The prescription-only drug fuelling classical music

Andrew Gillett, a viola player in his 60s, first took beta‑blockers about 30 years ago. “It wasn’t just the experience of performance anxiety, which was terrifying and completely overwhelmingly uncontrollable,” he says. “What it did to me mentally was really crushing. It made me feel useless and that I couldn’t do it.”

Gillett is not alone. As it turns out, most musicians you see on stage are taking medication to help with their nerves. A 2024 study in the journal Medical Problems of Performing Artists surveyed 311 professional musicians and found that 51 per cent take beta blockers before performances.

Beta blockers are a medication developed for heart conditions but also prescribed to manage symptoms of anxiety, as well as glaucoma, tremors and an overactive thyroid. They work by blocking the effects of adrenaline, slowing the heart rate and steadying performers’ hands.

In 2019, Shawn Mendes announced in front of thousands of pop fans in Glasgow that he is finally not taking beta blockers to enable him to perform. But the classical world is far less open. John Beder, a documentary filmmaker who directed the 2017 film Composed, found that “despite the widespread use of these drugs today… the issue is almost never openly discussed by professional musicians”.

Zara Hudson-Kozdoj, a cellist, composer and conductor, is helping to change that. She studied at the Royal College of Music and plays with the London Contemporary Orchestra and Chineke! Orchestra, has recorded with Celeste and tours with composer Max Richter’s ensemble.

She first took beta blockers after a period of personal stress, when she started to develop bow shakes. “When you’re playing a string instrument, it’s important to have a smooth and steady bow. If you have a bad technique or if you get stressed, your hands can shake. For public speakers, it may not be such an issue, but for a musician, it can be very serious, and very obvious.”

It was an important time – she was releasing her debut album, Remember Who You Are and was about to start performing it live. “I didn’t know how to approach it. I didn’t have time to go to therapy for an extended amount of time to get to the root cause. A lot of my friends had mentioned beta blockers to me, which I hadn’t thought about before.”

Typically, musicians will take beta blockers up to an hour before their performance. Hudson-Kozdoj doesn’t use them for every stage performance, but is selective. “I’m more likely to take them for solo live concerts, rather than in a group, or if it’s a recording.”

As a younger musician, she doesn’t see her medication as a taboo issue. “My favourite thing in life is breaking taboos. There is so much wrong in classical music around mental health, so anything that is breaking the mould is a good thing. I’ll take them quite openly. I’ll take them at the lunch table or the dressing room. I’m not running to the toilet to swallow my pills.” She has noticed a generational divide. “From the vibe that I am seeing, the older generation are more anxious about it being known than people in their 30s and under.”

Gillett might agree. He studied at the Royal College of Music in the 1980s and has played in orchestras, ensembles and string quartets since then. “Yes, that may be a generational thing, and people do talk about it more nowadays, but I think a lot of it has got to do with the competitive nature of music. If you show any signs of weakness or you’re difficult, you’re not going to get work. It would be an amazing thing to be completely honest about it.”

When he was a student, playing Mahler in an orchestra in the Royal Albert Hall, Gillett recalls: “I found myself on the outside of the orchestra, right next to the audience. It was the first time I had played in such a grand place. The whole event meant so much. But I had a really nasty feeling of ‘I can’t control my bow. I’m completely out of my depth.’ Those experiences feed into you and do a weird thing with your memory, which hauls up that experience and employs it in the present.”

Doctors were not always sympathetic. One told him: “This is ridiculous – if music making is causing you to go to this place, you should just give it up.” But he found a more understanding GP and got a prescription. They worked. “My physical symptoms of flight or fright were diminished quite dramatically, so it made it possible to go on stage thinking, ‘I can do this.’”

Chris Sullivan, deputy chief pharmacist at Devon Partnership NHS Trust, is concerned, though, that musicians are not taking the correct medication. “The fact that they are not part of the NICE guidelines for treating anxiety suggests there is no robust clinical evidence that supports their use. They are good for managing symptoms, but they are not addressing the underlying causes.”

They can also come with unwanted side effects. Gillett found that after concerts, he was suffering. “It subdued my heart rate. My whole system slowed down. After a concert, if I walked uphill to get to my car, it was really hard work. I think it also had a slightly depressive effect. It made me feel low and sluggish, and slightly lose my sense of being alive, somehow.”

Hudson-Kozdoj is also curious about whether the medication takes something away from a live performance. “Because a lot of musicians are living off their adrenaline in the live performance, sometimes I wonder whether you still get the post-performance high afterwards if you take beta blockers. For me, though, the jury’s out on that question.”

Gillett decided to wean himself off and stopped completely about six years ago. “I gradually cut them down. I started by cutting them in half until I was literally just taking a crumb of it. In the end, it became a sort of placebo; I was taking so little of it.”

Beta blockers helped both Gillett and Hudson-Kozdoj, yet they believe solutions lie elsewhere. Hudson-Kozdoj is currently having counselling with BAPAM, the medical charity for the performing arts. “I have been going to therapy for performance anxiety since January, and am currently feeling really confident that taking medication isn’t going to be a forever thing for me.”

Sullivan agrees that beta blockers are not a long-term solution. “It’s a bit of a plaster. It might be a very effective plaster, but it’s a shortcut. In terms of treating anxiety, the mainstays are psychological therapy and, based on NICE guidelines, anti-depressants.”

Gillett was helped by a book. “I was helped a lot by The Inner Game in Music by W Timothy Gallwey. This book shifted my thinking a lot.” Psychology matters, he thinks: “A lot of it is the expectation you put on yourself.”

Hudson-Kozdoj’s advice to other musicians is to take a holistic approach. “First, it happens to the best of us. I’ve seen almost everyone have a little wobble on stage at some point. Second, we should look at performance anxiety holistically. Sometimes your anxiety can come out on the instrument, but it’s probably there in another place in your life.”

But when you don’t have time for therapy and a performance is looming, beta blockers are a quick fix. As Hudson-Kozdoj says: “If you need a little side effect-free pill to help you do your job, then don’t beat yourself up about it.”