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.

by Ian Larson

Joshua Rohde smiled backstage as he wiped loose rosin off his cello. âÄúIâÄôm excited for this. I donâÄôt know if IâÄôm like the average musician whoâÄôs wetting their pants right here.âÄù The University of Minnesota School of Music senior tuned his A string while he waited to go on stage for his senior recital âÄî 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. âÄúAt the moment when the conductor looks up and you have a solo, you want it to be perfect,âÄù sophomore bassoonist Katie Bauernfeind said. âÄúIt has to be perfect.âÄù 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 bodyâÄôs 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. âÄúIs it giving them any specific advantage?âÄù asked Dr. Gary Christenson, director of Mental Health Services at Boynton Health Service. âÄúOnly if youâÄôre in any type of competition or something like that. I think thatâÄôs something people have to argue about whatâÄôs fair and whatâÄôs not.âÄù An antidote for anxiety Christenson said beta blockers donâÄôt prevent the mental symptoms of anxiety, but they do reduce physical manifestations. âÄúThey help with keeping peopleâÄôs heart rate from getting too fast. It suppresses tremor as well, and therefore, your body and your brain arenâÄôt saying, âÄòOh, wow, IâÄôm starting to get shaky,âÄô which only makes you more anxious and makes you more shaky. It really kind of cuts that feedback loop,âÄù 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. âÄúObviously neither of those things is useful when youâÄôre on stage performing,âÄù Rittberg said. Anxiety is a normal response to being on stage in front of an audience, but itâÄôs the level of reaction that determines whether physicians medicate a patient. âÄúMost people do get a little stage fright,âÄù Christenson said. âÄúBut [musicians who are prescribed the drug] are not having a natural reaction âÄîtheyâÄôre having an excessive reaction.âÄù 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. âÄúIn my profession,âÄù Rittberg said, âÄúwe take oral board exams, which can be very anxiety-provoking, so sometimes people will take a beta blocker before that.âÄù Christenson said musicians with performance anxiety sometimes specifically request beta blockers. If the studentâÄôs 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. âÄúThatâÄôs the ultimate for good mood,âÄù cello professor Tanya Remenikova said. Some performers drink alcohol. Others perform yoga, and even bananas have become a cure-all for stage fright. âÄúOn performance days, the cafeteria is [sometimes] out of bananas,âÄù Bauernfeind said. But when bananas and breathing techniques arenâÄôt 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. âÄúWeâÄôre not on any kind of witch hunt to out students or anything else,âÄù Myers said. âÄúBut if we become aware of this, it is certainly something I think we need to address.âÄù 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. âÄúIt is something IâÄôve never experienced, witnessed or heard of in the School of Music,âÄù Katie Bauernfeind said. âÄúI donâÄôt talk about it because nobody really asks me about it,âÄù cello instructor Tanya Remenikova said. âÄúI assume that nobody takes it.âÄù Remenikova said she coaches students through preparation techniques to avoid using the drug. âÄúThere are certain studios that encourage, or certainly donâÄôt discourage, the use of beta blockers,âÄù said School of Music alumna Veronica Staupe. âÄúItâÄôs intense pressure, be it self-induced or pressure from the studio and other people.âÄù Anna Clearman, a recent graduate, said she knew that some of her peers took beta blockers, but only before auditions and competitions. âÄú[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,âÄù Clearman said. âÄúAnd a class, or a jury, was never one of those [situations].âÄù Sally OâÄôReilly, one of the UniversityâÄôs 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. âÄúIt just makes people so much more aware of their flaws,âÄù OâÄôReilly said. âÄúThey can be almost imperceptible, but it can cost you a job. ThatâÄôs just reality.âÄù 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 drugâÄôs properties match up with physical conditions. âÄúIf a doctor chooses to use the drug off-label, thatâÄôs his discretion,âÄù FDA spokeswoman Sandy Walsh said. âÄúWe donâÄôt regulate the practice of medicine.âÄù Walsh added that she has received numerous inquiries into the prescription of beta blockers for musicians. BoytonâÄôs Christenson said it is unlikely that the drug will be tested by the FDA as a treatment for anxiety. âÄúSome [drugs] become so commonly used that physicians probably donâÄôt even realize theyâÄôre off-label anymore. TheyâÄôve just been used so thoroughly that theyâÄôve just become part of the treatment as usual,âÄù 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. âÄúProbably people with bad asthma wouldnâÄôt play the flute anyway,âÄù Rittberg said. Christenson said beta blockers donâÄôt relax musicians who are already calm. It simply âÄúnormalizesâÄù those who are overly anxious. Even if the drug isnâÄôt making musicians better, it challenges perceptions of natural performing talent and ability. OâÄôReilly said that in the past, students have spoken with her about the drug, but outside the school, it may be rampant. âÄúI 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,âÄù OâÄôReilly 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. âÄúI was jittery. I played much worse. I felt calm, but I was just shaking, and it was not a good idea,âÄù Staupe said. âÄúI didnâÄôt feel nervous, but I couldnâÄôt play. I couldnâÄôt physically play. It was like I couldnâÄôt control my body.âÄù Staupe never took the drug again. Most musicians downplay the drugâÄôs 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. âÄúIf youâÄôre a bad musician, youâÄôre a bad musician with or without beta blockers,âÄù Rittberg said. Cello professor Remenikova agreed that the drug isnâÄôt the panacea some students may think it is. âÄúIt wouldnâÄôt help if you werenâÄôt adequately prepared anyway,âÄù she said. In most cases, music isnâÄôt a competition; itâÄôs about the passion and the interpretation, Clearman said. Clearman did not know who, if anyone, is cheated when a musician takes the drug. âÄúI would even say that an audience âÄî that if their performer needs to take beta blockers âÄî they would even appreciate it, so they donâÄôt see their performer struggling on stage.âÄù Yet, even if the beta blockers are a boon, there is a stigma attached to them. âÄú[Students deny taking beta blockers] if they have insecurities about it, or if they think other people wonâÄôt approve,âÄù Clearman said. In prescribing the drug, Christenson said doctors are helping musicians who might otherwise be unable to perform. âÄúAnd what happens if you have incredible musical talent,âÄù Christenson asked, âÄúbut when you get up on stage âĦ 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?âÄù 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. âÄúThe fear is that you wonâÄôt communicate it the way you want to, youâÄôll screw up a bowing and a fingering. ThatâÄôs the fear, and it is a very valid fear because 99.9 percent of the time, you will do something because youâÄôre human.âÄù