Metoprolol for Anxiety: Can This Beta-Blocker Help Your Symptoms?
If you’re considering metoprolol for anxiety, you may be feeling frustrated by conflicting information online. Some sources describe it as helpful for performance anxiety, while others question whether it works at all. You might be wondering why your doctor suggested a heart medication for your racing thoughts before a big presentation or whether this approach… Read more
Reviewed by The PsychPlus Team
December 4, 2025
If you’re considering metoprolol for anxiety, you may be feeling frustrated by conflicting information online. Some sources describe it as helpful for performance anxiety, while others question whether it works at all. You might be wondering why your doctor suggested a heart medication for your racing thoughts before a big presentation or whether this approach is even right for you.
These feelings are completely valid. The truth is that metoprolol’s role in anxiety management is nuanced and limited. While some individuals find that it reduces physical symptoms such as a rapid heartbeat in specific situations, recent research raises important questions about its overall effectiveness. You deserve clear, evidence-based information to make an informed decision with your clinician.
Educational Disclaimer: This content is for educational purposes only and should not replace professional medical advice. Always consult your healthcare provider before starting, changing, or stopping any medication. If you experience thoughts of self-harm, call 988 (Suicide & Crisis Lifeline) immediately.
Understanding What Metoprolol Is and Isn’t
Metoprolol is a beta-blocker, a class of medications that work primarily on the cardiovascular system by blocking receptors that respond to adrenaline (epinephrine). It is FDA-approved for high blood pressure, angina (chest pain), heart failure, and preventing complications after heart attacks but not for anxiety disorders.
When doctors prescribe metoprolol for anxiety, they are using it off-label, meaning for a purpose not formally approved by the FDA. Off-label prescribing is common and not inherently inappropriate, but it typically indicates that the supporting evidence base is limited or inconclusive.
A 2024 systematic review of beta-blockers for anxiety disorders found no significant benefit compared to placebo, although the total evidence base included only 179 patients across all studies, the largest analysis to date.¹ This finding underscores the need for cautious interpretation and informed decision-making when considering beta-blockers for anxiety.
How Metoprolol Might Affect Anxiety Symptoms
Metoprolol is a cardioselective beta-blocker, meaning it primarily blocks beta-1 receptors in the heart. This reduces heart rate, cardiac output, and blood pressure. During anxiety, your body releases adrenaline, which triggers physical symptoms like palpitations, trembling, and sweating. By dampening this adrenergic response, metoprolol may help reduce the physical sensations of anxiety in certain short-term or situational contexts.
However, it’s crucial to understand that metoprolol does not treat the psychological or cognitive components of anxiety, such as worry, rumination, or intrusive thoughts. For this reason, it is typically used for performance-related anxiety (e.g., public speaking) rather than for generalized or chronic anxiety disorders.
Metoprolol vs. Propranolol: An Important Distinction
When beta-blockers are prescribed for anxiety-related symptoms, propranolol is more commonly chosen than metoprolol. Here’s why this matters:
When beta-blockers are used for anxiety symptoms, propranolol is prescribed far more often than metoprolol. The key pharmacologic difference lies in receptor selectivity:
| Characteristic | Metoprolol | Propranolol |
| Receptor Selectivity | Cardioselective (beta-1) | Non-selective (beta-1 and beta-2) |
| Common Use for Anxiety | Less common | More common, especially for performance anxiety |
| Physical Symptom Coverage | Primarily cardiac effects | Broader, including tremor and sweating |
| Evidence Base for Anxiety | Very limited | Slightly more, though still limited |
| FDA Approval for Anxiety | No | No |
Because propranolol blocks both beta-1 and beta-2 receptors throughout the body, it may better address peripheral physical symptoms such as trembling or sweating. In contrast, metoprolol’s cardioselectivity limits its effects to the cardiovascular system.⁴⁵⁶
Propranolol is more commonly prescribed than metoprolol for anxiety-related symptoms, though direct comparison studies are limited.⁴⁵⁶ Because metoprolol is cardioselective, it may be less effective at managing some of the peripheral physical symptoms of anxiety, such as trembling hands or excessive sweating.
What Does the Research Actually Show?
The evidence base for metoprolol as an anxiety treatment is extremely limited. Most research on beta-blockers for anxiety has evaluated propranolol, and even those studies show mixed results.
The 2024 Systematic Review
A systematic review, considered the gold standard of evidence, by Archer et al. (2024) analyzed beta-blockers for anxiety disorders and found:¹
- No significant benefit over placebo for anxiety symptoms.
- No advantage over benzodiazepines.
- Only 179 total participants across all trials.
- Low overall evidence quality.
Interpretation: The current best evidence does not support beta-blockers as effective treatments for anxiety disorders. However, given the small sample size, more research is needed before firm conclusions can be drawn.
When Metoprolol Might Be Considered
Metoprolol may be considered in select, situational cases, particularly when physical symptoms of anxiety are prominent:
- You experience predictable physical anxiety symptoms (e.g., rapid heartbeat) in specific situations.
- You have performance or situational anxiety rather than generalized or chronic anxiety.
- You have comorbid cardiovascular conditions where metoprolol is already indicated.
- You understand and accept the limited evidence base supporting its use.
Metoprolol is likely not appropriate if:
- Your anxiety is primarily cognitive or emotional (e.g., worry, rumination).
- You have generalized anxiety disorder, panic disorder, or social anxiety disorder.
- You seek a comprehensive, long-term treatment rather than situational relief.
- You have contraindicated medical conditions (e.g., asthma, hypotension, bradycardia).
Your personal medical history and symptom profile should always guide this decision, ideally in consultation with a qualified clinician.
Important Safety Considerations
Paradoxical Effects
While prescribed for anxiety, metoprolol can paradoxically increase anxiety in some individuals.²³⁷ The FDA lists “anxiety” and “nervousness” as potential adverse effects.⁷¹² Though rare, case studies and user reports document this phenomenon.²³ If you experience new or worsening anxiety after starting metoprolol, contact your healthcare provider promptly.
Common Side Effects and Monitoring
Understanding what to expect and when to seek help is crucial for safe use. Side effects can range from mild to serious.
| Severity | Symptoms | Recommended Action |
| Common (mild) | Fatigue, dizziness, cold extremities, mild stomach upset | Usually self-limited; report if persistent. |
| Concerning | Unusual fatigue, sleep disturbance, mood changes, increased anxiety | Contact your provider within 1–2 days. |
| Serious | Severe bradycardia, fainting, shortness of breath, swelling, confusion | Seek immediate medical care. |
Who Should Not Take Metoprolol
Metoprolol may be unsafe in individuals with the following conditions:⁴¹²¹³
- Asthma or other bronchospastic diseases
- Bradycardia or significant conduction abnormalities
- Hypotension
- Peripheral vascular disease
- Severe depression
- Diabetes (can mask hypoglycemia)
- Thyroid dysfunction
- Liver disease
Always disclose your full medical history and medication list before starting treatment.
What to Expect: Timing and Effects
Before starting:
- Discuss goals, alternatives, and monitoring plans.
- Review full medication and medical history.
30–60 minutes before a stressful situation:
- Follow provider instructions; effects on heart rate begin within this window.
- You may notice a calmer pulse, though anxious thoughts may persist.
During use:
- Reduced palpitations or tremor may be noticeable.
- Cognitive anxiety may remain unchanged.
After use:
- Track your response and any side effects.
- Reassess with your clinician before ongoing use.
If prescribed daily:
- Regularly monitor blood pressure and heart rate.
- Never discontinue abruptly. This can cause rebound effects.
Better-Studied Alternatives for Anxiety
Because evidence for metoprolol is weak, consider therapies with stronger research support:¹⁵¹¹
| Treatment Approach | Evidence Strength | Best For |
| Cognitive Behavioral Therapy (CBT) | Strong | Most anxiety disorders; long-term skill-building |
| SSRIs/SNRIs | Strong | Generalized anxiety, panic, social anxiety |
| Buspirone | Moderate | Generalized anxiety disorder |
| Benzodiazepines (short-term) | Strong (short-term only) | Acute relief; not for chronic use |
| Combination (Therapy + Medication) | Strongest | Moderate-to-severe anxiety |
CBT remains the gold standard for treating anxiety, teaching long-lasting cognitive and behavioral coping skills. Many individuals benefit most from combined therapy and pharmacologic management.
The Role of Comprehensive Care
Effective anxiety management typically includes:
- Professional support (psychiatry and/or therapy)
- Evidence-based psychotherapy
- Medication management, if indicated
- Lifestyle interventions (exercise, sleep, stress regulation)
- Supportive relationships
Individual responses vary widely based on genetics, individual biochemistry/metabolism, comorbidities, and environment.
Making an Informed Decision
If your clinician recommends metoprolol for anxiety, consider discussing:
- Why this medication? What’s the rationale?
- What are our goals? Is it symptom control or long-term treatment?
- How will we measure benefit?
- What are the alternatives?
- What if it doesn’t help or worsens anxiety?
- How long is the planned duration?
- How can I safely discontinue if needed?
You deserve transparent answers and collaborative care. Seeking a second opinion is always appropriate if you feel uncertain.
The Bottom Line
Metoprolol is a cardiovascular medication sometimes prescribed off-label for anxiety-related symptoms. However, the best available research shows no clear benefit over placebo, and some individuals may even experience worsened anxiety.¹²³⁷
For most people with anxiety, especially when symptoms are psychological or persistent, evidence-based treatments such as CBT and SSRIs/SNRIs are more effective.¹⁵¹¹ Metoprolol may have a limited role for short-term, situational physical symptoms, but only under close medical supervision and with realistic expectations.
Your anxiety deserves comprehensive, research-backed care, not trial-and-error approaches with limited data.
If you’re struggling with anxiety and want evidence-based, compassionate care, PsychPlus can help. Our licensed psychiatrists and therapists provide both in-person and virtual appointments, offering flexible scheduling and insurance-friendly options.
Contact PsychPlus today to schedule a consultation and start your journey toward better mental health.
References
- Archer CS, Wiles NJ, Kessler DS, Turner KM, Caldwell DM. Beta-blockers for the treatment of anxiety disorders: A systematic review and meta-analysis. Journal of Affective Disorders. 2025;368:90-99. https://pubmed.ncbi.nlm.nih.gov/39271062/
- Shah R, Babar A, Patel A, Dortonne R, Jordan J. Metoprolol-Associated Central Nervous System Complications. Cureus. 2020;12(5):e8236. https://pmc.ncbi.nlm.nih.gov/articles/PMC7306637/
- Ahmed AI, van Mierlo PJ, van Waarde JA, Jansen PA. Hallucinations and vivid dreams by use of metoprolol. Tijdschr Psychiatr. 2010;52(2):117-21. PMID: 20146183
- Morris J, Awosika A, Dunham A. Metoprolol. StatPearls [Internet]. 2024. https://www.ncbi.nlm.nih.gov/books/NBK532923/
- Steenen SA, et al. Propranolol versus Other Selected Drugs in the Treatment of Various Types of Anxiety or Stress. International Journal of Molecular Sciences. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9456064/
- SingleCare. Propranolol vs. metoprolol: Differences, similarities, and which one is better. 2024. https://www.singlecare.com/blog/propranolol-vs-metoprolol/
- FDA. LOPRESSOR (metoprolol tartrate) Label. 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/017963s074lbl.pdf
- SingleCare. Metoprolol for anxiety: Efficacy and dosage. 2024. https://www.singlecare.com/blog/metoprolol-for-anxiety/
- Cleveland Clinic. Beta-Blockers for Anxiety: Benefits & Risks. 2022. https://health.clevelandclinic.org/beta-blockers-for-anxiety
- Burkauskas J, et al. Impact of metoprolol treatment on mental status of chronic heart failure patients. Drug Design, Development and Therapy. 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC5279819/
- UW Medicine. Should You Try Beta Blockers to Treat Your Anxiety? 2025. https://rightasrain.uwmedicine.org/mind/mental-health/beta-blockers-anxiety
- Mayo Clinic. Metoprolol (oral route) – Side effects & dosage. 2025. https://www.mayoclinic.org/drugs-supplements/metoprolol-oral-route/description/drg-20071141
- Cleveland Clinic. Beta-Blockers: Uses & Side Effects. 2025. https://my.clevelandclinic.org/health/treatments/22318-beta-blockers
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