Medication for public speaking phobia?
June 18, 2016 4:02 AM   Subscribe

I have a severe public speaking phobia, and am considering asking my GP about short-term medication to get me through presentations. Very concerned about being labelled a drug-seeker, though -- how to avoid this? Snowflake deets inside.

I'm in grad school, where I have to give presentations on an infrequent but semi-regular basis, and my public speaking phobia is making this hell. I know this is something many others struggle with, but I stutter, which seems to compound everything: whenever I'm anxious, I have much less fluent speech, which I then become even more self-conscious about, and so on. I also have cerebral palsy, and so when my legs begin to shake out of sheer terror, I sometimes lose my balance, which adds to the overall anxiety.

So I was thinking of asking my GP for some short-term medication to help me stay relaxed (mentally and physically) in these situations. I've never discussed a prescription for a controlled substance though, and am really concerned about being labelled a drug-seeker, or, for that matter, not being taken seriously ("just take some deep breaths..."). I usually have fairly fluent speech and control over my limbs in a familiar, non-threatening environment, so I'm worried this would seem like blatant fakery to get a prescrip for the good stuff.

Does anyone have any experience in having these concerns heard with a doctor, without them calling in the Feds?
posted by jejak to Health & Fitness (19 answers total) 4 users marked this as a favorite
You might consider asking about beta blockers, which work by blocking epinephrine. They're not officially on-label for anti-anxiety but they are widely used by musicians, public speakers, etc. with anxiety etc. and can reduce tremors and heart rate.

They're also one of the duller classes of drug from a regulatory perspective. They are mostly prescribed for high blood pressure (and widely prescribed to the elderly). It's not a recreational drug.

Whether *you personally* could take beta blockers is kind of a separate thing, since, y'know, Mefi is not your doctor or pharmacist and there are drug interactions. But I highly doubt anybody would assume someone asking about beta blockers for stage fright is a drug seeker.

Beyond that -- if beta blockers aren't an option -- I would still talk to your doctor about this. Rather than asking about drugs up-front, frame the conversation as "I have this specific problem which is caused by anxiety. Are there any options open to me?" Include details about the specific effects of the anxiety on your body. And then see what they have to say.
posted by pie ninja at 5:12 AM on June 18, 2016 [13 favorites]

BETA BLOCKERS. I have a hideous fear of flying, and often have to fly for work. Beta blockers mean I'm not a sweaty hideous mess when I get off a plane and can go straight into a meeting.
posted by nerdfish at 5:28 AM on June 18, 2016

I think your concern about being labeled a drug-seeker may be a manifestation of anxiety though. I agree with pie ninja's framing suggestion, but, I think it's opioid drugs or stimulants that get monitored so closely now. (And even then, I would hope that a decent doctor wouldn't treat you as a liar right off the bat.)

What about going to a psychiatrist instead of your GP? They might be more knowledgable about your options of anti-anxiety meds, and maybe you'd feel better talking to a new person (that you never have to talk to again if it goes badly) than with your current regular GP?
posted by oh yeah! at 5:46 AM on June 18, 2016 [1 favorite]

Best answer: When I've talked to my doctors about controlled medications, I've framed it in terms of the problem. "I'm experiencing X, I've tried Y and Z and they haven't worked for me. I've read that Drug C can be helpful for people in my situation. I'd like to talk about whether Drug A is a good option for me. I'm open to trying other options as well."

From doctor friends I've talked to in the past, I think the red flags for drug-seeking behavior include 1) no prior relationship and 2) insistence on a particular drug 3) anger if they don't get that drug. 2 and 3 are the big ones.

As an aside, I also suggest Toastmasters. I believe the reason that most of us are so anxious about public speaking is that we don't have much practice. Toastmasters would give you opportunities to speak both briefly and at length in a supportive environment, which would build your confidence in your speaking ability, which would carry over to grad school. It's key to find a club you like.
posted by bunderful at 6:24 AM on June 18, 2016 [8 favorites]

If beta blockers are not appropriate I am hard pressed to imagine a physician unwilling to prescribe a short acting benzodiazepine (PRN) for public speaking--This is assuming you have a relationship with the physician, it is not contraindicated by other medicines you might be taking and there is no history/evidence of addictions. This is something that would not be occurring frequently--no different than fear of flying. I would make sure you tolerate it and it does not have any adverse effects on your presentation skills. If you only take one in a standard dose you should be able to function just fine. The other suggestions re: some behavior mod/toastmasters are good. This all from one who had a stammer and ended up doing a regular public speaking--I mean a lot--from university through out my career. Mine resolved itself as long as I had control of the script and presentation. Good Luck
posted by rmhsinc at 7:09 AM on June 18, 2016

What you describe is exactly the kind of thing benzos can be helpful for: treating infrequent, situation specific anxiety. Also, as noted already, for some people, beta blockers can be a good alternative to benzos. I personally take clonidine, which isn't a beta blocker but is somewhat similar to them in that it's primarily for high blood pressure and has essentially no potential for abuse.

You definitely shouldn't let your concerns about being mislabelled as drug seeking keep you from getting help for this. It is true that some medical professionals can be prone to jump to this conclusion, and while benzos may not be quite as likely to trigger alarms compared to opioids or stimulants, it can happen. As noted above, you can mitigate this by starting off describing your problem and not jumping straight to asking for a benzo.

I agree with others that your best bet is to go to your doctor, and explain the problem, without jumping straight to asking for benzos. What you wrote in the question is actually a really good summary of your issues:

I'm in grad school, where I have to give presentations on an infrequent but semi-regular basis, and my public speaking phobia is making this hell. I know this is something many others struggle with, but I stutter, which seems to compound everything: whenever I'm anxious, I have much less fluent speech, which I then become even more self-conscious about, and so on. I also have cerebral palsy, and so when my legs begin to shake out of sheer terror, I sometimes lose my balance, which adds to the overall anxiety.

You might want to print this out and bring it with you to your appointment, especially if you think you might have trouble expressing yourself with the doctor. Depending on how easy it is to get in to see a psychiatrist, that could be a good avenue as well. A therapist, particularly someone who specializes in CBT therapy could be useful as well. A few sessions might be enough to help you work out some strategies to mitigate your anxiety around public speaking. I'm not suggesting this as an alternative to pursuing medications, more as an additional step to take.
posted by litera scripta manet at 7:29 AM on June 18, 2016

Best answer: I've never discussed a prescription for a controlled substance though, and am really concerned about being labelled a drug-seeker, or, for that matter, not being taken seriously ("just take some deep breaths...").

Usually the way to work with this is to indicate what you have already done. So a script like this

- I have this problem that I have been working on
- It's interfering with my life at this point
- I've already tried this, this and this (including "deep breaths" and whatever else you've tried)
- I'd like to consider medication, what would you suggest?

Often the prescription they'd give you for something like this would be small (10-15 pills, nothing that would be worth it for a drug seeker) but would last through a pretty long time of public speaking engagements.
posted by jessamyn at 7:54 AM on June 18, 2016 [4 favorites]

I took beta blockers for an oral exam (which I passed) and then later took them for a job interview. I didn't get the job because I wasn't sufficiently "enthusiastic." I tell this story to let you know that there are downsides to the drug approach.
posted by Obscure Reference at 8:20 AM on June 18, 2016

Best answer: primary care doctor here--this isn't medical advice, but this is the sort of problem I love to get from my patients because it's a situational issue that is totally amenable to low-risk treatment options.

I would just go in and present the issue as you've described it. Be prepared to be offered propranolol as a first line option, because it is actually quite effective for situational anxiety with minimal potential for abuse or diversion.

And honestly, even if your doctor thought you were drug seeking, its likely the most they'd do is say no unless you got completely obnoxious about it. At least once a quarter I have people literally scream at me for not prescribing controlled substances, and I promise your doctor has had the same thing happen.
posted by The Elusive Architeuthis at 8:26 AM on June 18, 2016 [5 favorites]

My doctor had no issues at all prescribing me first beta blockers for public speaking anxiety and then xanax when the beta blockers didn't work for me.
posted by ilovewinter at 8:32 AM on June 18, 2016 [1 favorite]

Propranolol (beta blocker) works great, has very little potential for abuse, is safe, and is inexpensive in the generic form. I use it a couple of times per year when I have to give a presentation. Works like a charm for me. Atenolol is another option and is very similar to Propranolol. I would stay away from benzodiazepines (such as Valium, Xanax, Klonopin, and Librium).
posted by alex1965 at 8:41 AM on June 18, 2016 [2 favorites]

I was in your exact same position. I have general anxiety, and high-anxiety regarding public speaking, important meetings or negotiations etc.

I also had your same anxiety about asking my doctor about it. But I've now asked 2 general practitioners about it and had ZERO issues. They were both very understanding. The first time I said something like, "I have an important presentation at work coming up and I get very visibly nervous - shaky speech, sweaty palms, short of breath. I read that beta blockers can be used for this performance-related anxiety. Is this something you would recommend, or is there something else you'd suggest?" And she was like, "Yes, great, that would be perfect for you."

And the second time to a different doctor, I was like, "Beta blockers have been prescribed for me in the past for this issue and I have some large public speeches coming up, is this still something that's a good idea?" And she was like, "Yes of course, here's the prescription and you go get 'em girl!"

Before I went in, I reminded myself that incredibly talented and powerful people have asked their doctors for help with this "stage fright." Virtuoso musicians use beta blockers for performances. Incredibly talented singers, stand up comics, actors, etc have this problem and have asked their doctors about it. IF on the off chance your doctor diminishes your symptoms, it's not your fault, it's NOT a good doctor, find a new one.

The beta blockers are highly effective for me (may not be for you, but ask and try if recommended!) They don't affect my cognitive function at all. Instead it just feels like they slow everything down a bit and cut that negative-feedback loop of "Oh my gosh, I'm nervous, now I'm appearing nervous and everyone can tell I'm nervous, and that is making me more nervous!"

In addition to this quicker-fix, I'd also recommend some longer-term therapy to address this anxiety. I no longer take beta blockers because I'm now on Lexapro for generalized anxiety, and have had effective therapy for anxiety as well. Good luck and knock 'em dead!
posted by Uncle Glendinning at 3:04 PM on June 18, 2016

As long as you are not asking about a drug with high street value (oxycontin and other opioids, adderall and other amphetamines), it is uninteresting to physicians if you "seek" them. Anything you can get for $5 at Target (which includes half the antidepressants and almost all the routine anxiolytics like generic Xanax) is worthless on the street. If you're showing up twice a month asking for more, they're gonna raise an eyebrow, but saying "can we talk about something for my gut-wrenching public speaking requirements" and walking away with a trivial amount of beta blockers or alprazolam that you re-up once a year is nothing. (Hell, my *dog* has a prescription for alprazolam. We get it at Target.)

Your doctor would much rather you periodically take something for anxiety than develop drinking/overeating/sleep/blood pressure problems from it.
posted by Lyn Never at 4:03 PM on June 18, 2016

I asked my GP what she thought about giving me a prescription for a beta blocker for occasional performance anxiety. Even though I have chronic medical conditions and take other medications regularly, she had no problem writing me a prescription for a low dose of propranolol. What I find it does most is deal with the physical symptoms like the pounding heart, sweaty palms, trembling, and muscle spasms. Without those, the mental and emotional stress sort of takes care of itself.
posted by The Underpants Monster at 4:06 PM on June 18, 2016

Beta blockers all the way! I've never had downsides to taking them, and since they really don't make you "feel" anything, they're not a drug used recreationally. I've never had an issue asking for them. I have a public speaking phobia and I used them frequently. I have had the best results with Nadalol.
posted by afton at 7:41 PM on June 18, 2016

I agree also. I took these once for an MRI I needed. I knew I would be clostophobic. I was amazed how I wasn't! However, then I needed an MRI done AGAIN, And thought oh I don't need to take that I was just fine. So I don't and I completely freaked out and had a panic attack! It was awful. What's amazing how much they help and you don't even feel drugged .
posted by tangomija at 8:35 PM on June 18, 2016

Nthing that this shouldn't be a big deal.

I have terrible anxiety when I fly. When I explained this to my doc (and why I was unwilling to just take sleeping pills) she had no problem prescribing me a low dose of Xanax. I can't see most docs being unwilling to do the same, if beta blockers don't work for you.
posted by Tamanna at 9:18 PM on June 18, 2016

I just finished two years of grad school full of presentations and other heart-pounding examinations that required thinking on my feet, and beta blockers saved me. I never did try benzos, but I bet they would have made me a little too relaxed. Beta blockers made me feel just normal - I'd still get teeny little pangs of nervousness, and I'd still think nervous thoughts, but they didn't manifest physically into the trembling, voice-shaking, or red-facedness that makes it awkward for everyone in the room. I hope you give it a try - it's been a life-changer for me! Oh, and my past two PCPs have had absolutely no hesitations prescribing it to me.
posted by sweetpotato at 9:20 PM on June 18, 2016

I think your question has already been answered well, specifically, one of the best things you can do is just present your problem to the doctor without requesting any particular drug or treatment, and be open to what they recommend. This way you will never come off as drug seeking.

Also, I'm not sure what you're thinking would happen if you were perceived as a drug seeker - I'm nearly 100% sure based on what you've laid out that even if you said "I have anxiety. Can I get some benzos?" You probably wouldn't be perceived as a drug seeker. But even if you were, no one ever 'calls in the feds'. Even with the absolute worst drug seekers I've ever dealt with who screamed at me, threatened me, told me they would sue me, etc - I don't notify anyone about the incident. I just put a flag in the chart under a section called "FYI" and briefly describe objectively what happened in the visit, so that other providers will be aware of my concerns. It's not a crime, per se, to be a drug seeker.
posted by treehorn+bunny at 10:29 PM on June 19, 2016 [1 favorite]

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