Are drugs needed to help stage fright?

Most people have experienced performance anxiety at some time during their life. Acting in an amateur theater group can trigger stage fright. So can giving a presentation in front of business colleagues. Some people become paralyzed if they have to perform a musical composition for an audience.

People taking tests also can be gripped with terror about their performance. Symptoms include butterflies in the stomach, rapid heart rate, shaky hands, sweaty palms and dry mouth.

It is hard to do your best when you are flooded with adrenaline. But the drugs that may be prescribed to counteract stage fright have downsides of their own.

Doctors often prescribe a beta blocker heart medicine such as atenolol, metoprolol or propranolol. These drugs slow heart rate and moderate the effects of adrenaline. However, they also can trigger an asthma attack in susceptible individuals.

One reader shared this story: “I love acting, but I suffer from stage fright. My doctor prescribed propranolol to ease my anxiety during a play. Fortunately, I experimented during the final days of rehearsal. The first night, I couldn’t remember where I put my clothes during a scene change. The second night, I couldn’t recall my lines. It was a very strange and frightening experience.”

An anti-anxiety drug (benzodiazepines) such as alprazolam (Xanax), diazepam (Valium) or lorazepam (Ativan) can take the edge off. But they, too, have side effects. Some people find them too sedating. Others can’t perform at their peak.

Nondrug approaches are appealing because they are less likely to cause complications. One reader suggests: “A much better solution than drugs or therapy is to join a local Toastmasters club. They will give you the experience and confidence you need for successful public speaking.” Another agrees: “There’s nothing like practice to help you deal with that type of anxiety. Every performing artist I know experiences unpleasant feelings before going on. The trick is to learn to channel them into useful expression rather than dull them.”

A reader endorsed both strategies: “I wholeheartedly agree with the writers who commented above. I play the bagpipes. When I was learning to play, I practiced constantly, both solo and with our pipe band. As I played for my first public event with the band, I was slightly nervous, but my practice carried me through the event, and I didn’t freeze. After a while, I rarely gave it a second thought.

“I had been away from the band for many years, and rarely played except for an occasional request. The last time I played with them I was sorely out of practice. My knees began to knock together, my hands were shaking, and I ended up shaking the chanter right out of the bag! It sounded like someone trying to kill several cats at once. I was horrified and walked away.

“The Toastmasters suggestion is truly the way to go. I know several people who’ve been members, and they became wonderful speakers. I’ve heard that folks who wrote down their fears and anxieties before taking a test or performing were able to bypass the emotional anxiety and fear response, and maintain a strong link to logical thinking and processing. Perhaps this research will help people with performance anxiety.”

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. In their column, the Graedons answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website:

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