What is the best medication for performance anxiety?

October 6, 2025 •

4 min read

According to the Anxiety and Depression Association of America, social anxiety disorder affects 12% of U.S. adults, with performance anxiety being a common manifestation. Finding what is the best medication for performance anxiety? depends heavily on individual symptoms, frequency, and overall health.

Quick Summary

This article provides a comprehensive overview of pharmacological options for performance anxiety, including situational treatments like beta-blockers and fast-acting sedatives, as well as long-term strategies like SSRIs and CBT.

Key Points

Propranolol for situational anxiety: A beta-blocker that effectively blocks the physical symptoms of performance anxiety, such as shaking and a racing heart, and is typically taken as needed before an event.
SSRIs/SNRIs for chronic anxiety: Long-term medications like Zoloft and Effexor are the first-line choice for managing persistent performance anxiety associated with social anxiety disorder, as they balance brain chemistry over time.
Benzodiazepines are short-term: Fast-acting sedatives like Xanax can provide rapid relief but carry risks of dependence and sedation, limiting their use to brief periods under a doctor's supervision.
Hydroxyzine is a non-addictive alternative: This antihistamine can offer quick, non-addictive relief for situational anxiety but can cause drowsiness and is not recommended for long-term use.
CBT is a foundational treatment: Cognitive Behavioral Therapy, alongside lifestyle changes, is a highly effective long-term solution that addresses the root psychological causes of performance anxiety, offering sustainable coping strategies.
Combine treatments for best results: Many people benefit from a multi-faceted approach, combining medication for symptom management with CBT and healthy habits to address underlying issues.

While the answer to what is the best medication for performance anxiety is not one-size-fits-all, certain drugs and therapeutic approaches have proven effective for different situations. The right treatment depends on whether the anxiety is chronic or situational, as well as the specific symptoms experienced. Beta-blockers, for example, are often the go-to for situational performance anxiety, while other medications may be more suitable for persistent anxiety disorders.

Situational Relief: Beta-Blockers

For many people, performance anxiety is an acute, situational problem rather than a constant, generalized feeling. For this, beta-blockers like propranolol (brand names Inderal, Innopran XL) are frequently prescribed off-label. They work by blocking the effects of adrenaline, which is responsible for the physical symptoms of the body's 'fight or flight' response.

How Beta-Blockers Work for Performance Anxiety

Instead of affecting the brain's emotional centers directly, beta-blockers target the body’s physical reactions to stress. This means they can help prevent or reduce the following physical symptoms that can interfere with a performance or presentation:

Rapid heart rate
Sweaty palms
Trembling hands or voice
Shallow breathing
Nausea
Dry mouth

Beta-blockers are typically taken about one hour before an anxiety-inducing event and do not carry the same risk of dependence as some other fast-acting anxiety medications. Side effects are generally mild, but can include fatigue, dizziness, and low blood pressure. They may not be suitable for people with certain health conditions, including asthma or diabetes.

Long-Term Management: SSRIs and SNRIs

For those whose performance anxiety is a persistent or chronic issue, often linked to an underlying social anxiety disorder, long-term medication may be a better solution. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line treatments. These medications work by gradually balancing brain chemistry over several weeks or months.

Commonly prescribed SSRIs and SNRIs for social anxiety include sertraline (Zoloft), paroxetine (Paxil), and venlafaxine XR (Effexor XR). Unlike beta-blockers, they address the root cause of the anxiety rather than just the physical symptoms. Side effects can include nausea, headaches, and sleep disturbances, though these often subside over time.

Quick-Acting Alternatives: Benzodiazepines and Hydroxyzine

For immediate, short-term relief, other medications are available, but they are generally reserved for specific cases due to potential risks.

Benzodiazepines: Drugs like alprazolam (Xanax) and lorazepam (Ativan) can quickly reduce anxiety symptoms but have a high risk of dependence and sedation, making them unsuitable for long-term use and not ideal for situations requiring focus.
Hydroxyzine: This antihistamine (brand names Vistaril, Atarax) has sedative properties that can reduce anxiety quickly without the risk of physical addiction associated with benzodiazepines. It can cause drowsiness and is best used for infrequent, situational anxiety.

Non-Pharmacological Treatments: CBT and More

Medication is not the only solution. Cognitive Behavioral Therapy (CBT) is an evidence-based and highly effective psychological treatment for performance anxiety, often used alone or in combination with medication.

CBT for Performance Anxiety

CBT helps individuals identify and challenge the negative thought patterns that fuel anxiety. Key components include:

Cognitive Reframing: Shifting negative self-talk into more positive and realistic thoughts.
Exposure Therapy: Gradually facing anxiety-inducing situations in a controlled manner to build resilience.
Relaxation Techniques: Practicing controlled breathing and progressive muscle relaxation to calm the nervous system.
Mindfulness: Learning to stay present in the moment and manage anxious thoughts without judgment.

Lifestyle and Supporting Strategies

In addition to therapy, lifestyle modifications can significantly impact anxiety levels:

Exercise: Regular physical activity can reduce anxiety and improve mood by releasing endorphins.
Diet: Eating a balanced diet and avoiding excess sugar and caffeine, which can exacerbate anxiety, can be beneficial.
Sleep: Prioritizing adequate sleep is crucial for managing stress.

Comparison Table of Performance Anxiety Treatments


Treatment Type	Mechanism of Action	Best For	Onset	Duration	Risks/Considerations
Beta-Blockers (Propranolol)	Blocks physical effects of adrenaline.	Short-term, situational anxiety (e.g., public speaking, performances).	30-60 minutes	Several hours	Dizziness, fatigue, slow heart rate; not for asthma or diabetes
SSRIs/SNRIs	Balances brain neurotransmitters over time.	Chronic, persistent performance anxiety linked to social anxiety disorder.	4-6 weeks	Long-term use	Initial side effects, sexual dysfunction; consistent use required
Benzodiazepines (Xanax)	Increases calming neurotransmitter (GABA) in the brain.	Short-term, urgent relief; sometimes used while SSRIs take effect.	Very fast (hours)	Short-acting	High risk of dependence, sedation, withdrawal symptoms
Hydroxyzine	Antihistamine with sedative properties.	Quick, non-addictive relief for situational anxiety or insomnia.	30-60 minutes	4-6 hours	Drowsiness, dry mouth; short-term use only
CBT	Addresses underlying thought patterns and coping strategies.	All types of performance anxiety, long-term solution.	Varies (weeks/months)	Sustainable, long-term effects	Requires commitment and practice

Conclusion

There is no single "best" medication for performance anxiety, as the ideal choice depends on individual factors and the nature of the anxiety. For targeted, situational relief from physical symptoms, a beta-blocker like propranolol is often effective and safe for many people. For chronic, persistent anxiety, long-term solutions such as SSRIs or SNRIs may be necessary. For those needing rapid but non-addictive relief, hydroxyzine can be an option for occasional use. Importantly, all pharmacological treatments should be combined with non-drug therapies like Cognitive Behavioral Therapy (CBT) and healthy lifestyle changes for the most comprehensive and sustainable results. Consulting with a healthcare provider is essential to determine the most appropriate and safest treatment plan.

For more information on different treatment options, the National Institute of Mental Health provides detailed resources on social anxiety disorder.

Frequently Asked Questions

Yes, for situational performance anxiety, beta-blockers like propranolol can be taken as needed (often about an hour before an event), and antihistamines like hydroxyzine also offer quick, on-demand relief.

Benzodiazepines like Xanax carry a high risk of dependence and addiction, which is why they are typically only used for short-term situations. However, propranolol and hydroxyzine are not known to be physically addictive, making them a safer option for occasional use.

SSRIs and SNRIs are long-term medications that require consistent use over several weeks to several months before a noticeable improvement in anxiety symptoms occurs.

While some over-the-counter antihistamines like Benadryl can cause drowsiness, they do not offer the same anxiety-specific benefits as prescription hydroxyzine. Prescription options are recommended for effective treatment.

CBT is often highly effective for addressing the psychological roots of anxiety and provides sustainable coping strategies. It is not necessarily 'better' but can be used alone or in combination with medication to offer a more complete treatment plan.

Common side effects of propranolol can include fatigue, dizziness, and low blood pressure. These symptoms often subside over time, but it is important to inform your healthcare provider if they are bothersome.

People with certain pre-existing conditions, such as asthma, diabetes, or a slow heart rate/low blood pressure, should generally avoid beta-blockers due to potential complications. A doctor's consultation is crucial.