Test anxiety is a type of performance anxiety. People who suffer from test anxiety often have other types of anxiety, in particular social anxiety. Nonpharmacological methods are considered the first line of treatment, but if they fail, or if the anxiety is truly incapacitating, medications can be helpful.
Propranolol (Inderal) is a beta blocker, a medication usually used to treat high blood pressure, that can also be used for performance anxiety. Its use is particularly common among stage performers. Propranolol blocks the physical manifestations of anxiety. It slows the heart, reduces tremors and decreases sweating. It's taken about 30 minutes before the event. It should never be used for the first time on the day of the test--some people don't respond to it well. Side effects include lightheadedness and a very slow heart beat. There are certain medical conditions where its use is not recommended, such as asthma.
Benzodiazepines can be used on a regular basis or as needed. For treatment of test anxiety, they should be taken about 30 minutes to one hour before the test. Commonly used medications from this class include alprazolam, clonazepam and lorazepam. The dose required is variable and needs to determined on an individual basis. Using these drugs before tests can cause sleepiness and can impair memory and clarity of thought. With high initial levels of anxiety, these medications can lower the anxiety to a tolerable level and can improve performance. They have an addictive potential, but if taken rarely, this is less of a problem than with regular use.
Antidepressants can be used for treatment of more generalized anxiety, such as social anxiety, which can be accompanied by test anxiety. Most commonly used are the serotonin specific reuptake inhibitors such as paroxetine and sertraline. Their adverse effects include a potential to cause agitation and suicidal thoughts. Also, they can’t be used just before and exam--they have to be taken on a regular basis.
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz, editors; 2009
- University of Maryland Medical Center: Anxiety Disorders--Medications