Whether it’s your wedding day, a job interview or a big test coming up, everyone gets nervous from time to time — some more than others. And the body sure has a way of showing it — whether through sweaty palms, even sweatier underarms or a racing heart you just can’t seem to calm.

Maybe that helps explain why celebrities including Robert Downey Jr., Khloé Kardashian and Rachel Sennott have spoken so openly about using beta blockers to get through performances and other high-pressure moments. Originally developed for heart conditions, these medications are sometimes prescribed off-label to help manage certain symptoms of anxiety. Just imagine performing live in front of thousands of people. You’d probably be nervous, too.

But just because beta blockers have become popular among some of Hollywood’s biggest names doesn’t mean they’re right for everyone. Like nearly every medication, they come with trade-offs. Do they make you feel numb, as some people suggest? And what does taking one mean for your heart rate or blood pressure?

To separate what beta blockers actually do from what their recent buzz might suggest, we spoke with Dr. Oluwaposi Omiwade, a primary care physician at Houston Methodist, to find out.

What is a beta blocker?

First, what is a beta, and why is it being blocked?

The word “beta” refers to beta receptors, which are found throughout the body and respond to hormones such as adrenaline. Beta blockers are a class of prescription medications that prevent adrenaline from activating some of these receptors. Depending on the medication, that can affect how quickly the heart beats, how strongly it pumps and how blood moves through our vessels.

Doctors use beta blockers to manage conditions ranging from high blood pressure and abnormal heart rhythms to migraines and tremors. But the medications aren’t all interchangeable.

“Some are more potent on the heart, some on the blood vessels and some on receptors in the lungs,” Dr. Omiwade says. The right beta blocker depends on what a doctor wants to treat and how well the medication acts on the necessary receptors, he adds.

Propranolol is the beta blocker most closely associated with treating anxiety — particularly performance anxiety. While some beta blockers act more selectively, propranolol is considered "non-selective," meaning it targets several types of beta receptors throughout the body.

How do beta blockers help with anxiety?

When your brain senses a threat — whether it’s actual danger or perceived danger, say, speaking in front of a packed auditorium — it activates your sympathetic nervous system, better known as your fight-or-flight response. Adrenaline surges, your heart beats faster, your breathing speeds up, and you may start sweating or shaking. In turn, these symptoms can create an additional layer of anxiety, adding to the already-anxious feelings.

“Thinking about your heart racing can make your heart race more,” Dr. Omiwade says. “Thinking, ‘Oh my goodness, I’m sweating,’ can make you even more anxious. Cutting off those physiological symptoms can help stop that feedback loop.”

Beta blockers can interrupt the cycle by limiting adrenaline's effects on certain receptors in the body. With fewer physical sensations demanding their attention, some people may find it easier to focus on the presentation, performance or other stressful task in front of them.

Doctors sometimes prescribe propranolol for this purpose, but treating anxiety is technically considered an off-label use in the U.S. That means the medication is approved by the FDA, though anxiety isn’t among its officially approved indications. Doctors, however, may still prescribe an approved medication for another purpose when they determine it is medically appropriate for a patient.

That said, a steadier heart and drier palms do not necessarily mean the anxiety itself has disappeared.

(Related: Can Anxiety Cause Nausea? Plus 5 More Questions About How Anxiety Might Feel)

Do beta blockers make you feel numb?

When someone appears unusually calm or detached during an interview, viewers may speculate that beta blockers are responsible. But you can’t tell whether someone has taken a medication based on their demeanor alone. And according to Dr. Omiwade, emotional numbness isn’t what beta blockers are designed to produce.

“People may think, ‘I’m no longer anxious because I’m no longer having palpitations. I’m no longer sweating significantly, my heart isn’t racing, and I’m not shaky,’” he says. “But it’s their body’s response that’s actually being improved.”

Someone taking a beta blocker may still recognize that a situation is stressful and worry about making a mistake, forgetting what to say or being judged. Their body simply may not react as strongly.

“It doesn’t necessarily change how someone perceives the anxiety,” he continues. “Even though they perceive it as an anxiety-inducing event, their body isn’t physiologically responding to it in the same way.”

With fewer bodily sensations competing for their attention, some people may find it easier to concentrate on what they need to do, but that isn’t the same as feeling sedated or emotionally detached — and it doesn’t mean the worries or fears behind the anxiety have disappeared. Beta blockers can cause fatigue, dizziness or lightheadedness in some people, which may affect how they feel while taking one. Those are potential side effects, though — not evidence that the medication is intended to numb emotions.

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How do beta blockers compare with other anxiety medications?

So, what can help when anxiety is less about a pounding heart and more about persistent worry? That depends on the symptoms, how often they occur and how much they interfere with someone’s life. Not all anxiety medications work the same way — probably for the best.

Beta blockers such as propranolol primarily help manage the body’s response to anxiety. Benzodiazepines, including alprazolam and diazepam, work differently.

“Beta blockers and benzodiazepines can both work fairly quickly, but benzodiazepines act on the brain and can cause tolerance, dependence and misuse,” Dr. Omiwade says. “Beta blockers don’t carry that same dependence risk.”

While that may help explain some of the increased interest in beta blockers, a lower risk of dependence doesn’t necessarily make them the better choice. If persistent worries, fears or thought patterns are the main concern, reducing a racing heart or shaky hands may not be enough. Doctors may instead consider a medication intended for longer-term anxiety management, such as a selective serotonin reuptake inhibitor, or SSRI.

Medications such as escitalopram, fluoxetine and paroxetine are generally taken every day. Unlike beta blockers and benzodiazepines, these medications may take several weeks or even a month to reach their full effect, Dr. Omiwade says. They do not carry the same addiction risk as benzodiazepines, but they have their own potential side effects and do not provide immediate relief.

Some people may benefit from therapy, another type of medication or more than one approach. According to Dr. Omiwade, the decision ultimately comes down to which symptoms need treatment, how quickly relief is needed and whether the anxiety calls for a longer-term strategy. No option is without trade-offs. That said, the goal is to find an approach that matches how anxiety is showing up, rather than choosing a medication simply because it works quickly or has become popular.

When might a beta blocker make sense for anxiety?

According to Dr. Omiwade, people may benefit most from beta blockers when their anxiety is tied to a predictable event, and their body’s reaction is getting in the way of what they need to do. For example, a musician might worry about shaky hands before an audition, while someone giving a presentation may get distracted by a racing heart or excessive sweating.

That often makes propranolol a better fit for occasional, high-pressure situations than anxiety that persists throughout the day. But its potential role isn’t necessarily limited to someone preparing for a performance. Dr. Omiwade has also treated patients who continued to experience physical symptoms despite already taking another medication for anxiety.

“I’ve seen patients taking other anxiety medications who continued to have breakthrough panic attacks or physical symptoms,” he says. “We added propranolol, and it seemed to work fairly well for them.”

Whether a beta blocker makes sense depends on more than having butterflies before a big event. A doctor will also consider how often the anxiety occurs, what triggers it and whether it interferes with work, relationships or everyday life. Propranolol may help with occasional situations in which physical symptoms become especially disruptive. If anxiety is persistent or follows someone from one situation to the next, a broader treatment approach may be needed.

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What are the risks and side effects of beta blockers?

If you don’t have a heart condition, you’re probably wondering what taking a heart medication could do to your heart.

“If someone’s heart rate is already low, a beta blocker may decrease it even more,” Dr. Omiwade says. “We’re also cautious when someone has a heart rhythm problem, low blood pressure or uncontrolled asthma or COPD.”

Before prescribing a beta blocker, Dr. Omiwade considers a patient’s resting heart rate, blood pressure and medical history. Because the medication can slow the heart and lower blood pressure, it may cause problems for someone whose numbers already run low. Some people may also experience fatigue, dizziness or lightheadedness when standing. He says these side effects may prompt a doctor to adjust the dose or stop the medication.

Should you consider a beta blocker for anxiety?

If you're considering asking your doctor about prescribing beta blockers, think about when your anxiety occurs and which symptoms cause the most trouble. Is it limited to an occasional presentation, performance or other high-pressure event? Or do worries follow you throughout the day and interfere with work, relationships or things you otherwise want to do?

Bring those details to your clinician, along with a list of your medications and any history of heart problems. That conversation can help determine whether calming the body’s response would be enough or whether treatment should also address the thoughts and perceptions driving the anxiety.

“What propranolol does very well is treat the physiological consequences of anxiety,” Dr. Omiwade says. “SSRIs act on the brain as a long-term solution, while a medication such as propranolol is shorter-acting and can help with case-by-case situations. Every provider is different, but I tend to approach it based on what we’re trying to treat and how quickly the medication works.”