The symptoms of anxiety can be all-consuming: sweaty palms, shallow breaths and a churning stomach. Like the symptoms, the approaches to anxiety management vary, such as therapy, peer support groups and mindfulness strategies. One increasingly common approach is medication — the percentage of adolescents receiving antidepressant medications has more than doubled from 2006 to 2023 for children aged 3 through 17 in the U.S., from 1.5% of children to 3.6%.

Along with some turning to medications like antidepressants, others have turned to beta-blockers as a psychiatric medication option — a medicine that lowers blood pressure and blocks adrenaline’s effects like a quick pulse, headaches and sweatiness. Researchers first synthesized beta-blockers in 1958, originally intending to treat cardiovascular disease. In 1965, scientists identified beta-blockers as having calming effects. Sixty years later, 25 million adults in the U.S. take the medication for both anxiety and cardiovascular issues, but the number of patients prescribed beta-blockers for anxiety nearly doubled from 2008 to 2018. According to University of Texas at Austin professor Robert Seilheimer, beta-blockers today are off-label for anxiety, meaning the FDA hasn’t approved them for that specific use.

From heart attack recovery to anxiety, beta-blockers are used to treat a variety of conditions, with the dosage and frequency of each type varying. The most common beta-blocker, metoprolol succinate, makes up 36.9% of all beta-blocker prescriptions. Metoprolol succinate is used to treat heart and circulatory issues, and one pill can be taken a day. Despite their off-label status, doctors often prescribe propranolol, the fourth most common beta-blocker, for anxiety, making up 8.4% of all the medicine’s prescriptions.

People who suffer from situationally induced anxiety, as opposed to generalized anxiety disorder, may choose beta-blockers rather than other anxiety medications with more routine use. However, the medication can only address anxiety’s physical reactions, not its underlying chemical imbalances or psychological causes.

Now, some students are taking advantage of these physically calming effects to manage anxiety and exam stress, increasing academic performance. Five percent of health profession-related students, who often face a high-stress learning environment, use beta-blockers to relieve anxiety. Though there are several recommended options for young people to combat test anxiety, like practicing deep breathing, improving study methods and getting enough sleep, medication seems to be an answer for some adolescents. 

While beta-blocker prescriptions have increased in recent years, their use, specifically with adolescents, remains somewhat uncommon. Pediatrician Dana Kornfield said she rarely prescribes beta-blockers to treat adolescent anxiety.

“Medication can definitely help,” Kornfield said. “My very first intervention would be to work on therapeutic strategies for calming and breathing for them to be empowered to handle the stress of an exam.”

Some nervousness before an important event is natural. Test anxiety, however, is an extreme feeling of anxiety and stress that can prevent students from performing well on their exams. This anxiety can manifest itself through symptoms like lightheadedness, an increased heart rate and feelings of helplessness. In addition to the hightened difficulty during a test, students experiencing test anxiety are typically less prepared for their tests because of the negative impact in the preceding days. In 2019, 25-40% of U.S. students reported suffering from some degree of test anxiety. 

A high-stress academic environment is prevalent at Whitman, where students often balance a heavy schedule. Overall, 85% of Whitman students participate in the school’s Advanced Placement (AP) program.

Psychology teacher Kenneth Heckert said Whitman students often compete with each other over their schedule’s rigor and the number of AP classes they take, contributing to an academically pressured atmosphere. 

“If you’re trying to keep up with others and base your success in comparison to others, you’re never going to be happy,” Heckert said.

After COVID-19’s long-term effects and extended uncertainty, many adolescents’ brains showed thinning of the cortex, an area that helps execute processes like planning and self-control. Additionally, parts of the hippocampus and amygdala — sections of the brain responsible for accessing memories and regulating fear and stress — decreased in volume. Younger generations in particular report poor mental health, with 46% of Gen Z being diagnosed with some sort of mental health condition, anxiety being the most common. In May, the leading causes for poor mental health in teens were reportedly social media at 39%, an uncertain future or career instability at 22% and a poor economy at 11%.

In response to poor mental health, 34% of Gen Z currently take prescription medication to manage their symptoms, and another 19% take non-prescribed drugs such as cannabis. However, taking medication without an official prescription can be dangerous — substance misuse, substance dependency and medical complications can result. Despite their use within the medical community, beta-blockers have attracted controversy in recent years due to the possibility of increasing depressive symptoms.

Some of the beta-blockers’ negative mental health effects can target students in particular. Researchers conducted a survey on Danish students with a median age of 19 during their schools’ exam periods from May through June. The survey found that 18.3% of students using beta-blockers were prescribed antidepressants after the students’ exam period, compared to 11.5% of non-beta-blocker users, and 10.1% of beta-blocker users were prescribed a psychotropic drug compared to 5.4% of non-beta-blocker users. 

In addition to mental health-related side effects, beta-blockers can have physical side effects. Kornfield said the medication can potentially leave a negative impact on the user. 

“The physical symptoms of anxiety are reduced,” Kornfield said, “but because it’s a blood pressure medication, people can feel tired or a little light-headed.”

With doctors diagnosing mental health conditions in their patients at a higher rate, prescriptions for medications to address these conditions are increasing as well. Diagnosis rates for anxiety disorder rose from 1.4% to 4.6% of ambulatory care office visits for adolescents between 2006-2010 and 2014-2018.

Despite a rise in the diagnosis of anxiety disorders, the use of therapy to treat medical conditions has dropped, from 48.8% of patients with a diagnosis to 32.6%. Some mental health professionals have questioned whether medication is the best option for treating mental health conditions, especially for teens. 

“The decision to take a beta-blocker — or any prescription medication — should be made with a doctor who can discuss the risks and benefits of these medications, as well as their alternatives,” Seilheimer said.

According to Seilheimer, no doctor’s decision to treat mental health conditions would be to “always” or “never” prescribe medication; rather, the decision-making process for distributing medication is much more complex.

Overall, taking medication as prescribed by a healthcare provider, being honest about treatment goals with a doctor and considering other mental health treatment options like therapy are all steps to take when starting anxiety medications. Kornfield noted that she prescribes medication in addition to therapy, with therapy as her first option.

“My goal with an adolescent who’s in high school with another 10 years of exams ahead of them,” Kornfield said, “is to help them learn strategies for anxiety regulation before turning to medication.”