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Any medicine, taken regularly have side effects. The more powerful they are, the more side effects there are. So unless one has real symptoms which are established and treatment recommended by a doctor, taking drugs without understanding the potential consequences is a risk i would not take. Especially if it is for a hobby. In general the less unnecessary drugs i take, the better for my health. In my profession i have to talk frequently to a large audience and i dont like it. But i prefer dealing with it naturally rather than getting used to take drugs.


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The thread is from 2009.


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This is just one of about twenty threads in PW about performance anxiety/stage fright and beta blockers. All degenerated into fisticuffs. thumb

So, as I subscribe to the premise of "if you can't beat 'em, join 'em", I'll throw in my expert opinion whistle (for the nth time). If I knew about propranolol when I was a student and doing piano exams, I'd have had no hesitation in taking them prior to each exam.

I was already well used to taking medications as a kid: daily for eight months a year (on average) for well over a decade, for a certain common condition that afflicts most teenagers. Those medications saved my skin.......

I have a violinist friend who freelances in various orchestras. She keeps a supply of propranolol for when she has to play a solo in a concert, like in this piece:


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You will find plenty of proponents and stories on both sides of the discussion. Surely, this has been beat enough not to start again with ‘just one more’.


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I had used it only on the days of my piano competitions. It was amazing, very low heartbeat and relax, the accuracy went up dramatically.
One time, the stage manager who is an MD measured my heartbeat, it was only 64 beats per minute right before I stepped out to the stage.
I know other amateur pianists also took beta-blocker, they admitted to me.

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My understanding is that, at least in the U.S., it is perfectly acceptable for physicians to prescribe inderal/propranolol "off label" to address physical symptoms of anxiety. It was once known as "the public speaking drug," and used by that significant number of people who rank death as their second greatest fear, ranking right after public speaking.

I haven't the least qualms about speaking to an audience of hundreds of degreed professionals from around the world in my field, but ask me to play something at the piano for three tone-deaf neighborhood 7-year-olds, and my hands shake and I lose focus.

I spoke to my (very good) doctor, who knows my medical situation and other medications, and he prescribed propranolol. I take it in 15mg doses sometimes when I have to play for others. It helps some to reduce physiological anxiety symptoms. It doesn't help me play any pieces better than I'm really able to play them, though.

Assuming one has good medical advice, I simply don't see a moral issue here.


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Originally Posted by ClsscLib
My understanding is that, at least in the U.S., it is perfectly acceptable for physicians to prescribe inderal/propranolol "off label" to address physical symptoms of anxiety. It was once known as "the public speaking drug," and used by that significant number of people who rank death as their second greatest fear, ranking right after public speaking.

I haven't the least qualms about speaking to an audience of hundreds of degreed professionals from around the world in my field, but ask me to play something at the piano for three tone-deaf neighborhood 7-year-olds, and my hands shake and I lose focus.

I spoke to my (very good) doctor, who knows my medical situation and other medications, and he prescribed propranolol. I take it in 15mg doses sometimes when I have to play for others. It helps some to reduce physiological anxiety symptoms. It doesn't help me play any pieces better than I'm really able to play them, though.

Assuming one has good medical advice, I simply don't see a moral issue here.

+1

Veda Kapinsky, the renowned pedagogue (affectionately known as as Darth for reasons that become self-explanatory if you watch her conduct a masterclass lol), endorsed beta blockers as a kind of ultimate solution to paralyzing performance anxiety during a seminar at PianoTexas in 2018; she even admitted to using them herself in the past. My doctor prescribed Propanalol for me several years ago, but I don't ever use it now because I take Metoprolol to control blood pressure. I've always had a low heartrate, and with the beta-blockers my resting rate is 46-48 BPM. As my doc has pointed out to me, if I were to take Propanolol now, because the effects of the drugs are additive I wouldn't ever be able to perform onstage at all because I'd have passed out or, worst case scenario, passed on.

So to anyone thinking of going this route without professional medical supervision or who may be tempted to "borrow" a tab from someone, don't. Because you may not live to regret it.


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Originally Posted by SiFi
....As my doc has pointed out to me, if I were to take Propanolol now, because the effects of the drugs are additive I wouldn't ever be able to perform onstage at all because I'd have passed out or, worst case scenario, passed on.

Great to have a doctor with a sense of humor.... ha

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Many people have some fixed beliefs about the subject of nerves and the use of beta blockers:
-people who need them have some kind of character flaw, and they should "gut it out."
-stage fright can be cured if you just do X, like having hypnosis or therapy, or practice harder, imagine this or that, read this or that book.

Here's one comment:
"Not to criticize in any way, but really curious: why do something, in this case, performing music in public, if it makes you so uncomfortable that you have to drug yourself to do it?"

I did use beta blockers on and off over the years as a professional violinist (they are easy to get a prescription for and not addictive). For one thing, stage fright can, in many people, be very fickle. One perform well for many years, and then suddenly it hits out of nowhere. It might be just at the moment of a big orchestral solo, but not otherwise.

If you are a professional, nerves can ruin a career you spent years to build. Your performance may involve something important, like an audition. You ability to pay the mortgage, send your kid to college, pay medical bills could hinge on that solo or that audition. Imagine the threat of being fired or demoted over a shaking bow arm. In a major orchestra, that would be the kiss of death for a concertmaster or other principal player. I remember playing with a very well-known violin soloist whose are was visibly shaking--very sad to see him struggle.

Are beta blockers a magic bullet? For some, yes. Personally, I'm not sure how much of their effect is due to placebo. It might well be. I remember taking a dose and thinking "now I'm set. I'll be fine." Remember that beta blockers at small doses used by musicians are pretty harmless for most, although they can cause a dry mouth.

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I’ve been taking 80 mg propranolol daily for 20 years for migraine prevention. It has NEVER helped me with performance anxiety. Either with piano performance or public speaking. I have been warned I cannot suddenly stop taking it due to risk of heart attack. At one time I did try to slowly wean myself off over a period of a couple of months because the migraines stopped. The migraines returned with a vengeance and I had such bad anxiety attacks I had to go back on it. My doc has tried switching me to another beta blocker, to no avail. Supposed to be non-addictive, but I will be on it for the foreseeable future. I understand this is all due to the amount I take. I just wanted to make sure others understand the possible issues with taking this drug, particularly on a regular basis.

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Originally Posted by Wood-demon
Has anybody ever tried hypnotherapy to overcome any of these problems?

I have, didn't do a damned thing. But maybe it was my hypnotherapist? Depends what they do to you I guess.

Last edited by Emery Wang; 07/02/21 03:30 PM.

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Reading through this thread and some of the comments, I can see why anyone taking beta blockers would be hesitant to discuss it openly — the amount of judgment and stigma that people rush to with these things… :-(

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hahaha, drugs, nerves, anxiety, all poppycock, your greatest enemy is your own conscience: am I master of the stuff? If your conscience says: 'maybe not', don't sit down and perform, get back to your piano stool and make your hours.


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Referring to my personal experience of using a beta-blocker to combat performance nerves, I could only describe them as totally game-changing. Prior to first using them (i.e. during my first five years of performing in public) within seconds of starting to perform, I'd invariably find myself next to paralysed with the shakes and loss of kinaesthetic sensation of the keyboard, which might take 10 or more terrifying minutes to overcome, at least to a more copeable level. Three or four far more experienced musicians who themselves took blockers urged me to ask my GP (=MD) to prescribe me a suitable type (oxprenolol, in the propanolol family of beta blockers), which, being knowledgeable as to their benefit for performing musicians, he did without hesitation. Bingo - problem gone, from my very first use and ever after, and no immediate intoxicating sensations or other side effects whatsoever.

After 12 or so years of dosing myself (one pill, about 30 mins before going onstage), I'd gained enough experience of performing unimpaired to venture to try performing without doing so, relying instead on a deliberately self-confident and musically assertive mindset - rather than an apprehensive, lamb-to-the slaughter one - and found myself able to bypass my earlier symptoms almost entirely. I do, though, reckon I perform more comfortably and dependably with the med than without it. But taking it has become optional for me, and I have to admit that opting to perform without leaves me with a special sense of satisfaction and pride at the end of a performance that I've succeeded at keeping fully in command of my playing "all by myself" (In that respect, for the record, I have to contend with ADHD, which is no small obstacle in itself!)


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Scordatura, excellent observations.

Thanks!


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I have some propranolol tablets I was prescribed for migraine, but I had to stop taking them as I was having breathing problems. If I could take them, and I felt they worked for stage fright, I wouldn't think twice about it.

There's no need to seek anyone's approval once the doctor is willing to prescribe them. It's not really anyone else's business.

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Though I have a very stressful job, I managed not to take any drugs to keep up with it. What surprises me is that piano is supposed to be a relaxing activity, a hobby that relieves stress. And yet, putting aside those who need it professionaly, there are people who are ready to take a heavy drug (which BTW is mainly designed for other purposes) fairly regularly just so that they can perform well (or better) .... it does not look like a very relaxing activity to me. I dont take drugs when I play tennis or go swimming. Unhapilly I do know people that actually do (some a lot, and of those some that did have consequences).

BTW, I think all sorts of drugs should be forbidden in competitions, just like they theoretically are in sports. And I think doctors should not be prescribing such drugs for convenience (professional reasons can be discussed).


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Originally Posted by johnstaf
I have some propranolol tablets I was prescribed for migraine, but I had to stop taking them as I was having breathing problems. If I could take them, and I felt they worked for stage fright, I wouldn't think twice about it.

There's no need to seek anyone's approval once the doctor is willing to prescribe them. It's not really anyone else's business.

+1


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I tried a half tablet about 5 mg of propranolol before a performance at school all it made me was nauseous. In another instance I had to give a deposition for a legal matter involving my company. I did great and was completely relaxed and nailed it. YMMV depending upon the situation at times.

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Some might find interesting this discussion of the legal and ethical issues regarding “off-label” prescription of medications (e.g., propranolol) approved by regulators for other specific indications. In short, off-label prescription by a U.S. physician is legal, ethical, and common (for reasons addressed in the article), provided the benefits outweigh the risks and the patient gives informed consent: https://journalofethics.ama-assn.or...l-what-should-physician-disclose/2016-06


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