Medication to reduce public speaking panic?

Dear Alice,

I am a young lawyer, and when I have to present in courts, I get REALLY nervous, my whole body is shaking, including my face, and I can hardly speak. I tried all kinds of relaxing techniques, such as breathing, meditation, hypnosis, etc. Nothing helps. What shall I do? It is a serious problem for me. Is there any medication that may prevent me from shaking? Please answer. Thank you very much.

Dear Reader,

Fear not — you are far from the only person who gets a little panicky when public speaking. In fact, public speaking is a challenge for so many people, there’s even a joke that people would rather lie in their own coffins than give a eulogy at someone else’s funeral. Talk about being scared to death! Performance anxiety can get in the way of many things, including speaking up in a classroom setting, giving presentations in front of colleagues, scoring well on exams or at athletic competitions, — and even getting married. But, there’s no need to run and hide! There are a variety of tips and techniques that can help cool those pre-speech jitters. However, when symptoms are severe enough that they start to disrupt your daily life, there are indeed some medications that a medical professional may prescribe if necessary. Before getting into the details of those options, though, it may be helpful to get to the bottom of why public speaking can be so terrifying first.

How some folks respond to a performance or speech in front of a live audience has a lot to do with the way the human body has been wired to respond to threats. The constellation of uncomfortable symptoms you experience is your body’s way of alerting you to a perceived danger. Unfortunately, the body can’t easily distinguish between the survival threat associated with being chased by a hungry tigress and the modern threat that comes with potentially looking silly, inexperienced, or unprepared in front of an audience. While it may seem like it’s less useful for your body to respond to the fear of public speaking by increasing your heart rate and elevating your blood pressure, it’s completely natural. So, what can be done to help?

As you mentioned, there are medications that can help reduce the anxiety you’re experiencing. Beta-blockers are one class of drugs that may be of some help. These medications are taken prior to the onset of your symptoms to temporarily block the effects of adrenaline — that flight-or-flight response hormone that prepares your body to react (a.k.a., run if your still being chased by that hungry tigress) to stress. This can reduce some of the physical symptoms that accompany speaking-related anxiety, including blushing, sweating, palpitations, hyperventilation, and tremors. Because beta-blockers are usually taken as-needed, they are best suited for the occasional speaking engagement or when performance anxiety is predictable. Other medications that may provide relief are anti-anxiety medications used to treat generalized anxiety or panic disorders. The most common of these are called benzodiazepines, which are meant for short-term use, and work by depressing the central nervous system to bring the high alert signal down a few notches. Additionally, anti-depressants, such as selective serotonin reuptake inhibitors (SSRIs), are typically used to treat depression, but can reduce anxiety by elevating a person's mood and be used long-term. It’s also good to keep in mind is that medications come with their own risks and side effects. Discussing these medications with a health care provider is advised in order to find out which medication might work best for you.

While medications can certainly help relieve some of the symptoms you’re experiencing, they aren’t necessarily a cure. Reader, if you’re looking to address the roots of your fear of public speaking, it might help to ask yourself some questions. Have you thought about when your symptoms started? Has public speaking always been this stressful for you, or have you noticed more extreme symptoms only recently or specifically in court? What about speaking in court makes you most anxious? Does your anxiety impact other parts of your life outside of work? Are you often worried that other people may judge you for being nervous? Talking with a mental health professional about some of these questions may help you explore the underlying source behind your fear of public of speaking. Support groups can also be helpful by connecting you to other people who experience similar problems. These groups can share coping strategies and provide encouragement while you work through your speaking anxiety.

Ultimately, even though many folks experience performance anxiety at one time or another, not everyone responds to the same treatment options or therapies in the same way. It’s possible that a combination of different approaches such as talk therapy, relaxation techniques, or medications might be necessary to achieve and maintain the results you need. Focusing on your strengths, visualizing success, and avoiding thoughts that cause you to doubt yourself are some strategies that can go a long way to calming your quiver.

Good luck taking on the court!

Last updated Jul 15, 2016
Originally published Apr 30, 1999

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