One pill makes you smaller, and one pill makes you normal...

August 12, 2009 5:18 PM

Is off label use of Beta Blockers for me? Will a doctor I've seen once be willing to prescribe a short supply?

I'm a healthy male in my mid twenties. I'm getting back into dating seriously for the first time in a couple years, and I find myself getting more nervous than I've ever been for anything. I realize it's silly, and I think it'll go away. In the meantime though, I've got a second date with a woman I'm really interested in and I'd like to control the heart pounding (in a bad way), sweating, shaking, and nausea which ultimately will lead to slightly too much drinking and a touch of *verbal* diarrhea.
I have insurance, but not a regular PCP. There's a small family run clinic/doc in the box I went to a couple months ago for completely unrelated issues. If I go to the same doc and explain my situation, will they be likely to help with some sort of temporary pharmacological stopgap?
Nothing like this has ever happened before, and I really do think it'll go away, so therapy feel unnecessary and time consuming.
Will pills help, can I get them, or am I barking up the wrong tree entirely?

posted by anonymous to health & fitness (9 answers total)

Probably depends on the doctor as well as your current state of health. If the doctor refuses, you can always try valerian for a bit.
posted by cmgonzalez at 6:41 PM on August 12, 2009

Doctors have told me that they prescribed beta blockers for stage fright for existing patients. This is a normal use, so they probably will write it for you.
posted by a robot made out of meat at 6:53 PM on August 12, 2009

I know a good number of musicians who, looking for a bit of a beta-blocker-like mellow but unwilling to go the prescription drugs route, swear by eating two or three bananas before big performances.

Alternatively, maybe all you need is a change of perspective? I HAVE been prescribed, and swear by, prescription beta blockers for musical performance (10mg of propanolol) because of an essential tremor. I've never taken them for social settings like you describe, and as a result, back in my single days I invariably would end up shaking noticeably in first-date cannoodlin'-type settings. It never got in my way -- in fact, several women (including the one that eventually married me) later confessed that they found it sorta sweet and flattering. It always went away in a date or two as familiarity set in and fear of rejection dissipated. If you don't make a big deal out it, it doesn't have to be a big deal.

In any case, there is one factor that you have complete control over: the "slightly too much drinking." Decide ahead of time how many drinks is a reasonable number, and stick to that.
posted by dr. boludo at 7:04 PM on August 12, 2009 [1 favorite]

Just a data point: one of the side-effects of beta blockers can be erectile dysfunction. Something to keep in mind when using them for social anxiety.
posted by dogmom at 7:10 PM on August 12, 2009 [1 favorite]

Odds are against you going to doctor you've seen once and getting a beta-blocker prescription after talking about 'anxiety' during a date with a women you like. The idea is just too much of a stretch of an already off label use of beta blockers for performance anxiety. What is the guy going to chart to protect himself from malpractice if you happen to have a fatal reaction from the drugs? "Patient complained of single instance anxiety during date with attractive woman, prescribed beta blockers." It's a liability nightmare.

If you want to get drugs for your date, you need to give your doctor a legitimate medical reason to prescribe medication and stroke their ego a big.

Beta blockers are probably a poor choice, as dogmom pointed out propranolol is known for its ED side effects, and they significantly drop your testosterone. If you are convinced they are the way to go, pretending to be a musician with performance anxiety that is affecting your ability to earn income is your best bet, as there are at least some studies on the subject.

It should be easy to get some benzo's (kpins or xanax) by (mis)representing what happening on this date as an anxiety disorder. Take panic order for example, look up the dsm iv criteria, and then paint a picture that allows the doctor to 'diagnose' you. Talk about 2-3 stressful events in the past six months that have given you "heart pounding (in a bad way), sweating, shaking, and nausea" and add dizzy for good measure, talk about worrying about additional attacks and how they affect your health.

The most important thing of all, is when you get a prescription, before you go out on the date, take half a pill on an empty stomach, have a beer, goto your neighborhood bar, have a stiff drink and see how you feel. You might want to take even less before your date.
posted by zentrification at 9:35 PM on August 12, 2009 [1 favorite]

From my experience, it really depends on the doctor/practice. You call it a "small family run clinic/doc in the box," and I'm not entirely sure what you mean. If it's a corporate-owned clinic that handles minor complaints (strep throat, vaccinations, ear infections for the kids, bladder infections, etc...), they probably have fairly regimented policies as to their practice that would preclude such a prescription. If it's a doc with his own small shop, than it's really up to his own comfort level on the matter. If he isn't comfortable with it, you could certainly ask him for a referral or a recommendation to a psychiatrist who may have more expertise with this type of thing.

I will note that beta-blockers are not controlled substances and can be purchased online from overseas suppliers without a prescription. My understanding is that personal importation of FDA-approved non-scheduled drugs without a prescription isn't exactly legal, but rarely intercepted by customs and doesn't result in more than a strongly worded letter if the package is seized. However, I am certainly not advocating this course of action as there certainly are risks involved nor should you begin to trust me for legal advice. You could read some of the past threads on the green about ordering prescription drugs from overseas for more information. Just wanted you to be aware of all your options here.
posted by zachlipton at 9:46 PM on August 12, 2009

Also, I'm not convinced you want to be asking for benzos as zentrification suggests. They actually are controlled substances and can cause physical dependence and even addiction. A doctor you don't really know may be uncomfortable prescribing them, not that they aren't plentiful out there. Painting such a perfect picture may well cause the doc to peg you incorrectly as an addict looking for his next fix; doc in the box practices tend to see a lot of these, although usually looking for opioid painkillers. More importantly, benzos tend to be sedating, mix quite poorly with alcohol, and it can be quite dangerous to drive while on them, especially if you've also been drinking. If you take them and your driving is impaired regardless of your alcohol consumption (in the judgment of a cop), you will be arrested, drug tested, and charged with a DUI. While you may well ultimately win at trial, this is a very bad way to end your second date.

As zentrification says though, absolutely positively get a good feel for how your body reacts to any medication well in advance of your date. Your date will almost certainly have a more favorable impression of you if you're nervous than if you're an obviously high space cadet.
posted by zachlipton at 10:00 PM on August 12, 2009 [1 favorite]

Propranolol 10mg

Performers typically take 1-2, 30 minutes prior to performance, but YMMV and you should be careful and start low.

Inhousepharmacy is often recommended on ask.mefi and I've had only positive experiences with them.

memail me for more information.
posted by bradly at 3:03 AM on August 14, 2009

Try Kava instead.
posted by Elysum at 6:06 PM on August 16, 2009