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Look at the Stigma of Beta-Blockers

Kayleigh Miller

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Published: October 7, 2014 at 10:01 PM [UTC]

Any conversation about audition and performance anxiety has to eventually address beta-blockers and their widespread use in music (and other performing arts). In the past few weeks since I first published this on my personal blog, I’ve received a range of emails, from complete condemnation to thanks for addressing a much ignored subject. Regardless of your opinions on beta-blockers, it’s useful to try to have an objective conversation about their widespread use, and why musicians turn to them in high stress situations, without condemning musicians who choose (or choose not) to use them.

A few weeks ago, I published an article just looking at the basic effects of beta-blockers on the nervous system, and some of the side effects of regular usage. One of the comments was interesting, "Implying that taking Drugs is great??????? Shocking ending to the article." It made me think, "Performers used to drink before performances and auditions- yet taking beta-blockers is still heavily stigmatized?" Here's some of my thoughts on the issue, and how my perspective has changed over the years.

Modern day classical music has moved to a place of elite virtuosity and a an emphasis on technical perfection and complete 100% accuracy. Anyone who is in the current orchestral auditioning circuit knows this to be true, and often musical intent and sound quality are ranked lower by committees to pure execution of technical passages. (Is this true for every orchestra and festival? Not necessarily, but it is a prominent priority). This is also true in competitions, and sometimes even collegiate auditions. There's a very high emphasis on playing with perfect pitch, rhythm, accuracy, etc., which is absolutely important, but can sometimes go to the wayside under pressure (AKA. sympathetic response). Anyone who has performed or auditioned (without the use of beta-blockers) knows that things get shaky, breathing can be tricky, and accuracy can be compromised. When committees and conductors are looking for perfection under pressure, performers are left wondering what to do when their bodies betray them.

Some people are lucky to not feel strong nerves under pressure, and other people have a debilitating response. Like all things, the human body is highly variable, and individual response to stress is highly dependent on the person. When a performer spends months preparing for a competition or audition, in addition to spending money on flights and hotels, the stakes get even higher. When a diminishing job pool couples with more qualified musicians, we have a serious problem of too much supply and decreasing (often poor orchestra management too!) demand. The pressure on auditioning classical musicians these days is incredible, and I don't think our art form has ever seen anything like it. Committees have become more and more picky, looking for perfect performance under pressure that often results in no-hires and perpetual vacancies, and many musicians stay on perpetual sub lists because they are deemed worthy to play with the orchestra regularly, but not worthy enough to be given a contract. I find the whole system to be distressing, and I completely understand why people use beta-blockers, to give themselves a better chance at employment.

Classical music is not always the most forgiving art form. Many students go to expensive private music schools for either undergrad or grad school, take out loans, and then reach a point where they need to take out another loan for an instrument. If one chooses to take auditions (large ensemble, chamber music, or solo competitions), each audition will cost anywhere from $500-$1000 domestic, and a few thousand if international. Let's assume that many students have $50,000 in debt, and are somewhat unemployed after graduate studies. Students (or post-grads) might work a day job (administrative, educational, or retail) to start to pay back loans, and then still try to take auditions in between. The financial pressure alone is intense, and when it combines with a high volume of auditioners and a higher expectation of perfection, there's a volatile and very intense environment. If you put in a lot of time and money to an audition of 7 minutes duration, and you slightly speed something up or play a little sharp from sympathetic response, that's rarely forgiven by a panel. It's the unfortunate reality of our world.

I used to be a person who judged others for using beta-blockers. I thought that real musicians could control their nerves and keep calm under pressure if they prepared well (not a fair perspective at all!). I then saw how hard many of my colleagues were working, and how stressed they were, and I started to understand their situation. I did not use beta-blockers for auditioning and performing throughout my studies, and I do believe that school is a crucial incubator for learning performance skills (in a relatively low risk environment). I also realize that some people have debilitating performance anxiety, either on a physical response level or a mental level, and I will never know what that's like. I'd love for everyone to eat bananas and meditate and breathe their stress response away, but I honestly know that everyone is different and that every body responds differently to stress. When we're looking at audition stress and performance under pressure, we're not just looking at isolated anxiety, but often a whole host of issues: lack of job, huge financial pressures, need for stability for spouse/children/ etc. If I judge someone who needs beta-blockers in auditions, I'm perpetuating this idea that people must have something wrong with them if they can't perform perfectly under pressure, and that's not fair to the true host of stresses of our career.

The solution? Let’s look at the whole picture of auditioning in general, and be respectful or those who choose (and abstain) from beta-blockers. I’d also love to see orchestra auditions change entirely. I don't necessarily think that playing 7 minutes of orchestral excerpts is a good indicator of how one plays in a section (especially for strings), and I think hearing solo repertoire is often more telling than standard excerpts. As classical music loses funding and audience, maybe it's time to rethink our harsh perfection oriented standards, and instead ask 'what makes a thoughtful musician?' This standard is not only for auditioners, but also for many symphonic musicians who play under intense conductors in high pressure ensembles. I'd love for a shot at an even audition playing field in which no one uses beta-blockers and there's a mindset of forgiveness for any initial shakiness. Until then, it might be time to check that harsh judgment of beta-blocker users at the door and look at the big picture issues.

From John Cadd
Posted on October 8, 2014 at 7:20 AM
Kayleigh you made me feel slightly famous by quoting my comment . The subject has been well ,and bravely , described in your blogs . I made my comment reacting to the idea of drugs but you wrote the sentence using a politeness to allow other opinions to be aired . But drugs have been used from Satchmo to the Beatles which almost gave a casual respectability to what grew into a monstrous trade worldwide .
Just imagine a cross over from athletics where any musical competition winner has to be ushered into a cubicle offstage to give a sample before the prizes are awarded. I hope they wash their hands before accepting first prize .
From Karen Rile
Posted on October 8, 2014 at 11:54 AM
Beta blockers are neither recreational nor performance-enchancing. They don't improve concentration, nor do they give any kind of performance boost. All they do is calm heart rate and reduce symptoms like sweaty palms.

It makes no sense to compare beta blockers to performance enhancing drugs used by athletes or to heroin. And, beta blockers aren't (and never will be) part of the "monstrous trade world wide"--they aren't addictive or sexy enough to do well in that market.

If you argue that beta-blockers are unethical because they reduce undesirable symptoms, then so are anti-inflammatories, anti-depressants, antacids…

From elise stanley
Posted on October 8, 2014 at 12:07 PM
I think your comments are fair, as are the two replies above. Using artificial help to get into a position that you can then sustain without it is one thing (and might be argued for reasonably) but if you then also need that drug to permit you to do your daily work I think you should reconsider that particular career option. What if you have to take it for 30 years? Leaving aside the possible long-term medical implications (which are probably unknown), is that how you want to live your life?

And there are many who do this - I know people who take Sudafed-containing cold medications or pain-relievers just to get through each day. Even if this is usual, its surely not healthy for the spirit.

From Elmer Phillippi
Posted on October 8, 2014 at 2:14 PM
I am just an amateur fiddler and so have no experience with high-pressure auditions. But concerning beta-blockers, they are very commonly medically prescribed. They are prescribe for high blood pressure, and I was using Timolol eye drops for eye pressure. But I changed to another drug because the Timolol beta-blocker caused some fatigue, which I did not like.
Posted on October 8, 2014 at 3:30 PM
"but if you then also need that drug to permit you to do your daily work I think you should reconsider that particular career option."

Coffee, anyone?

From Christina C.
Posted on October 8, 2014 at 3:42 PM
Just a voice of caution chiming in here. I have no medical issues and I was nearly denied a prescription several years ago because I had a very low heart-rate. Nowadays I see people sharing beta-blockers with others before concerts. Based on my own experience I just cannot help but question the wisdom of that.
Despite their very wide-availability, beta-blockers are technically still prescription only, is that correct? Assuming they still are (if they're not then forget everything I'm about to say), these discussions have been great but I'd hope to see just a little more emphasis on that fact, especially in a forum like this. If one is choosing to take beta blockers for performance anxiety, hopefully the choice is being done responsibly

From Jim Hastings
Posted on October 8, 2014 at 4:33 PM
I've harped on this subject before, so to recap my position: I'm a non-user who learned as a kid to out-bully the nerves and found the adrenaline rush in recitals and auditions to be a performance-enhancer, not a hindrance.

Still, I realize that some players simply can't deal with nerves drug free as I did. If so, remember that beta-blockers do require a prescription -- at least in the USA -- and for very good reasons. If you have a medical condition that these drugs could aggravate -- or adverse interactions with other meds you're already taking -- that could spell big trouble. See your doc first.

Although beta-blockers may not be part of the "monstrous trade world wide," the pharmaceutical industry nevertheless has a vested interest in pushing these products -- even when they may not be medically necessary. Keep in mind, too, that physicians can prescribe medications for uses other than those approved by the FDA -- the USA's Food and Drug Administration. Also, while beta-blockers may not be addictive in the same way cocaine is, they can lead to physical dependence over time.

I did a Net search on this subject and came across the following article -- check it out:

Beta Blockers and Performance Anxiety in Musicians

From Krista Moyer
Posted on October 8, 2014 at 5:10 PM
I would also add a word of caution. Please seek medical advice before taking beta blockers. I was prescribed them to treat a medical condition and had an immediate strong allergic reaction. It was unexpected, as to this day, I have not been found to be allergic to anything else. Don't try it for the first time when the stakes are too high.
From Scott Slapin
Posted on October 8, 2014 at 5:15 PM
I rarely agree with articles attempting to describe the orchestral world (which I spent a decade in and happily left.) This however is excellent, and I found myself in agreement with everything you wrote.
From Paul Deck
Posted on October 8, 2014 at 5:52 PM
I think what everyone else has written in these comments is well reasoned even though there is a distribution of opinion. Needing to take some pills once in a while to get through the next performance, even over the entirety of one's career, is not a deal breaker. Lots of careers have risks, including overwork, stress, various types of exposure, physical damage, and so on.

Analogies are hard, but cosmetic surgery comes to mind. If liposuction is the difference between an acting career and no acting career, can we really expect people always to choose the latter? Whose body is it anyway?

The point is well taken, though, when you have competitions. Even though beta blockers don't seem as hazardous as anabolic steroids, to the extent that the emerging stars are role models for our kids, does it make sense to test the competitors?

From Kayleigh Miller
Posted on October 8, 2014 at 6:47 PM
Lots of great thoughts here- I previously wrote about beta-blockers and their side effects. I am neither for nor against their use, and I absolutely agree that one should check with a medical professional about side effects, especially with any current health conditions. I'm always fascinated by the general view in the music media that professionals don't get nervous for auditions or have work related anxiety, when in fact most of my colleagues, have quite a lot of it. When I was diagnosed with a non-cancerous brain tumor a few years back, I was forced to acknowledge that my body was unable to regulate itself under stress. My experience at that time showed me that even if you prepare, there are things beyond your control, and that everyone's body (even my own, under different circumstances) reacts very differently.
From Gregory Lawrence
Posted on October 8, 2014 at 8:34 PM
I would rather miss a few shifts due to some nerves during a recital or audition than be 'fake' and 'dishonest' in
taking a drug to 'stay calm'.

Such drugs should NOT be allowed for auditions, and I think the AFM should make mandatory that symphony orchestras have musicians tested 2 hours before an audition... and if found,
that person should not be allowed to audition at all, auto disqualified.

I in fact run a pro orchestra, and I do not want
musicians in my orchestra who cannot control their nerves

I also believe, anytime one interferes with the body's and mind's own natural processes, one will pay a hire price later...

There should VERY much be a stigma related to using these drugs, just as there is a stigma in athletes blood doping and using steroids to enhance their performances.

Gregory Lawrence - violinist and CCO director

Posted on October 8, 2014 at 9:02 PM
Beta blockers are not performance enhancing. If anything they they take away some of the adrenaline that can actually enhance one's performance. I take them only when I am playing any violin/viola solo so that my hands don't shake. You cannot compare this to athletic performance enhancing drugs. I don't take them for orchestra or chamber music performances.
Posted on October 8, 2014 at 9:06 PM
I wrote an article about this subject for The New York Times in 2004. For those who believe these drugs should be banned from auditions, consider this: some 10 percent of the US population takes them for life-saving medical reasons.

One simply cannot ask musicians who need these drugs daily for heart, circulation, migraine and other issues not to take them because you don't want the drugs involved in a performance. In addition, medical dosages can be 20-40 times the dosage a musician typically takes for performance anxiety, which makes the stage-fright use seem inconsequential.

In the case of the conductor above, I'm reasonably sure some members of his orchestra are prescribed these drugs for essential medical reasons. If you would fire them based on these medical needs, that action could become a serious legal issue of discrimination that could easily result in an expensive lawsuit.

It's pretty safe to say that during any performance, particularly one that includes musicians over 50 or so, there will be players using beta-blockers daily -- just as many must take cholesterol, diabetes, or other medications. --Blair Tindall

Posted on October 8, 2014 at 10:23 PM
Any comparison of beta blockers to illegal drugs or anabolic steroids is absurd. Every day I take about 12x the dose often taken before an audition (to control tachycardia) and the dose I am on is considered low by cardiology standards.

They do nothing to calm a racing mind, they do nothing to abolish fears of messing up or suffering a wardrobe malfunction, and they do nothing to compensate for poor or incomplete preparation. They do calm shaking hands and a racing heart, manifestations of anxiety in some people, but do not quell the anxiety itself.

The pharmaceutical industry, everyone's favorite straw man, has no stake in this, as most B-blockers are generic and quite cheap: for me, $4/month, with or without insurance. When prescribed by a doctor they are no more illegal than other blood pressure drugs, allergy medicines, or antibiotics. There is no equivalence to a pro athlete bulked up on steroids or a person trying to forget their crappy life with painkillers or street narcotics.

Excellent post, and some excellent comments as well.

From Scott Slapin
Posted on October 9, 2014 at 12:57 AM
Gregory Lawrence clearly doesn't understand how beta-blockers work nor does he understand the current realities of the audition circuit. His is nothing less than a ridiculous, draconian solution, unless he'd like only to favor psychopaths in auditions, who are much less likely to have nerves affect their audition performance.
From Karen Rile
Posted on October 9, 2014 at 3:20 AM
I remember that excellent article you wrote, Blair!
From Gene Wie
Posted on October 9, 2014 at 5:47 AM
The best a beta blocker drug can do is stem some of the extreme "flight or fight" response which could include rapid heart beat, irregular heartbeat, sweating, tremors, and the like. We're not talking about normal nervous reactions in most of the general population here, we're talking about physical issues that would outright prevent a person from being able to function in their desired activity because of their biochemistry.

The extreme stigmatization of those who need them to function normally reminds me of the same attacks against the clinically depressed who benefit from anti-depressants, or student athletes who have type 1 diabetes and require insulin. It's a good thing that medical science isn't so ignorant!

Posted on October 9, 2014 at 6:46 AM
I don't mean to start an argument, but I think it's necessary to clarify Mr. Lawrence's (previous commenter) status. For this season, his Cabrillo Chamber Orchestra lists only two duo recitals on its website -- no orchestral performances or orchestral musicians are mentioned; only those of Mr. Lawrence and a pianist. Also, the organization lists no 990 forms filed at, so it's impossible to determine what sort of budget or activities the group engages in. If the group indeed doesn't hire professional musicians, his recommendations for players he would theoretically employ are difficult to support. Where I come from, we'd say he ain't got a dog in this fight. ;-) --Blair Tindall
Posted on October 9, 2014 at 4:28 PM
Thanks for a terrific article, Kayleigh. In response to those who question and condemn, to varying degrees, the use of beta blockers, I would like to offer my experience. Twenty years ago, I auditioned for a position in a local semi-pro orchestra, after taking nearly 15 years off from playing. After getting my master's in performance, I quit. The performance anxiety was too much. This was a terrible decision, made when I was 23, too young to give up on my dream. How much I missed playing, you cannot know. When I decided to audition, 15 years later, for a rare opening in the flute section, I worked very hard for a long time to prepare as best I could after such a hiatus. I had never tried beta blockers, but thank goodness I followed someone's recommendation. If I hadn't, I would not have won the audition. The shaking and breathing difficulties would have prevented me from doing what I actually could do. I've been a roster musician in this orchestra for 20 years now, serve as a musician's rep on the board, chaired the strategic planning committee and perform in chamber groups (using, occasionally, beta blockers for the chamber stuff). If it weren't for this orchestra, and music in general, I'm not sure I'd be functioning at the level I do today. Social anxiety, performance anxiety and depression take a huge toll on many individuals who have much to contribute to society. How unfair to compare 5 milligrams of a drug that simply reduces the worst (for musical performance, anyhow) physical manifestations of fear. Beta blockers don't improve your technique, your intonation, your tone, your interpretive skills, or anything else. These drugs are obtained through prescription, and to compare them to athletic enhancement drugs, or recreational drugs, is a little thoughtless and too easy. As someone else mentioned -- should anti-depressants be forbidden, too? I'll bet there are musicians at all levels who depend on them, at least at various points in their lives. I've never needed them, thanks to the music in my life, made possible by winning one audition 20 years ago!
From Gregory Lawrence
Posted on October 9, 2014 at 6:39 PM
Addendum to my last comments.

Well, it appears I have ruffled some feathers in my opinion that drugs not be used to enhance one's performance.

Not my intention at
all to make anyone feel defensive...

Hey, I used to be one of the MOST nervous musicians ever.
I had the best down bow (unintentional) down bow spicatto of anyone in the business (LOLOL)... I almost hung up
my violin many times due to my nerves... I have had many colleagues tell me that I should use Beta Blockers, or this or that, etc.

It's a purely personal choice for me to not avail myself
of anything to make me, Greg, more calm. Any and all of you who want to take something to help you 'play your best', you are CORRECT that it's 100% your right to do so...

And ... please, let me qualify, and say that I would prefer anyone who might audition for CCO, feel that they don't need to take anythin; that I from much experience and pain, understand nerves, and can hear excellence and commitment to our craft despite a less than perfect audition, or even a shaky bow. If one is not at all nervous, it means one doesn't care :)

I do feel I have the right to voice my opinion without being made a villain by my colleagues.

Best to all of you!!! Greg

From Jim Hastings
Posted on October 9, 2014 at 11:52 PM wrote:

"The pharmaceutical industry, everyone's favorite straw man, has no stake in this, as most B-blockers are generic and quite cheap …."

First, a review of the definition of "straw man" is in order here. Look it up. I don't think the pharmaceutical industry fits the definition.

Second, the pharmaceutical industry does, indeed, have a stake in this. The collusion between some physicians and some pharmaceutical sales reps, at times involving commissions and kickbacks, is well known and well documented on the Net.

I have become somewhat of an insider on this. A fair percentage of my customers over the last 18 years have been pharmaceutical sales reps whose CV's I have reviewed. Often, among their significant accomplishments, they list impressive sales quotas of specifically named prescription meds. I've long known that these people are under the gun from their higher-ups to sell, sell, sell.

I did a Net search this evening on the subject of overprescribing drugs. Here is one result I came up with -- many others also corroborate what I've observed firsthand:

Doctors … Massively Overprescribing Drugs

From Brent Hudson
Posted on October 11, 2014 at 3:01 AM
Essential tremors are bad news for a violinist. They worsen with age. Recent instances of violinists performing during brain surgery to treat such tremors have made the news, and those surgeries have been reported as successful. (Having the patient play during the surgery helps the surgeons locate the site of the tremor.) Short of that, Beta blockers have worked for me. A side-benefit may be a somewhat better tolerance for stress, generally. Though the tremors are not caused by stress, stress may magnify them once they come into existence.
Posted on October 11, 2014 at 7:23 PM
I think it is 'dishonest' and 'fake ' to deny your body what it needs! And quite frankly ,crazy. What is this machoism about 'thrashing out nerves'? We'd have to all choose programmes to suit. Or do we beat drums and do a hundred press ups before performing .
From Jim Hastings
Posted on October 14, 2014 at 3:45 PM
Greg, you wrote:

"If one is not at all nervous, it means one doesn't care."

Yes. This reminds me of what I heard from one of several CSO section leaders I worked with during my 2 years in the CSO's training school. He told us during one of our weekly section rehearsals:

"When someone auditions for the Chicago Symphony, THEY'RE NERVOUS. That's because this audition is important to them. If they get the job, this is where they'll be playing -- maybe for the rest of their career. If they don't get the job, they may have to settle for Indianapolis -- maybe for the rest of their career."

You also wrote:

"I do feel I have the right to voice my opinion without being made a villain by my colleagues."

Agreed. Over the years, I've many times been one who actually points out and names the elephant in the room -- and consequently ends up being, you guessed it, "the bad guy."

Yeah -- that's life. But life goes on. What really grinds my gears in threads and blogs dealing with beta-blockers is the apparent readiness of some nervous, relatively inexperienced players to try these meds as a first resort -- instead of last. I've said: "No -- don't do it -- unless they're medically necessary."

As I've related before, I know what it's like to feel the nerves. Who doesn't? But I also learned very early to out-bully the nerves -- not by "beat[ing] drums and do[ing] a hundred press ups before performing" -- see right above me -- but by knowing the material very well and performing often. I can't speak for the next player. But for me, this tried and true plan of action worked.

From Jim Hastings
Posted on October 14, 2014 at 10:14 PM

I don't think anyone here has suggested denying our bodies what they actually need -- and I emphasize the word actually. If I'm tired, does my body "need" caffeine to stay awake? Or does it need sleep and rest to recharge? I say the latter. When body and mind are tired, why put them to cross-purposes? People often find it much easier to chase the symptoms rather than try to solve the actual problem that's causing the symptoms. Consequently, the "cure" is often worse than the "disease."

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