Which medication is used to treat performance anxiety such as public speaking?

• A. Beta-blocker
• B. SSRI
• C. MAOI
• D. Antipsychotic

Answer: (A)

Situational performance anxiety is driven by rapid sympathetic activation before and during a performance, leading to tachycardia, tremor, sweating, and a sense of racing thoughts. A beta-adrenergic blocker is the best choice here because it blunts these physical symptoms by blocking the effects of adrenaline on the heart and other organs. This helps the performer feel steadier and speak more clearly, without necessarily dulling cognition or mood. The effect is fast-acting and short-lived, making it ideal as a PRN, pre-event medication for public speaking or similar performances.

Beta-blockers are preferred for this use over long-term antidepressants or antipsychotics, which are not aimed at treating the acute, situational symptoms of performance anxiety. SSRIs can help with generalized or social anxiety disorders when used chronically, but they’re not the immediate fix for a single performance. MAOIs and antipsychotics aren’t appropriate treatments for performance anxiety. Be mindful of potential side effects like bradycardia, hypotension, and, in those with asthma or COPD, bronchospasm risk with nonselective beta-blockers.