The following blog arose from contributing to an article in The Strad by Catherine Nelson on drugs and occupational stress amongst professional musicians.
As clinical pharmacologist and amateur violinist gives me two perspectives on performance or audition anxiety: this is due to the triggering of an extra release of
adrenaline – and other fight-or-flight response hormones – which in turn can cause
string players to feel anxious and suffer a shaking bowing arm. Beta-blockers can stop
unwanted reactions to these hormones, such as an increased heart
rate, and thus lessen detrimental effects of stress on the musician’s performance.
I had heard of a violinist who was so anxious and stiff during an audition that the bow simply flew out of his hands. Many professional musicians are worried by the stress of performance, and beta-blockers may help some players control the debilitating physical symptoms of this stress.
It is of course extremely important that musicians, for whom medical treatment of occupational stress may be indicated, work with a medical practitioner to ensure, if a beta-blocker appears worth a trial, that they take the right dose, provided it has been checked that this would be medically safe to do so. I am particularly concerned about anecdotal evidence of players sharing medicines - which may not be the right medicine, or a possible cause of severe and rapid onset harmful effects. People are increasingly turning to the internet to obtain drugs. At best these pills may be out of date – at worse they may be contaminated. Taking them without getting advice from a doctor can be very dangerous.
Beta-blockers slow the heart, helping to make people feel calmer, but they also make your heartbeat less forceful than it should be, so that even fit people may feel tired and short of breath, and some people may be tipped into heart failure. Players with certain pre-existing medical conditions may suffer worse adverse reactions. These drugs also make the airways less open, so are dangerous in asthma. Other side effects include sleep disturbance, weight gain and stomach upset, including increased stool frequency and urgency. There are also reports of people suffering depression while taking beta-blockers, though it may be that people with heightened anxiety are more prone to suffering depression. It is therefore better to avoid medicines if possible.
The message for beta-blockers should be that if they are worth a trial on medical grounds, to try a low dose under the advice of a medical practitioner; the dose may then be carefully increased if needed. If medically indicated, it is also very important always to try beta-blockers first under rehearsal conditions, as being made too relaxed or having unwanted effects could be harmful when performance really matters.
The implications of the broader issue of anecdotal widespread use of beta-blockers raise important occupational health and ethical concerns which deserve to be discussed nationally and internationally, both by the music profession and relevant medical organisations.
See The Strad for more on the article.
I had heard of a violinist who was so anxious and stiff during an audition that the bow simply flew out of his hands. Many professional musicians are worried by the stress of performance, and beta-blockers may help some players control the debilitating physical symptoms of this stress.
It is of course extremely important that musicians, for whom medical treatment of occupational stress may be indicated, work with a medical practitioner to ensure, if a beta-blocker appears worth a trial, that they take the right dose, provided it has been checked that this would be medically safe to do so. I am particularly concerned about anecdotal evidence of players sharing medicines - which may not be the right medicine, or a possible cause of severe and rapid onset harmful effects. People are increasingly turning to the internet to obtain drugs. At best these pills may be out of date – at worse they may be contaminated. Taking them without getting advice from a doctor can be very dangerous.
Beta-blockers slow the heart, helping to make people feel calmer, but they also make your heartbeat less forceful than it should be, so that even fit people may feel tired and short of breath, and some people may be tipped into heart failure. Players with certain pre-existing medical conditions may suffer worse adverse reactions. These drugs also make the airways less open, so are dangerous in asthma. Other side effects include sleep disturbance, weight gain and stomach upset, including increased stool frequency and urgency. There are also reports of people suffering depression while taking beta-blockers, though it may be that people with heightened anxiety are more prone to suffering depression. It is therefore better to avoid medicines if possible.
The message for beta-blockers should be that if they are worth a trial on medical grounds, to try a low dose under the advice of a medical practitioner; the dose may then be carefully increased if needed. If medically indicated, it is also very important always to try beta-blockers first under rehearsal conditions, as being made too relaxed or having unwanted effects could be harmful when performance really matters.
The implications of the broader issue of anecdotal widespread use of beta-blockers raise important occupational health and ethical concerns which deserve to be discussed nationally and internationally, both by the music profession and relevant medical organisations.
See The Strad for more on the article.
No comments:
Post a Comment