Anxiousness problems are widespread psychological well being circumstances characterised by persistent and intense emotions of unease which are disproportionate to the scenario (Craske et al., 2011). Generalised Anxiousness Dysfunction (GAD) is the commonest sort of tension dysfunction, occurring in roughly 4-8% of individuals in UK main care (NICE, 2024).
UK scientific tips for managing nervousness problems suggest Normal Practitioners (GPs) refer individuals 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 options to assist individuals handle their signs.
One such various is the beta-blocker Propranolol, which is normally used to deal with hypertension. This medicine is believed to work by blocking the motion of adrenaline and noradrenaline hormones, which may be liable 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 enhance, beta-blockers are usually not talked about in UK scientific tips (NICE, 2024). This might be as a result of lack of high-quality proof to assist 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 necessary.
This qualitative interview examine by Archer et al. (2024b) aimed to “perceive when and why GPs prescribe beta-blockers for individuals with nervousness.”
Regardless of an increase in prescribing for nervousness problems, beta-blockers are usually not really useful in UK scientific tips, highlighting a key discrepancy in present follow.
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 companies researcher, with questions specializing in GPs’ causes for prescribing beta-blockers for nervousness, related danger elements, and their information of related tips. Questions have been reviewed by two individuals with lived expertise of an nervousness dysfunction previous to information 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 frequently mentioned and refined by group 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. Based mostly 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 tips don’t suggest beta-blockers for nervousness. Some imagined this was as a consequence of low proof or as a result of the medicine solely addresses bodily signs. Regardless of this, most GPs thought of beta-blockers a realistic “instrument 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 instrument for individuals on lengthy ready lists for counselling.
If their nervousness is kind of delicate … they’re ready for CBT [cognitive behavioural therapy] and notably if these bodily signs are notably unhealthy, I’ll say, ‘nicely this will allow you to cope along with your nervousness assaults’ … that’s in all probability once I would go along with them first-line.
Theme 2: Security-driven prescribing
Most GPs prescribed beta-blockers for nervousness as a consequence of perceptions of the medicine as low danger, notably for younger adults. They have been usually seen as a safer various to benzodiazepines and, in some instances, antidepressants, which might initially enhance suicidal ideation. GPs have been solely cautious about prescribing beta-blockers in particular instances, equivalent to for individuals with bronchial asthma, low blood stress, or those that have been pregnant. Resulting from this notion of beta-blockers being low danger, most GPs have been comfy with individuals utilizing them long run. Nevertheless, there have been blended views on the precise effectiveness of beta-blockers for nervousness, with GPs usually leaving the choice to proceed the medicine as much as the particular person.
[There can be] Early suicide danger on antidepressants … rising impulsivity round self-harm, so I assume 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 motive GPs prescribed beta-blockers for nervousness was when individuals mentioned they needed quick symptom aid they usually have been on lengthy ready lists for counselling. GPs mentioned that individuals most popular beta-blockers as a result of they might help with the bodily signs of tension shortly in comparison with antidepressants that may take weeks to work. Many individuals additionally needed to keep away from antidepressants as a consequence of a notion that they dulled feelings or due to the stigma related to them. GPs discovered that individuals usually noticed beta-blockers as a extra agreeable possibility for managing their nervousness and that some individuals 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 should you say … “that is propranolol and it bodily stops your coronary heart from racing, due to this fact could abate your panic assault” … that’s much more comprehensible.
GPs reported pragmatic, safety-driven, and patient-driven causes for prescribing beta-blockers for nervousness, like quick symptom aid and avoiding the stigma related to antidepressants.
Conclusions
This qualitative examine highlights a niche between scientific tips for using beta-blockers for nervousness and GP prescribing practices. GPs defined utilizing beta-blockers to supply quick symptom aid whereas persons are ready for counselling, as a consequence of their perceived low danger 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 remedy for nervousness problems.
GPs’ perceived advantages of beta-blockers for nervousness underscore a necessity for additional analysis and up to date scientific steerage to align follow with proof.
Strengths and limitations
The use of interviews was a power, because it offered 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 power, as their enter grounded the interview questions and evaluation in what was most necessary to them. One other power was the numerous pattern of GPs, who assorted by gender, age, function, and their follow’s Index of A number of Deprivation decile. This range could have helped to seize a broader variation of experiences and views than a convenience-only pattern would have.
Nevertheless, ethnic range was restricted, with most GPs being White. Research have discovered that taking drugs for psychological well being is extra stigmatising for Black individuals than for White individuals (Hunt et al., 2013). Nevertheless, it’s not but understood if Black GPs’ prescribing of beta-blockers could be influenced by their very own stigmatisation of the medicine, or by a protecting intention to mitigate individuals’s publicity to such stigma. The same limitation is that GPs have been recruited from Southwest England for comfort. Findings, due to this fact, will not be transferable to GPs in different areas of England or the broader UK. Most variation of GPs’ sociodemographics needs to be thought of in future research.
The findings could also be vulnerable to recall bias, the place GPs misremember the main points of their consultations or decision-making. There may be additionally the potential for social desirability bias. That is when contributors share views they understand to be extra socially acceptable or what they consider the researcher desires to listen to. Nevertheless, 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 in regards to 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 information assortment and evaluation (Gill and Johns, 2019). Nevertheless, 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 area out there for in-depth description of the strategies and findings, and the variety of quotes reported.
Whereas there was some range among the many recruited GPs, recruitment was confined to Southwest England and there was restricted ethnic range.
Implications for follow
Regardless of inconclusive proof on the security of prescribing beta-blockers for nervousness, the GPs interviewed on this examine perceived them as ‘low danger,’ notably for younger adults, and seen them as a safer various to benzodiazepines and antidepressants when the particular person 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 wide selection of doses, durations of prescribing, and related nervousness displays, a couple of trial could also be required.
Till such proof is accessible, 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 assessment and take into account applicable time factors for dose discount or discontinuation. GPs can also discover it useful to clarify to individuals 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 assessment discovered that antidepressants have been more practical than placebo in lowering nervousness (Kopcalic, 2025).
Till definitive proof is accessible, 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 remedies.
Statements of pursuits
None.
Hyperlinks
Main paper
Archer, C., Kessler, D., Wiles, N., Chew-Graham, C. A., & Turner, Okay. (2024b). GPs’ views of prescribing beta-blockers for individuals with nervousness problems: a qualitative examine. British Journal of Normal Apply, 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 Scientific Apply Analysis Datalink. British Journal of Normal Apply, 72(720), e511-e518.
Archer, C., Wiles, N., Kessler, D., Turner, Okay., & Caldwell, D. M. (2024a). Beta-blockers for the remedy of tension problems: a scientific assessment 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). Tips for reporting well being analysis: a consumer’s guide, 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 blended 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 assessment of the literature for psychopharmacologic options to newer antidepressants and benzodiazepines. The Main 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 remedy 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 Critiques, (1).
Nationwide Institute for Well being and Care Excellence. (2024). Generalized nervousness dysfunction (GAD): Background info – Prevalence. CKS NICE.
