Better music by prescription

Amid growing expectations and pressures, some musicians are turning to medications to calm their nerves, but in the School of Music, the topic remains taboo.
March 01, 2010
Editor's Note: Editor’s Note: This is the first in a three-part series investigating how some University of Minnesota students use drugs to excel in their studies. The second part will focus on students who take psychostimulants as a study aid.

Joshua Rohde smiled backstage as he wiped loose rosin off his cello.
“I’m excited for this. I don’t know if I’m like the average musician who’s wetting their pants right here.”
The University of Minnesota School of Music senior tuned his A string while he waited to go on stage for his senior recital — the culmination of a lifetime of study and practice.
After seeing his flushed face in the mirror, Rohde admitted he was a little anxious.
Rohde prayed, then bent over and untied his shoes. He pulled the laces tight again and walked to the stage, content with his ritual.
One slip of the hand, one tremor, a single wrong note and the entire performance can go flat.
“At the moment when the conductor looks up and you have a solo, you want it to be perfect,” sophomore bassoonist Katie Bauernfeind said. “It has to be perfect.”
The pressure can be high on stage and even higher during auditions, but some musicians are finding a solution to their big performance anxiety problems in a little white pill.
The drugs, known as beta blockers, plug the body’s beta receptors and prevent adrenaline from taking effect. Without that adrenaline, the sweaty palms, soaring heart rate and anxiety that plague performers largely disappear.
Most students say beta blockers are not commonly used, but some quietly acknowledge that the drug is more common than outsiders would imagine or administrators might like to admit.
Veronica Staupe, a 2008 graduate of the School of Music, posited that a quarter of students use the drug during auditions and solos.
“Is it giving them any specific advantage?” asked Dr. Gary Christenson, director of Mental Health Services at Boynton Health Service. “Only if you’re in any type of competition or something like that. I think that’s something people have to argue about what’s fair and what’s not.”
An antidote for anxiety
Christenson said beta blockers don’t prevent the mental symptoms of anxiety, but they do reduce physical manifestations.
“They help with keeping people’s heart rate from getting too fast. It suppresses tremor as well, and therefore, your body and your brain aren’t saying, ‘Oh, wow, I’m starting to get shaky,’ which only makes you more anxious and makes you more shaky. It really kind of cuts that feedback loop,” he said.
Performance anxiety hinges on the adrenaline spike evoked by major stress, said Dr. Barry Rittberg of the University Department of Psychiatry.
That reaction evokes the fight-or-flight response that could be lifesaving in an emergency, but it can sink a concert performance.
“Obviously neither of those things is useful when you’re on stage performing,” Rittberg said.
Anxiety is a normal response to being on stage in front of an audience, but it’s the level of reaction that determines whether physicians medicate a patient.
“Most people do get a little stage fright,” Christenson said. “But [musicians who are prescribed the drug] are not having a natural reaction —they’re having an excessive reaction.”
In a testament to its efficacy at calming nerves, the drug has even been used by public speakers, marksmen and surgeons.
It is also banned by the International Olympic Committee, and in 2008, the Committee stripped a North Korean marksmen of two medals after he tested positive for the banned substance.
“In my profession,” Rittberg said, “we take oral board exams, which can be very anxiety-provoking, so sometimes people will take a beta blocker before that.”
Christenson said musicians with performance anxiety sometimes specifically request beta blockers.
If the student’s condition rises to the level of social anxiety, physicians usually prescribe a different medication.
Physicians also prescribe non-medicinal remedies such as anxiety management techniques.
Scores of musicians reach for chocolate before stepping on stage.
“That’s the ultimate for good mood,” cello professor Tanya Remenikova said.
Some performers drink alcohol. Others perform yoga, and even bananas have become a cure-all for stage fright.
“On performance days, the cafeteria is [sometimes] out of bananas,” Bauernfeind said.
But when bananas and breathing techniques aren’t enough, a bottle with enough beta blockers for 50 concerts costs $14, Rittberg said
A taboo in the classroom
David Myers, director of the School of Music, said the school discourages students from using the drug unless prescribed to do so by a doctor.
Myers said the school has no policy specifically addressing beta blockers, but if students are caught using the drug without a prescription they will be dealt with on an individual basis.
“We’re not on any kind of witch hunt to out students or anything else,” Myers said. “But if we become aware of this, it is certainly something I think we need to address.”
The school is divided into different studios run by individual professors. Each studio admits a limited number of students every year, and coursework, technique and expectations among them vary widely.
But almost universally, beta blockers are taboo.
“It is something I’ve never experienced, witnessed or heard of in the School of Music,” Katie Bauernfeind said.
“I don’t talk about it because nobody really asks me about it,” cello instructor Tanya Remenikova said. “I assume that nobody takes it.”
Remenikova said she coaches students through preparation techniques to avoid using the drug.
“There are certain studios that encourage, or certainly don’t discourage, the use of beta blockers,” said School of Music alumna Veronica Staupe. “It’s intense pressure, be it self-induced or pressure from the studio and other people.”
Anna Clearman, a recent graduate, said she knew that some of her peers took beta blockers, but only before auditions and competitions.
“[Most users] definitely would be the top performers who take what they do very seriously. It would be for the very important situations where they need to win something, or it would cost them a job,” Clearman said. “And a class, or a jury, was never one of those [situations].”
Sally O’Reilly, one of the University’s most prominent violin instructors, said heavily edited CDs and the knowledge that others are using beta blockers can put extra pressure on performers to deliver a flawless performance, especially in auditions.
“It just makes people so much more aware of their flaws,” O’Reilly said. “They can be almost imperceptible, but it can cost you a job. That’s just reality.”
Off the label
Inderal, one of the most popular brand-name beta blockers, is not approved as a treatment for anxiety. It has been a marquee drug in its 40-year history, though it first came to market as a treatment for high blood pressure.
Physicians can prescribe a drug off-label, or for purposes other than its FDA-approved use, if they believe the drug’s properties match up with physical conditions.
“If a doctor chooses to use the drug off-label, that’s his discretion,” FDA spokeswoman Sandy Walsh said. “We don’t regulate the practice of medicine.”
Walsh added that she has received numerous inquiries into the prescription of beta blockers for musicians.
Boyton’s Christenson said it is unlikely that the drug will be tested by the FDA as a treatment for anxiety.
“Some [drugs] become so commonly used that physicians probably don’t even realize they’re off-label anymore. They’ve just been used so thoroughly that they’ve just become part of the treatment as usual,” Christenson said.
Rittberg said the drugs are generally safe, especially at the low dosages prescribed for treating anxiety, but they can mask blood sugar deficiencies in diabetics and aggravate existing asthma.
“Probably people with bad asthma wouldn’t play the flute anyway,” Rittberg said.
Christenson said beta blockers don’t relax musicians who are already calm. It simply “normalizes” those who are overly anxious.
Even if the drug isn’t making musicians better, it challenges perceptions of natural performing talent and ability.
O’Reilly said that in the past, students have spoken with her about the drug, but outside the school, it may be rampant.
“I would imagine that in the professional world, when people are taking an orchestra audition, I would bet that anywhere from 80 to 90 percent of people who are taking those auditions are taking a beta blocker,” O’Reilly said.
Fear and stigma
Veronica Staupe tried beta blockers during a summer performance while she was at the University. Another student offered her the drug, and she said she took it as an experiment.
“I was jittery. I played much worse. I felt calm, but I was just shaking, and it was not a good idea,” Staupe said. “I didn’t feel nervous, but I couldn’t play. I couldn’t physically play. It was like I couldn’t control my body.”
Staupe never took the drug again.
Most musicians downplay the drug’s possible effect on a performance and said they would not feel cheated if they were competing against a performer who was taking beta blockers. Rittberg said the drug is not a performance enhancer.
“If you’re a bad musician, you’re a bad musician with or without beta blockers,” Rittberg said.
Cello professor Remenikova agreed that the drug isn’t the panacea some students may think it is.
“It wouldn’t help if you weren’t adequately prepared anyway,” she said.
In most cases, music isn’t a competition; it’s about the passion and the interpretation, Clearman said. Clearman did not know who, if anyone, is cheated when a musician takes the drug.
“I would even say that an audience — that if their performer needs to take beta blockers — they would even appreciate it, so they don’t see their performer struggling on stage.”
Yet, even if the beta blockers are a boon, there is a stigma attached to them.
“[Students deny taking beta blockers] if they have insecurities about it, or if they think other people won’t approve,” Clearman said.
In prescribing the drug, Christenson said doctors are helping musicians who might otherwise be unable to perform.
“And what happens if you have incredible musical talent,” Christenson asked, “but when you get up on stage … you blank out, you get frightened? Should that person not be a musician? Should the audience be deprived of someone with that much musical talent?”
But for Clearman, fear is a natural part of a live performance. Musicians find a thrill in attempting to communicate to a large audience, she said.
“The fear is that you won’t communicate it the way you want to, you’ll screw up a bowing and a fingering. That’s the fear, and it is a very valid fear because 99.9 percent of the time, you will do something because you’re human.”

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