Public Speaking Anxiety Medication
This is not medical advice and is not a recommendation.
Consult your doctor.
I’m not a medical doctor, but this is how I think about medications for speaking anxiety. For more information, take the free course Navigating the Medicine Cabinet for Speaking Anxiety.
Medications can be “lifesavers” when you’re in the deep end of the pool. Meds can keep you afloat in high-pressure speaking situations. There’s no shame in using a flotation device.
Just remember, meds only mask symptoms – they’re not a cure. But they can be a good short-term strategy while you’re going through the cure.
The long-term cure is new self-talk with frequent exposures in the medium range of anxiety. The cure can take about a year…with significant progress at 2, 3, 6, 9 and 12 months. Meds can be a stop-gap while you’re doing the hard work over that longer period of time. The hard work is like going to the gym – you have to do the reps (practice several times per week).
In short, if you can manage the deep end of the pool without meds, that’s ideal. Otherwise, I recommend a beta-blocker (and maybe a benzodiazepine) in your back pocket in case you need it. Beta-blockers and benzodiazepines are not taken every day. You take them as needed 30-60-minutes before a speaking event or meeting. A beta-blocker reduces your heart rate. A benzodiazepine (benzo) relaxes your muscles and works similar to a glass of wine. Each one alone can make you feel more calm and prevent anxiety from escalating. For high-stakes events, talk to your doctor about taking both.
Here are the pros and cons of meds:
| Pros | Cons |
| Reduce anxiety | Side effects |
| Reduce the risk of a panic attack | Not a cure – just masks symptoms |
| Ensure that you’re building a database of positive memories | High relapse rate after stopping meds. (Exposures + Mindset shifts can prevent relapse) |
| Reduce the risk of quitting your job, losing your job or passing up a promotion | You’ll attribute your success to the meds instead of to yourself |
| Beta blockers and benzodiazepines are taken only as needed. You don’t have to take them everyday | You have to plan ahead with beta-blockers and benzodiazepines. Take them 30-60 minutes ahead of a speaking event |
Please don’t take meds during safe practice groups. I want you attribute your success to yourself. Also, always test any medication at home for side-effects before using them in work situations.
Our goal in the SpeakCalmHQ program is to build a database of positive memories. You may already have a layer of negative or traumatic memories and we don’t want to add to that. Sometimes medication is the best way to manage risk to avoid getting re-traumatized.
Most people in this program don’t want to be on medication. A good strategy is to use this program as a way to gradually wean off the medication, and use medication as a survival tool while you’re going through that process. Think of medication and gradual desensitization on temporary parallel paths with the goal of gradually weaning off the medication as you become desensitized.
There are disadvantages of medication. First, they have side-effects. Second, you want to develop “self-efficacy” and do this on your own without meds. Third, there is a high relapse rate. Once you stop the medication, you revert back to the same old anxiety. It’s not a cure. Fourth, I want you to attribute your success to yourself and not to the medication – but you will attribute much of your success to the medication. For all of these reasons, use them temporarily and wean off gradually as you desensitize.
Check out these authoritative sites for researching medications and side-effects:
Key Takeaways
A psychiatrist or medical doctor is the best person to assess your symptoms and recommend the right treatment. They’ll create a plan based on your specific needs.
If you only get nervous about certain events, there are “as needed” medications you can take before things like speeches or presentations. These usually include a mix of Alprazolam and Propranolol, taken about 30 minutes before your event. They don’t bring the same risks as daily medications, but always talk to your psychiatrist before trying anything new.
You can also talk about “take every day” medications if your anxiety is more regular. Your doctor can help you decide.
Types of Public Speaking Anxiety Medication
Public speaking anxiety medications fall into two main groups: “every day” and “as needed.”
1. Medications You Take Every Day
This kind of medication helps people with ongoing anxiety, not just nerves before a big event.
SSRI Examples
- Paxil (Paroxetine)
- Zoloft (Sertraline)
- Effexor (Venlafaxine)
- Celexa (Citalopram)
- Luvox (Fluvoxamine)
- Prozac (Fluoxetine)
MAOI Examples
- Marplan (Isocarboxazid)
- Nardil (Phenelzine)
- Emsam (Selegiline) (can be used as a patch)
- Parnate (Tranylcypromine)
Other Antidepressants
- Tofranil (Imipramine)
- Norpramin, Pertofrane (Desipramine)
- Aventyl, Pamelor (Nortriptyline)
- Elavil (Amitriptyline)
- Sinequan, Adapin (Doxepin)
- Anafranil (Clomipramine)
- Desyrel (Trazodone)
Daily medications like SSRIs and MAOIs take several weeks before you notice their full effects. Side effects may be part of the process, so keep your doctor updated on anything you feel. Everyone’s body reacts in its own way. Finding the right dose and brand could take time, with some adjustments along the way.
Stopping these medications suddenly can be rough because of withdrawal symptoms. Your doctor will give you a safe plan to lower your dose slowly if you ever want to stop.
If you don’t want to deal with daily side effects, you might prefer the “as needed” option.
2. Medications You Take As Needed
These are a good fit if your anxiety only hits before certain situations, like presentations or interviews. You can take a dose 30 minutes before the stressful moment. If your anxiety sticks around most days, daily medication might be better.
“As needed” meds include beta blockers and benzodiazepines (or “benzos”).
Beta Blocker Examples
- Inderal (Propranolol)
- Tenormin (Atenolol)
Beta blockers cut down physical symptoms like a racing heart and shaky hands. They keep anxiety from building on itself. If you have low blood pressure, they can make you feel dizzy or weak, so be careful.
Benzodiazepine Examples
- Klonopin (Clonazepam)
- Xanax (Alprazolam)
- Valium (Diazepam)
- Ativan (Lorazepam)
- Centrax (Prazepam)
- Dalmane (Flurazepam)
- Halcion (Triazolam)
- Librium (Chlordiazepoxide)
- Paxipam (Halazepam)
- Restoril (Temazepam)
- Serax (Oxazepam)
- Tranxene (Clorazepate)
Benzodiazepines can help you relax quickly, but they carry a risk of addiction if used too often. You may need to see a psychiatrist monthly to get these prescribed, since many primary care doctors avoid them due to their addictive potential.
Using Both Beta Blockers and Benzodiazepines
Some people find that a combination of a beta blocker and a benzodiazapine, taken together half an hour before an important event, works well for calming nerves. These meds work best when paired with positive self-talk and gradual desensitization and practice.
Always work with your doctor or psychiatrist when starting, stopping, or combining any public speaking anxiety medication.