Can Beta Blockers Help with Stage Fright?

betaStage fright has nothing to do with talent. Barbara Streisand, for example, is loaded with talent and yet fears appearing on stage. Some people just don’t like the focus that the stage or podium affords and develop classic physical symptoms. The sweaty palms, the pounding heart, the shaking hands, and the increased blood pressure are all part of stage fright. The chemical explanation is quite straight forward. Fear of public scrutiny causes the adrenal glands to pump out adrenalin, the classic fight or flight hormone. When a really serious situation presents itself, adrenalin is great. The boost it affords when running away from a pursuant is most welcome. But when it comes to the stage, we can do without an adrenalin overdose. Especially when it comes to musicians. Trembling hands are not a plus when it comes to playing the violin. That’s why sometimes those trembling hands reach out for beta blockers, the same drugs that have been proven to be a boon for patients suffering from high blood pressure or various types of heart disease.

In simple terms, beta blockers counteract the effects of adrenaline by blocking its receptors on muscle cells. Receptors are actually specialized protein molecules that recognize and interact with adrenaline that has been pumped into the bloodstream by the adrenal glands. The molecular structure of beta blockers resembles that of adrenaline closely enough to fool the receptors into extracting these molecules from the blood, but the fit isn’t perfect. The consequence is that the receptors are blocked but not activated. Although the adrenal glands keep spewing out their adrenaline, essentially these molecules have no place to go and eventually end up being broken down and excreted. In the case of heart patients, beta blockers slow the pulse and prevent arteries from constricting, relieving angina. Sir James Black, who developed beta blockers, justifiably received the 1988 Nobel Prize for Medicine and Physiology. He probably had no idea that his discovery would be welcomed by musicians suffering from performance anxiety. But there is another issue here. Is the use of beta blockers to block stage fright akin to an athlete using performance enhancing drugs? After all, the desired goal is performance enhancement. Is it fair for a “clean” violinist to lose a seat in the New York Philharmonic to another candidate who relies on the use of beta blockers? Is this different from a swig of alcohol to “calm the nerves?” Not a simple question to answer. Apart from ethical issues, beta blockers have few side-effects. In some cases they can cause weakness or drowsiness but in general are well tolerated. The fact is that unlike steroids for athletes, which can increase performance, beta blockers cannot help a musician play better. They can, however, ensure that the musician plays up to his ability. And isn’t that what we want when we go to a concert?

Joe Schwarcz

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