but concluded that it is not clear that Kava may be as effective following long-term use.(11)
One trial has compared the effects of Kava administration for 8 weeks to those of the anxiolytic drugs buspirone and opipramol in treating generalized anxiety. The study showed that Kava had a similar efficacy to buspirone or opipramol, with 75% of patients responding to treatment and 60% achieving full remission.(12)
Kava’s reputation has been tainted by reports of possible toxic effects in the liver. However, reviews of Kava’s safety reports indicate that adverse effects caused by Kava are generally rare, mild, and reversible. The cases of human liver toxicity were most likely associated with poorly prepared extracts. Given the lack of studies on the long-term use of Kava, the hypothesis that in may induce liver toxicity after prolonged use has not been excluded. But Kava seems to have a good safety profile for short-term use.(10, 11)
The extensive research on the anxiolytic effects of Kava place it among the best natural herbs with anxiolytic actions. Although its efficacy following a single administration has not been reported, Kava’s efficacy following short-term administration indicates that it may also be useful in reducing acute anxiety, as an alternative to beta-blockers.
- Altamura AC, Moliterno D, Paletta S, Maffini M, Mauri MC, Bareggi S. Understanding the pharmacokinetics of anxiolytic drugs. Expert Opin Drug Metab Toxicol. 2013;9(4):423-440. doi:10.1517/17425255.2013.759209.
- Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phyther Res. 2018;32(7):1147-1162. doi:10.1002/ptr.6055.
- Sarris J, McIntyre E, Camfield DA. Plant-Based Medicines for Anxiety Disorders, Part 2: A Review of Clinical Studies with Supporting Preclinical Evidence. CNS Drugs. 2013;27(4):301-319. doi:10.1007/s40263-013-0059-9.
- Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26(5):363-367. doi:10.1046/j.1365-2710.2001.00367.x.
- Movafegh A, Alizadeh R, Hajimohamadi F, Esfehani F, Nejatfar M. Preoperative Oral Passiflora Incarnata Reduces Anxiety in Ambulatory Surgery Patients: A Double-Blind, Placebo-Controlled Study. Anesth Analg. 2008;106(6):1728-1732. doi:10.1213/ane.0b013e318172c3f9.
- Dantas L, de Oliveira-Ribeiro A, de Almeida-Souza L, Groppo F. Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction. Med Oral Patol Oral y Cir Bucal. 2016:0-0. doi:10.4317/medoral.21140.
- Kennedy DO, Scholey AB, Tildesley NTJ, Perry EK, Wesnes KA. Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). Pharmacol Biochem Behav. 2002;72(4):953-964. doi:10.1016/S0091-3057(02)00777-3.
- Kennedy DO, Little W, Scholey AB. Attenuation of Laboratory-Induced Stress in Humans After Acute Administration of Melissa officinalis (Lemon Balm). Psychosom Med. 2004;66(4):607-613. doi:10.1097/01.psy.0000132877.72833.71.
- Alijaniha F, Naseri M, Afsharypuor S, et al. Heart palpitation relief with Melissa officinalis leaf extract: Double blind, randomized, placebo controlled trial of efficacy and safety. J Ethnopharmacol. 2015;164:378-384. doi:10.1016/j.jep.2015.02.007.
- Pittler MH, Ernst E. Kava extract versus placebo for treating anxiety. Cochrane Database Syst Rev. January 2003. doi:10.1002/14651858.CD003383.
- Smith K, Leiras C. The effectiveness and safety of Kava Kava for treating anxiety symptoms: A systematic review and analysis of randomized clinical trials. Complement Ther Clin Pract. 2018;33:107-117. doi:10.1016/j.ctcp.2018.09.003.
- Boerner RJ, Sommer H, Berger W, Kuhn U, Schmidt U, Mannel M. Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder–an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients. Phytomedicine. 2003;10 Suppl 4:38-49. doi:10.1078/1433-187X-00309.