With a Little Help From His Friends
A few years ago, one of my colleagues did a live interview on CNN about one of the public health topics we cover. Fifty bazillion people are watching, and he’s sitting there as calm as if he’s doing a crossword puzzle, answering questions like this is his full-time job.
It’s not. He had help.
All of us get interviewed from time to time— usually on the radio — though sometimes on live TV, which can be scarier. Afterwards, I asked him how the hell he was so calm and matter-of-fact and got the surprising answer...
“I was heavily medicated.”
Cool, if you ask me. Instead of being a blabbering, sweaty mess, he looked about as stressed as if he were playing canasta. How?
“Klonopin. And plenty of it.”
Is there a pharmaceutical way to turn down the hysteriometer? It would seem so. In fact, there are several ways.
Drugs are commonly used by terrified performers and public speakers. Some work better than others. Let’s look at some of them.
Benzodiazepines: Effective, but…
Let’s start with my colleague’s choice: Klonopin (clonazepam), a benzodiazepine. Its pharmacological cousins—diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax)—work the same way: they enhance the effect of GABA, the brain’s primary inhibitory neurotransmitter.
GABA (gamma-aminobutyric acid) acts like the brain’s main “brake pedal.” When it binds to its receptor, nerve cells become less likely to fire. That may sound backwards—doesn’t receptor binding usually activate something? Yes. But activation doesn’t always mean “go.” Some neurotransmitters excite neurons (like glutamate); others inhibit them (like GABA). Glutamate hits the gas. GABA hits the brakes. Benzodiazepines make that braking system more effective.
In plain English, they turn down the brain’s internal alarm system.
For acute anxiety, benzodiazepines work quite well. They quiet racing thoughts, minimize catastrophizing, and dampen the creeping sense that you’re about to melt down in front of fifty bazillion viewers.
But there’s a catch. Several, actually: oversedation, impaired memory, tolerance [1], and reduced psychomotor performance—slower reactions and poorer coordination between your brain and your muscles—are all possibilities.
These risks can be minimized with careful dosing and a trial run. If I’m about to be clipped to a live CNN microphone in an altered state, I’d want to be absolutely sure I’ve test-driven the drug and its dose long before the red light goes on.
The drug. The dose. The situation. It’s a balancing act. Peeing yourself on network TV isn’t great. But peeing yourself on network TV and not caring is arguably worse.
So yes, benzos work for some—but they’re a blunt instrument. Fortunately, there is a better alternative.
Beta Blockers: The Crutch du Jour
A very popular, more precise class of drugs is the beta blockers — an older class of heart medications from the 1960s that are now widely used for stage fright. There is an impressive list of celebrities who claim they've used propranolol, including Katy Perry, Chelsea Handler, Robert Downey Jr., and Khloé Kardashian.
Beta blockers (technically beta-adrenergic antagonists) control the physical symptoms caused by anxiety, not the anxiety directly. Common symptoms include:
- Shaky hands
- Racing heart
- Quivering voice
- Sweaty palms
These symptoms are largely driven by epinephrine (adrenaline), which is released during the fight-or-flight response and binds to beta-adrenergic receptors in the heart and other tissues, causing a number of responses. You’ve all heard of an “adrenaline rush.” It’s great when something is trying to catch and eat you. Not so great when you’re trying to play the piano in front of an audience.
Propranolol — Today’s Performance Darling
Unlike benzodiazepines, propranolol doesn’t sedate you or significantly alter your thinking. Instead, it blocks the peripheral effects of adrenaline — so your heart doesn’t pound, your hands don’t tremble, and your voice doesn’t crack. You may even feel less inclined to spit up on stage. It doesn’t remove fear from your brain. It removes it from your body.
In addition to helping people who are terrified of public speaking, one of the most common fears, studies suggest that it can improve performance in highly anxious test-takers by reducing the physical symptoms of anxiety.
Typically, the drug is taken an hour before (fill in your particular terrifying event) and is generally well tolerated in healthy individuals. People with heart conditions and possibly asthma [2] may have to avoid it. (Despite asthma, I would have been sucking those bad boys like Good and Plenty had it been an option during my performing days.)
Alcohol: The Worst Idea That Almost Works
Yes, a drink can reduce inhibition. That’s why it’s tempting.
It also impairs coordination, timing, memory, and judgment—precisely the things performers and speakers need most.
Unlike propranolol, alcohol is far less predictable. A small amount might calm you. A little more can impair your timing, coordination, and judgment. The line between “relaxed” and “sloppy” is thin — and easy to cross.
There’s a reason serious performers don’t rely on it.
Bottom Line
Stage fright isn’t a personal weakness. It’s physiology.
Your brain perceives a threat. Your body mobilizes for battle, just like nature intended. We evolved to fight off a sabre-toothed tiger, not to be calm in a TV studio. Pharmacology can dial down the sabre-tooth response, but it can’t supply competence. When the skill is there — something my colleague had in spades — and the body is the only thing betraying you, a small chemical nudge may be the difference between paralysis and performance. Or peeing yourself.
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