Anxiousness issues are widespread psychological well being circumstances characterised by persistent and intense emotions of unease which can be disproportionate to the scenario (Craske et al., 2011). Generalised Anxiousness Dysfunction (GAD) is the commonest kind of tension dysfunction, occurring in roughly 4-8% of individuals in UK main care (NICE, 2024).
UK scientific pointers for managing nervousness 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 stories that solely 50% of individuals with nervousness 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 often used to deal with hypertension. This medicine 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 fee, sweating, and shakiness (Archer et al., 2024a). The prescribing of beta-blockers for nervousness 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 usually are not talked about in UK scientific pointers (NICE, 2024). This could possibly be as a result of 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 examine by Archer et al. (2024b) aimed to “perceive when and why GPs prescribe beta-blockers for folks with nervousness.”
Regardless of an increase in prescribing for nervousness issues, beta-blockers usually are not really useful in UK scientific pointers, highlighting a key discrepancy in present apply.
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 providers researcher, with questions specializing in GPs’ causes for prescribing beta-blockers for nervousness, related threat components, and their information of related pointers. Questions have been reviewed by two folks with lived expertise of an nervousness 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 usually mentioned and refined by way of crew conferences that included a healthcare skilled and other people with lived expertise of an nervousness 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 main 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 nervousness. 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 realistic “software within the toolbox” (GP11) for the bodily signs of tension like coronary heart palpitations and fast respiratory. Some additionally used seen beta-blockers as a pragmatic software for folks on lengthy ready lists for counselling.
If their nervousness is sort of gentle … they’re ready for CBT [cognitive behavioural therapy] and notably if these bodily signs are notably dangerous, I’ll say, ‘properly this will enable you to cope along with your nervousness assaults’ … that’s in all probability after I would go together with them first-line.
Theme 2: Security-driven prescribing
Most GPs prescribed beta-blockers for nervousness because of perceptions of the medicine as low threat, notably for younger adults. They have been typically seen as a safer various to benzodiazepines and, in some circumstances, antidepressants, which might initially improve suicidal ideation. GPs have been solely cautious about prescribing beta-blockers in particular circumstances, corresponding to for folks with bronchial asthma, low blood strain, or those that have been pregnant. On account of this notion of beta-blockers being low threat, most GPs have been snug with folks utilizing them long run. Nonetheless, there have been combined views on the precise effectiveness of beta-blockers for nervousness, with GPs typically leaving the choice to proceed the medicine as much as the individual.
[There can be] Early suicide threat on antidepressants … growing impulsivity round self-harm, so I suppose there’s a larger dedication as a GP to start out 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 nervousness was when folks stated they needed quick symptom reduction and so they have been on lengthy ready lists for counselling. GPs stated that folks most well-liked beta-blockers as a result of they might help with the bodily signs of tension rapidly in comparison with antidepressants that may take weeks to work. Many individuals additionally needed 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 typically noticed beta-blockers as a extra agreeable possibility for managing their nervousness and that some folks weren’t within the headspace to enroll to counselling.
There may be nonetheless this large 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 nervousness, like quick symptom reduction and avoiding the stigma related to antidepressants.
Conclusions
This qualitative examine highlights a spot between scientific pointers for the usage of beta-blockers for nervousness and GP prescribing practices. GPs defined utilizing beta-blockers to supply quick symptom reduction 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 must additional examine beta-blockers security and effectiveness as a therapy for nervousness issues.
GPs’ perceived advantages of beta-blockers for nervousness underscore a necessity for additional analysis and up to date scientific steerage to align apply with proof.
Strengths and limitations
The use of interviews was a energy, because it supplied extra in-depth element on why GPs prescribe beta-blockers for nervousness than attainable with a survey. The involvement of individuals with lived expertise of tension was a energy, as their enter grounded the interview questions and evaluation in what was most vital to them. One other energy was the numerous pattern of GPs, who various by gender, age, function, and their apply’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.
Nonetheless, 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). Nonetheless, it’s not but understood if Black GPs’ prescribing of beta-blockers is perhaps influenced by their very own stigmatisation of the medicine, or by a protecting intention to mitigate folks’s publicity to such stigma. The same limitation is that GPs have been recruited from Southwest England for comfort. Findings, subsequently, might not be transferable to GPs in different areas of England or the broader UK. Most variation of GPs’ sociodemographics needs to be thought-about in future research.
The findings could also be vulnerable 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 individuals share views they understand to be extra socially acceptable or what they imagine the researcher desires to listen to. Nonetheless, as a result of a researcher with out scientific 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 might need influenced knowledge assortment and evaluation (Gill and Johns, 2019). Nonetheless, 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 apply
Regardless of inconclusive proof on the security of prescribing beta-blockers for nervousness, the GPs interviewed on this examine perceived them as ‘low threat,’ notably 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 nervousness. Given the big selection of doses, durations of prescribing, and related nervousness displays, multiple trial could also be required.
Till such proof is out there, I like to recommend that GPs take into account the uncertainty of the proof and train warning when prescribing beta-blockers for nervousness. If prescribed, GPs could wish to have a plan for ongoing evaluation and take into account applicable time factors for dose discount or discontinuation. GPs may discover it useful to clarify to folks the uncertainty of proof for beta-blockers for nervousness and various drugs like antidepressants which have extra proof for effectiveness and clearer aspect impact profiles. For instance, one current systematic evaluation discovered that antidepressants have been more practical than placebo in decreasing nervousness (Kopcalic, 2025).
Till definitive proof is out there, GPs ought to train warning when prescribing beta-blockers for nervousness and have conversations with sufferers about their uncertainty of proof for his or her effectiveness and various therapies.
Statements of pursuits
None.
Hyperlinks
Major paper
Archer, C., Kessler, D., Wiles, N., Chew-Graham, C. A., & Turner, Okay. (2024b). GPs’ views of prescribing beta-blockers for folks with nervousness issues: a qualitative examine. 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 nervousness in UK main care between 2003 and 2018: a population-based cohort examine 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 therapy of tension issues: a scientific evaluation 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). Pointers 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 nervousness dysfunction?. Focus, 9(3), 369-388.
Huh, J., Goebert, D., Takeshita, J., Lu, B. Y., & Kang, M. (2011). Remedy of generalized nervousness dysfunction: a complete evaluation of the literature for psychopharmacologic alternate options to newer antidepressants and benzodiazepines. The Major 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 main 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 nervousness dysfunction (GAD). Cochrane Database of Systematic Opinions, (1).
Nationwide Institute for Well being and Care Excellence. (2024). Generalized nervousness dysfunction (GAD): Background info – Prevalence. CKS NICE.
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