The first time I had a panic attack, I genuinely thought I was dying. Unless you have experienced one, it is hard to understand just how physical the symptoms can be – the pounding heart, the shortness of breath, the dizziness, the chest pain, the nausea. When they became frequent, I would often have to go to bed to sleep them off, my body utterly spent from the strain of sheer, corporeal terror. A panic attack is not a physical state that I would wish on anyone. It is pure fight or flight.
Like many others, I was prescribed a drug called propranolol to help with my anxiety symptoms. Propranolol is a beta blocker used in cardiac patients to lower the heart rate, but it is increasingly prescribed to those with anxiety disorders because it has some calming effects, and can soothe symptoms such as sweating and shaking.
Prescriptions for teenage girls in particular have surged by 90% in a decade in England, and propranolol has been called a “magic pill” and a viral “panic pill” owing to its celebrity users and immense popularity on social media. This is despite “limited evidence” supporting its efficacy. Pharmacy bodies have also raised patient safety concerns, particularly related to the risk of overdose, and now the MHRA, the UK’s medicines regulator, is undertaking a review that will include its benefits and risks for use in anxiety.
I was in my early 20s rather than my teens when I was first prescribed propranolol, and I still remember the relief of being presented with a treatment option that I was told could nip a mounting panic attack in the bud with few side-effects. It wasn’t that I wanted a “magic bullet” necessarily, but the comfort of knowing I had something in my bag that could make those awful physical feelings go away meant a lot at the time, and certainly enabled me to live my day-to-day life more comfortably, including holding down a job when panic attacks were a several times weekly occurrence owing to post-traumatic stress disorder (PTSD).
Seeing it gain a reputation as a quick fix among teenage girls makes me feel uneasy, though. There is even an element of glamorisation and an overlap with celebrity culture, to the point where the actor Rachel Sennott’s quip “take that beta blocker, girl” has become a meme. As of late September, #betablockers has more than 55m views on TikTok. A recent investigation by Cosmopolitan found that the drugs were easily available via online pharmacies.
Yet beyond being a sticking plaster for those acute moments of terror, beta blockers do not treat the underlying causes of long-term anxiety disorders: your heart may slow down, but the maladaptive thoughts remain. I had a good doctor who explained this, referred me for therapy, and also put me on a type of antidepressant known as a selective serotonin reuptake inhibitor, or SSRI – something I had resisted for far too long. Propranolol appealed because at first I thought that I could avoid having to do those things. It was certainly less work than intensive therapy and didn’t come with some of the side-effects of antidepressants (emotional numbing and, particularly dauntingly for a young woman conditioned by toxic 1990s diet culture, weight gain).
That is not to say that today’s anxiety sufferers are resistant to other treatments. I know many would jump at the chance at therapy were it more widely available and waiting lists weren’t so long. Providing long-term therapy is always going to be more immediately costly to the health service, even if ultimately a failure to treat mental health conditions when they first begin to manifest can have all sorts of societal consequences – just look at the record number of young people not in the workforce due to mental health conditions. “I think they’re using the tablet essentially to get rid of young girls from the mental health system,” one young woman with anxiety told the Observer.
Ultimately, it was the mental health system and not the propranolol that saved me and essentially cured my anxiety disorder. Looking back years down the line, having not experienced a full panic attack for half a decade (and years before that they had become rare), what I have learned is that there are no shortcuts when it comes to an anxiety disorder, and no instant cure. I needed SSRIs in combination with several bouts of talking therapy, including in the perinatal period. I was lucky that this therapy was available on the NHS, and that my most recent therapist was also trained in EMDR (eye movement desensitisation and reprocessing). This form of psychotherapy involved me talking about difficult feelings and memories while the therapist moved her fingers sideways in front of my eyes. It is thought that the side-to-side eye movements help the brain reprocess memories, lowering the intensity attached to them.
EMDR, which sounds strange when you describe it, especially as experts still aren’t quite sure how it works, was genuinely life-changing when I had it a few years ago. It is approved by the National Institute for Health and Care Excellence for the treatment of PTSD, but it can also be used to treat more generalised anxiety and phobias. No course of treatment is effective for everyone, but I would love to see more research into EMDR for general anxiety.
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I feel very lucky to have largely recovered, but recovery can also come with mixed feelings. How I wish this treatment had been available to me earlier in my life. It could have changed my whole trajectory. Looking back, I remember how lost I felt, how young I was (despite feeling like a proper adult, I really wasn’t), and how desperate I was for a cure. My heart goes out to all the younger people who are in this situation with anxiety now, its seriousness exacerbated by the pandemic, intensive social media use and a crumbling mental health system. Beta blockers may have their place, but they are never the whole answer.
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Rhiannon Lucy Cosslett is a Guardian columnist
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In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, call or text Mental Health America at 988 or chat 988lifeline.org. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978
