Onstage, No Great Shakes

A hypertension drug provides an Rx for performance anxiety

The mouth goes dry, the palms turn sweaty. The heart races, the knees crumple. The symptoms of stage fright are familiar to anyone who has ever given a speech or been in a school play. Arthur Rubinstein called it "the price I pay for my wonderful life." It prevented Singer Carly Simon from performing for five years, and, without fail, it reduces Actress Maureen Stapleton to pale green mush.

Yet all this misery might be avoided, according to Dr. Charles Brantigan, University of Colorado heart surgeon and part-time tuba player. In an experiment conducted at New York's Juilliard School and the University of Nebraska, Brantigan, together with his conductor-brother Thomas (whose idea it was), tested the effect of a hypertension drug called propranolol on the performance anxiety of 29 professional and student musicians. Each subject gave two solo recitals before an audience of critics and faculty members. Ninety minutes before one recital, they were given propranolol; on the other occasion, a placebo.

Stage fright was assessed by wire-free, remote electrocardiogram monitoring during the performance and blood pressure readings before and after. The Brantigans also checked for such outward signs of stress as trembling hands and sweaty brows. By all measures, propranolol stopped the shakes. Heart rates that galloped at an average of 148 beats a minute with a placebo dropped to around 104 with propranolol (70 is a normal resting rate). Even more impressive, critics overwhelmingly favored the propranolol-soothed performances.

Brantigan, who has occasionally taken propranolol to calm himself before delivering a speech, admits that his study poses an ethical dilemma. Propranolol is strong stuff. It belongs to a class of drugs known as beta blockers, which interfere with the nervous stimulation of the cardiovascular system (by blocking "beta receptors" on cells). Though widely used to treat high blood pressure, severe chest pain (angina) and to prevent second heart attacks, beta blockers can be dangerous for people with asthma, hay fever and some types of diabetes and heart conditions. "It would worry me considerably if propranolol were being taken on the street," says Dr. Robert Temple of the U.S. Food and Drug Administration.

There is, however, growing evidence that beta blockers have uses beyond their current applications. Good results have been reported in the treatment of schizophrenia and other psychological disorders. A West German study shows that beta blockers can change Type A behavior, a pattern of aggressiveness linked to a higher risk of heart attack, into calmer Type B behavior.

The FDA is considering a proposal to approve the marketing of propranolol as a palliative for stage fright and other forms of anxiety. Many physicians are aware of this application. Reports one young intern at Johns Hopkins Hospital: "Many of us take a few milligrams before presenting on Grand Rounds--to keep our knees from knocking."

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