Adrenalin and nor-adrenalin are released by the autonomic
nervous system in response to stress. They speed up the heart
rate, raise the blood pressure, cause tremors (and have many
other effects) by interacting with (binding to) receptor
molecules on the the surface of their target cells. Caffeine and
theophylline (main "active" ingredients in tea and coffee,
magnify the effects of adrenalin on all systems, which is why
they seem to make performance anxiety worse.
There are two main classes of these cell membrane receptors for
adrenalin, alpha and beta. Beta Blockers are drugs (medications)
that bind to the beta receptors without activating them but at
the same time prevent adrenalin from getting to the receptor to
activate it. Inderal (generic name propranolol) was the first
beta blocker approved and was a major medical breakthrough
around 25 years ago. A person who has taken a beta blocker can
have a huge surge of adrenalin (from performance anxiety) and
not experience the pounding heartbeat, nausea, disabling tremor,
etc. that might normally result.
Beta blockers were created by design, by modifiying the
structure of adrenalin. Calcium is _not_ an ingredient in a beta
blocker, and an oral dose of calcium could not possibly have any
beta blocking effect. Beta blockers are also _not_ foodstuffs. I
keep an open mind, however, and will say that it is possible
that compounds with beta blocking activity might exist in
nature, but I am not aware of any formal research on this topic.
I do not know of any foods or herbs that have been shown
scientifically to have significant beta blocking activity. If
any of you know of any references, please e-mail them to me.
Alcohol and mood altering drugs are not related in any way
to beta blockers.
Any time one introduces a foreign substance into the body, one
is taking a risk of an adverse effect. This applies to aspirin,
tylenol, nicotene, ethanol, etc. Fortunately most adverse effects of
medications are mild and few are fatal; this applies especially
to medications approved for prescription in the US, which before
approval have already been taken by large numbers of people and
shown to have a very low incidence of severe side effects.
Beta blockers are among the safest of medications, used by
millions with only very rare adverse reactions. Allergic
reactions can occur to any medication, but are quite rare with
beta blockers. Extremely low blood pressure from a beta blocker
is also extremely rare.
One very predictable adverse reaction, however, is a worsening
of asthma. The normal effect of adrenalin on the lungs is to
dialate (open up) the airways, so that more air can be moved in
and out. Beta blockers will tend to close the airways. Someone
with normal lungs will not notice any change, but an asthmatic
person, with already narrowed airways, will risk a severe asthma
attack. No one with any history of asthma should consider taking
a beta blocker except under close direct medical supervision and
for the strongest of medical indications. Even a single dose
could trigger a severe bout of asthma.
Another side effect of long term usage, at least with Inderal,
is a worsening of depression. Depressed people may not be able
to take this class of medication long term, but I would be
surprised if a single dose taken to assist with performance
would cause a severe or prolonged problem. Nightmares might
be attributable to the beta blocker or to the underlying
thyroid illness.
Like any medication, beta blockers should be used only for a
valid indication. If performance anxiety is _disabling_ and
interfering with livelihood, use of a beta blocker (a single
dose of Inderal, taken a couple of hours before the performance)
is a reasonable medical intervention. Long before the
performance, it would be wise to try a dose a couple of hours
before a practice session or two, to be certain that there are
no idiosyncratic effects on coordination or reflex time (these
would be rare).
I would _not_ prescribe beta blockers for the mere convenience
of someone who was moderately nervous about a performance,
but disabling dread/fear is another matter. I have talked to
several musicians who took beta blockers only once or twice, to
get through a major performance hurdle, and were helped by
realizing that they could actually go through a stressful
performance with a feeling of still being in control - so that on
future preformances they no longer needed the medication, or had
to use it only for very uncomfortable/stressful situations. Two
examples of such a situation pertaining to a close friend: (1)
a first performance on a new double harp playing continuo,
realizing figured bass for the Monteverdi 1610 Vespers in a
concert with many prominent early musicians from Canada and
across the US, (2) a last minute call to play with the Houston
Symphony, sight-reading the harp parts for an entire concert with
less than 24 hours notice, under a prominent world famous
conductor.
BTW, as long as the use of beta blockers is taken as a sign of
weakness, many musicians who take them (some very prominent)
are not going to talk their need for the medication. Thus, you're
less likely to hear the success stories.
Could someone please e-mail me the reference to the controlled
study that was negative. I doubt that this dealt with severe
cases of performance dread, but I'd like to read the study for
myself.
Larry
mallette@bcm.tmc.edu
(alphabet soup after name ommitted)