Sitting next to me on an aeroplane is a specific kind of misery. At the first sign of turbulence, I'm shaking uncontrollably, white-knuckling both armrests in an effort to hang on for dear life. If things get really bumpy, I'm flinging my body over your seat mid sob to get my hands on miniature wine bottles by whatever means necessary. Since that's obviously not an ideal coping routine, I've begun researching other, medically approved methods to address what a therapist informed me is not just a distaste for travelling via tin can, but a case of anxiety symptoms flaring up midair.
Enter: my curiosity in health-and-wellness-focussed telemedicine brand hers. This digital start-up offers everything from birth control to prescription skin care in sleek, pastel packageing (my personal kryptonite) and recently added a prescription-only beta-blocker drug called propranolol ($25) to its retail lineup. Once users sign up for a monthly subscription of the drug, hers ships a package of five 20 mg propranolol pills to be delivered at home.
But before you can get your hands on these beta-blockers, you'll first need to get a prescription through hers' online system. Vice President of Medical Services at hers Adrian Rawlinson, MD, tells POPSUGAR that a propranolol prescription is not intended to be a solution for general anxiety disorder, a form of anxiety that the Mayo Clinic describes as "excessive, ongoing anxiety and worry that [is] difficult to control and interferes with day-to-day activities." Instead, hers has marketed its propranolol product as an option for treating performance anxiety, or anxiousness that makes it difficult to function in specific, high-pressure situations, like job interviews or auditions. Dr. Rawlinson adds that the "physician consultation process" customers use to check out through the hers platform is "designed to mirror what happens when you visit a doctor in person."
The process Dr. Rawlinson describes is a seven-step system that starts at checkout. When you finalize your propranolol order, a new $5 "medical fee" appears. Once your $30 total is paid via credit card, hers routes you to its pre-consultation phase, where you're asked to provide identification information (have your government-issued ID ready) and prompted to acknowledge that propranolol isn't suitable treatment for general or social anxiety disorders.
Next up, you receive an extensive consent document laying out benefits and potential risks of using telemedicine services. Once you check the requisite "I Agree" buttons, you're forwarded to the health evaluation. Hers' standard health evaluation questionnaire for propranolol includes around 12 multiple-choice questions, with the option to choose as many relevant answers per query as necessary. (A question about your symptoms, for example, lists several anxiety indicators – tight throat, pounding heart, shaking hands, and more – and you're encouraged to mark however many you experience.) If you respond to a question with "other" at any point, you're prompted to write out further details for the doctor's review. You're also asked to disclose your current roster of prescription medications in full, with special emphasis placed on 18 prescriptions, all listed by name. Through a partnership with Bailey Health, you're then matched with a physician licenced in your home state to review your feedback. As for the actual consultation, don't expect to hop on a video chat – physicians reach out through the hers platform's instant messageing system, or sometimes via phone call. From there, the doctor determines whether they're comfortable signing off on a propranolol prescription.
While I'm all for making birth control more accessible, and my interest was certainly piqued at the thought of avoiding unnecessary trips to the doctor's office, ordering anxiety medication from my couch still gave me pause. Is it safe? Does this drug even work? To find out, I tapped a few outside experts in the mental health field for their insights on what propranolol is, who should (and shouldn't) take it, whether it's safe to order without seeing a doctor in-person first, and what results to expect before giving it a try.
What the Heck Is Propranolol?
Franklin Schneier, MD, codirector of New York State Psychiatric Institute's Anxiety Disorders Clinic, tells POPSUGAR that propranolol is one of the original beta-blocker drugs and has been around for "at least 50 years." What's a beta-blocker, you ask? Dr. Schneier explains that beta-blockers "act as beta receptors to block the effects of adrenaline" in the body. "Beta receptors are located in many organs including the brain," he says, and "when [propranolol] blocks the beta receptors in the heart, for example, it prevents the heart rate from speeding up." This can potentially reduce physical symptoms of performance anxiety, like shaking hands or a pounding heart, that make it hard to perform in high-pressure situations.
Though Dr. Schneier pointed to the existence of what he considers "a few small studies" with findings that suggest beta-blockers help anxious performers, propranolol is not FDA-approved for anxiety treatment. It is, however, approved by the FDA to treat several heart conditions, high blood pressure, and the prevention of migraine headaches.
Does It Actually Work For Anxiety Treatment?
Tiffany Lago, MD, of the National Institute of Mental Health has studied beta-blockers like propranolol and says research suggests they can be useful for people with "predictable anxiety triggers" in specific situations. If you struggle with a particular social anxiety (like public speaking) or phobia (like a fear of heights), for example, she said propranolol could be a reasonable option for you. One benefit of propranolol, Dr. Lago notes, is that it can be taken "without affecting cognition," unlike some alternative medications. She also tells POPSUGAR that beta-blockers can be useful in quelling symptoms before they spin out of control. "For some people, these physical symptoms of anxiety lead to even more anxiety," she says, and beta-blockers can help prevent that dreaded full-on spiral.
When it comes to manageing anxiety symptoms on a day-to-day basis, though, Dr. Schneier says propranolol is "usually" not helpful – and he said it can potentially make depression worse. "This is important, because performance anxiety often occurs in combination with other psychiatric conditions," Dr. Schenier says. He recommends that people try other, longer-lasting methods of addressing anxiety head-on (like therapy) instead of relying on a beta-blocker as a "one size fits all" solution. "Cognitive behavioural therapy is preferable [to beta-blockers], because patients learn coping techniques that they can use the rest of their lives, whereas beta-blockers work only while they are in one's system." He also adds that propranolol can become a crutch: "If propranolol is effective, it often leads to a psychological dependence, and might, therefore, worsen anxiety in unexpected situations where there is not enough warning to take propranolol beforehand." If your situational anxiety manifests in struggling with public speaking, for example, he suggests giving a self-help group like Toastmasters a try.
Should Anyone Avoid Taking Propranolol?
Experts (including hers' Dr. Rawlinson) agree that no one should use propranolol without being completely forthright and honest during their physician consultation about their medical history and current roster of medications. Both Dr. Lago and Dr. Schneier point to a number of specific conditions that would likely rule it out as an option for patients, including asthma, heart disease, diabetes, and low blood pressure. (The hers site's "safety information" tab also says people with these conditions are not suited for propranolol, and lists a whole host of medications to avoid using in combination with it, including blood thinners, steroids, and some antidepressants.) Should it concern potential users that it's not technically approved for anxiety? Dr. Schneier says that it means "there is less evidence of its usefulness for anxiety, so that should be taken into account."
Is It Safe to Be Prescribed a Beta-Blocker Via Telemedicine Consultation?
Because of what she described as its "low risk of abuse and dependency," Dr. Lago says telemedicine prescriptions of propranolol are acceptable. "I think it's safe for a psychiatrist to prescribe propranolol via telemedicine if vital signs such as heart rate and blood pressure can be monitored routinely," she tells POPSUGAR.
During the consultation, Dr. Schneier says patients should look for a "thorough evaluation" that lasts around 30 minutes, and preferably one that includes discussion of "medical history and a psychiatric assessment, including details of the nature of the anxiety and its triggers, as well as any co-occurring conditions." But Dr. Schneier tells POPSUGAR that he's sceptical of medical evaluations offered online for a low cost: "It seems very unlikely that the $5 medical evaluation offered by some websites is adequate for safe prescribing."
After hearing what the experts have to say about propranolol potentially increasing my in-flight anxiety, I'm inclined to find a more permanent solution for my travel woes than beta-blockers. (We meet again, cognitive behavioural therapy.) But if you are going to give hers' propranolol product a go, remember to be brutally honest about your symptoms, medical history, and current prescriptions with your consulting doctor.
To find a mental health professional in your area, search this database.