C-C-Courage in a Pill  added 11/09/01
By: Mary Desmond Pinkowish   Business 2.0  December 2001
From http://www.business2.com/articles/mag/0,1640,34910,FF.html
 
Business presentations wreaking havoc on your nerves? Beta-blockers might be the answer.

Your sweaty palms streak the polished conference table. Papers flutter in your shaky hands. You imagine that your pounding heart drowns out your cracking voice. If only this presentation were over ...

Few of us are immune to the jitters that precede speaking engagements and business presentations, but executives aren't the only ones affected. Musicians, who call the condition "performance anxiety," can be hit hard with a case of nerves during a concert. Golfers may experience the "yips" -- tremors of the forearms that prevent them from putting well and in one study added nearly five strokes per round to their scores.

For about 30 years, though, musicians and athletes have had access to a medication that allows them to perform with a cool that otherwise eludes them -- and the business community is beginning to catch on. The drug is propranolol, better known by its brand name, Inderal. New York City-based pianist Bill Hirtz notes that in the late 1970s, at least 20 percent of his classmates at the Juilliard School of Music took Inderal before a public performance. "It kept my hands from shaking as I played," Hirtz says.

Inderal belongs to the beta-blocker family of drugs, which are commonly used to treat high blood pressure and heart rhythm irregularities. It works by blocking the action of adrenaline, the chemical that causes the fight-or-flight response. The International Olympic Committee, among others, thinks the drug works -- in 1985 it banned the use of Inderal in several sports that require steady hands.

Why use Inderal rather than a widely prescribed tranquilizer such as Valium or Xanax? Well, unlike those old standbys, beta-blockers typically don't cause drowsiness or impair mental acuity and manual dexterity. And many other drugs used to treat anxiety, like Klonopin or Paxil, must be taken daily, rather than on an as-needed basis. "If Inderal works for you, it's usually OK to use it before speaking engagements," says James W. Jefferson, a psychiatrist specializing in anxiety at the University of Wisconsin Medical School. However, he cautions that Inderal, whose effects last for a few hours, "doesn't work against the cognitive, or intellectual, symptoms of anxiety. It's most effective in slowing your heart rate, keeping your hands still, and quelling the jitters overall."

Although the Food and Drug Administration has not approved Inderal (or similar drugs such as Lopressor and Tenormin) for the treatment of performance anxiety, most doctors are aware of the benefits and will prescribe it if asked. Don't leave this for the last minute, though. "The worst thing you can do is take your first dose an hour before the presentation," Jefferson says. "Try the drug a few days ahead of time to make sure that the dose is right and that blood pressure and heart rate changes aren't too extreme." Never borrow a beta-blocker from someone else, he adds.

"The typical Inderal dose is low, about 10 mg, taken 30 to 60 minutes before the anticipated stress," says Ezra A. Amsterdam, a cardiologist at the University of California at Davis. "A single, low dose is unlikely to be harmful. But some people with asthma or certain heart problems may not be able to use beta-blockers this way."

For the long run, Jefferson advises his patients to join Toastmasters International or work with a therapist who can help them surmount the jangles. "This type of anxiety often dissipates when people make lots of presentations," he says. "But no drug," he adds, "will make you blase if you bomb."

 Beta-Blockers Help You Keep Your Cool
A normal body responds to extreme stress by activating the "fight-or-flight" response mechanism -- pumping adrenaline into your system, raising your heart rate, and giving you a sudden burst of energy and power. If you're running from muggers or about to fight a grizzly bear, this can come in handy. But if you need to remain calm, here's how beta-blockers can help