 The Clarinet BBoard
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Author: GBK
Date: 2007-12-27 19:10
"...That's why Sarah Tuck, a veteran flutist with the San Diego Symphony, takes them to stave off the jitters that musicians refer to as "rubber fingers."
"When your heart is racing and your hands are shaking and you have difficulty breathing, it is difficult to perform," said Tuck, 41, who discovered them when she began performing professionally 15 years ago.
A survey she conducted a decade ago revealed one-quarter of flutists used the pills before some or all of their performances or in high-pressure situations like auditions. She believes use is now more widespread and estimates that three-quarters of musicians she knows use the drugs at least occasionally..."
http://www.latimes.com/news/science/la-sci-braindoping20dec20,0,5741092,full.story
...GBK
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Author: David Spiegelthal ★2017
Date: 2007-12-27 19:51
I could have used some of them meds two concerts ago. Got a case of "da noivs", and choked a very easy short solo lick which normally I can play half asleep and behind my back.
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Author: tictactux ★2017
Date: 2007-12-27 20:12
Actually, I enjoy (not at the expense of) a musician showing nerves. Else we could as well put Asimo or some Korg or some other music machine on stage.
I think that's what a live performance makes a live performance and not some "canned art".
(I had my bleak moments in our last church concert as well)
Didn't we have this very same subject some twelve months ago?
--
Ben
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Author: John Scorgie
Date: 2007-12-27 22:57
It is a mystery to me why anyone would voluntarily take beta blockers.
Each of the various beta blockers on the market produces unpleasant side effects, some of which are quite serious.
If "nerves" are the problem, wouldn't a tranquilizer of some sort be a better solution?
FWIW, the principal reason virtually all of us heart attack survivors are on beta blockers is that our doctors adamantly insist on them. To give you a typical example, when I asked my doctor if I could please discontinue beta blockers, after stressing their medical justifications he then cut off any further discussion by asking "What do I have to do, get down on my knees and beg you to keep taking them?"
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Author: Ed
Date: 2007-12-27 23:19
It is strange, unless all of my friends and colleagues are doing it on the sly, I don't know anyone who takes them. I don't doubt that someone somewhere that I play with uses them, but none that I am aware of.
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Author: DougR
Date: 2007-12-28 01:59
I had no idea the practice was so widespread, but if you're talking "shaking hands and trouble breathing," beta blockers make perfect sense (assuming one's tried all the other stuff, meditation and/or biofeedback and/or hypnosis, and assuming one's prepared to live with whatever side effects accompany the beta blockers).
Leaving aside the negative value judgments about "taking drugs--BAD!!", the knock on beta blockers that I've heard from musicians who take them is that they tend to even out one's emotional response, such that one may play a passage gloriously on beta blockers, but one won't feel particularly elated about it.
If it were me, and my nerves were so bad it impaired my performance, I think I'd try hypnosis first, because I've heard good things about it.
Anybody on the board have any experience with hypnosis for performance anxiety issues?
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Author: hans
Date: 2007-12-28 02:25
Re: "wouldn't a tranquilizer of some sort be a better solution..." - No, because it impairs the user.
I took beta blockers for migraines. They didn't help but the side effects were significant. Look them up on Mayoclinic.com if you're curious.
IMO a better way to deal with performance anxiety is desensitization, avoidance of caffeine, and some relaxation techniques.
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Author: GBK
Date: 2007-12-28 02:44
The estimate (as quoted in the article) of 3/4 of classical musicians using beta blockers seemed rather (alarmingly?) high.
Hence, the reposting of this subject.
Have the percentages risen that dramatically?
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Author: MichaelR
Date: 2007-12-28 02:46
Another alternative would be acting classes or perhaps improvisational comedy workshops. Once you learn to get into character it's not a huge step to create a calm performer character and play him/her on the musical stage.
I first used the technique for job interviews.
--
Michael of Portland, OR
Be Appropriate and Follow Your Curiosity
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Author: clarnibass
Date: 2007-12-28 03:20
If I stayed on the road to be a classical player I wouldn't be surprised if I ended up taking something like that. Well maybe not I can't be sure but I'm not surprised many take them. The solution for my extreme stage fright was solved mostly by luck. It was over when I found what I wanted to play. Not only that but it was a major change in musical life, for the better! At some point I realized playing classical music is not for me and then started the long search to find out what I do want. When I found it, I noticed I don't have a serious stage fright like before.
Playing things you don't really want to play, but do anyway because you don't know anything else, was a big part of the cause of my stage fright. I still play some written music but the entire atmosphere when I play is different because I play only what I want or things that I choose to agree to play.
Eventhough I don't study there, I go to two classes in the local university. These are classes that IMO would help against stage fright a lot, especially to classical players or just shy people (like me). One is called Improvisation For Classical Players, and they basically learn to improvise. Not a specific style, just improvise. There are students from the jazz, composition, and classical performance departments and it all murges together. Some people in the first lessons were so scared to do anything other than what they know, but after a few lessons were making some weird noises with more confidence, for example in a lesson that was about all the different sounds you can do with your instrument.
The other class is improvisation with dancers. Basically musicians and dancers improvise together. One time it was suggested that maybe the dancers can make sounds too, and the musicians can move and dance while playing, so I did. If you think as a musician playing is scary, what about dancing in a room full of dancers. That was scary, but worth it! Something like that would really help against stage fright, and it did!
Post Edited (2007-12-28 07:22)
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Author: J. J.
Date: 2007-12-28 03:59
GBK, the numbers have definitely no risen that much. This was the estimate of one person that they are referencing in the article, not even close to a full study. We tend to remember the people we know who use them, not the ones who we don't discuss it with.
At any rate, to the poster who questioned why anyone would use them voluntarily, you just can't be expected to understand without being in the same circumstances and/or having tried them yourself. Many of us do not have any side effects other than some drowsiness afterwards and the benefits FAR outweigh any small risks.
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Author: Gregory Smith ★2017
Date: 2007-12-28 15:31
GBK said:
"Have the percentages risen that dramatically?"
--------------------------------
Perhaps they have. I suppose that no one really knows.
As long as their usage is stigmatized by some who don't understand why they are taken (the zero-tolerance crowd, the ideologues, etc,), that kind of thinking will not help illuminate to musicians, speakers, actors, etc, the nature of their underlying problem and a full disclosure of what help is available for them.
I don't have to repeat what professionals in the field have had to say about the subject (ie. those individuals wearing two hats as clarinetists and MD's who posted in the last thread), for those flat-out opposed to taking beta blockers to begin to understand that they are largely responsible for creating an entire subculture that is apprehensive about seeking the kind of help that could literally make or break a career...or at least turn their lives around enough so that they live a life of relative peaceful existence and productivity.
Gregory Smith
http://www.gregory-smith.com
Post Edited (2007-12-28 15:34)
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Author: MichaelR
Date: 2007-12-28 15:46
GBK wrote:
> The estimate (as quoted in the article) of 3/4 of classical
> musicians using beta blockers seemed rather (alarmingly?) high.
> Have the percentages risen that dramatically?
The estimate came from one performer who made a guesstimate concerning the circle of performers she knows.
This is not a very reliable sampling technique.
--
Michael of Portland, OR
Be Appropriate and Follow Your Curiosity
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Author: Lelia Loban ★2017
Date: 2007-12-29 22:27
I'm sure the people who manufacture and sell Beta blockers, especially the so-called detailers, would love for us to *think* that 3/4 of all musicians use Beta Blockers. Naturally the people who do use them would like to think they're comfortably in the majority, too. Oh, yeah, let's have some good old "But, Mom, everybody's doing it" peer group pressure. (I prefer to call the "detailers" what they really are: drug pushers, using the doctors as their street pushers, with the time-honored tactic of hooking the doctors with gifts and the customers with free samples.)
Lelia
http://www.scoreexchange.com/profiles/Lelia_Loban
To hear the audio, click on the "Scorch Plug-In" box above the score.
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Author: Gregory Smith ★2017
Date: 2007-12-29 22:52
That's really a very accurate observation Lelia - about how PHRMA (the biggest lobbying group next to the AARP) helps get the big Pharmaceuticals DE-regulated to the point that docs, at the end of the line, don't read anything in the literature except what their pharm reps bring them to read. Most docs don't even make or have time to read most of the latest literature - even within their own specialty.
But I personally don't get the impression from the many musicians that I know, both amateur and professional, along with docs, professors, etc, who have occasional speaking engagements, that they have succumbed to peer pressure. In fact it seems to me to be quite the opposite - that peer pressure *discouraged* them from seeking earlier the help that ultimately made a significant change for the better in their lives.
Since one has to make distinctions between controlled substances and other non-controlled prescription medications such as Inderal, it seems that there is by definition little or zero potential for abuse. My understanding is that if one takes beta blockers and doesn't really need them, they won't notice any difference (except for side effects) or improvement anyway. They are not a psychoactive substance.
Gregory Smith
http://www.gregory-smith.com
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Author: DaveF
Date: 2007-12-30 08:29
I'd like to give my side, as a physician and clarinetist, about a few of the statements made here, that I feel are misconceptions.
The pharmaceutical industry does just fine with the beta-blocker market as it exists, and could care less about any potential market among musicians. Beta-blockers are remarkable drugs for the millions of patients with coronary heart disease and hypertension, who take them daily and indefinitely. Many of these meds are generic now, and the profit margin is much higher for the drug companies in other areas.........lipid drugs in particular.
The influence of drug companies on physicians........Gregory, that's quite a statemtent you made, that we docs only read what the drug reps put in front of us. I'd like to think that many of my collegues practice evidence based medicine, and make use of great technology available to rapidly access good, unbiased information. As you all have noticed, drug companies invest heavily in marketing directly to the public, particularly new drugs with huge R&D investments........got "RLS", you need drug X. Also, I practice in a very large medical center in an urban location, that bans drug reps. None have access to us, and as a consequence, we also have no free samples to offer our patients. A trade off.
In the thread in "Keepers" on this, I think we hashed it out pretty well that beta-blockers only blunt the body's response to hormones like epinephrine, secreted in response to fright and/or extreme nervousness. They can't make you perform at a level higher than you're capable. They are non-addictive. Side effects are possible, and are not to be trivialized.
I agree with most here that beta-blocker use among musicians is greatly over-estimated. I also think it's benefit is over-estimated. However, for some with significant performance anxiety it can really help.
Dave F.
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Author: Sylvain
Date: 2007-12-30 10:30
A quick note as I read this thread and reread the old one.
Dave F. says: "They can't make you perform at a level higher than you're capable."
I would say:
They can't make you perform at a level higher than you're capable in a low-stress setting.
If one considers reducing one's stress an improvement, then one could argue that they can indeed help you perform better.
I still do not feel completely comfortable with the issue. On one hand I understand the necessity of beta blockers for some and believe they offer great help at a very minimal cost (they are non-addictive and have few side effects). On the other hand, a part of me (maybe the old fashioned one) still thinks that in certain settings, especially competitive ones, the ability to deal with stress is part of the "game", as is the speed at which one can single tongue.
The larger problem is in my opinion, the constant push for perfection in the classical music world. The field has become so tough (maybe it always was). It feels to me that one is always competing against someone or something, when one should enjoy playing music, instead one worries about missing a note. Anyway this discussion is probably for another thread.
--
Sylvain Bouix <sbouix@gmail.com>
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Author: cpark
Date: 2007-12-30 13:46
I believe you will find almost no professional performance musician who disagree with the use of beta blockers. It is hard for an amateur player to understand the demands and pressures of consistent performance.
If any professional performers on this board disagree I invite your thoughts.
-Chris
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Author: Gregory Smith ★2017
Date: 2007-12-30 14:08
Dave said:
"...that we docs only read what the drug reps put in front of us. I'd like to think that many of my collegues practice evidence based medicine, and make use of great technology available to rapidly access good, unbiased information. As you all have noticed, drug companies invest heavily in marketing directly to the public, particularly new drugs with huge R&D investments........got "RLS", you need drug X. Also, I practice in a very large medical center in an urban location, that bans drug reps. None have access to us, and as a consequence, we also have no free samples to offer our patients. A trade off..."
----------------------------------------------
I'm happy to hear that your medical center bans drug reps leaving more time for face-to-face with patients. I hope that you took no offense and felt singled out - for all I know, you understand exactly what I am going to say in this post. But in many cases, doctors are at the end of the proverbial chain of "evidence" that is in need of examination itself.
The fact that formularies produced for doctors practicing in HMO's such as Kaiser are dictated by "evidence based" medicine (who's evidence is filtered through the lens of the drug companies themselves) is a problem that I think that you and others in your profession would want to be concerned about.
You must know that the FDA once wasn't a revolving door for the pharmaceuticals' corporate scientists and CEO's - the fox guarding the hen house - but now is so incestuously involved with whom they oversee, that the "evidence" in much of evidence based medicine leans almost always in favor of however and whatever manner they want to conduct clinical trials for new products. If one reads the court cases, this becomes abundantly clear.
One of the little tidbits that has emerged in court cases concerning adverse effects of some SSRIs is that they have performed worse than placebo in many of their clinical trials. These meds are like poster children for a widespread problem in pharmaceutical research, namely selective publication.
A drug company funds 20 trials of a drug and publishes the 1 trial (in other words, the best 5%) that achieved better-than-placebo results. Researchers in the other 19 trials are contractually forbidden from even discussing their work privately among colleagues.
The problem is so pervasive and has become so widely recognized that an ad hoc coalition of medical journals last year forced the establishment of a database in which all trials must now be registered before they begin or else the journals will refuse to publish the results.
For instance, that's why it took 94 trials of the antidepressant Paxil to come up with 7 trials that were good enough to use in seeking FDA approval for its use against depression. Even then, it has come to light that the good results in those 7 trials depended on some highly questionable alterations to the raw data. (Alterations to raw data are never acceptable. You can throw out your data or use it, but modifying the data is generally considered to be fraud.)
Another unethical practice that has emerged in these lawsuits is that in a number of the most prominent trials leading to the early embracing of SSRIs, a benzodiazepine was administered together with the SSRI, but this was not mentioned in the published results.
How do they get away with it? We should ask Billy Tauzin, who went directly from being chief Congressional overseer of drug companies and legislation bearing on them to . . . highly paid president of PhRMA, the pharmaceutical industry's lobbying organization (coincidentally[?] the largest, most heavily funded governmental lobbying organization in the history of the world).
Just Google tauzin phrma (notice there is no "a" in the middle of phrma) and you'll find tens of thousands of articles on the blatant conflict of interest here and on all the favors Tauzin did for the industry while he held the reins of governmental power. Members of a one-party government apparently believe nothing can hold them accountable.
Gregory Smith
Post Edited (2007-12-30 14:47)
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Author: Gregory Smith ★2017
Date: 2007-12-30 14:28
Sylvian said -
Dave F. says: "They can't make you perform at a level higher than you're capable."
I would say:
They can't make you perform at a level higher than you're capable in a low-stress setting. If one considers reducing one's stress an improvement, then one could argue that they can indeed help you perform better.
--------------------------------------------------------------------------------
That would seem to be a distinction without a difference, Sylvian.
*Excessive* performance anxiety is not unlike diabetes, high blood pressure, or arthritis in that respect. It is absolutely correct to say that many are able to overcome those three conditions without lifelong dependence on medication.
That's in SOME cases. In other cases people would be crazy not to take their medications for diabetes, hypertension, arthritis - OR excessive performance anxiety.
It all comes down to skillful diagnosis, which is really the Achilles heel of American medicine. We're far too reliant on expensive technology and heroic procedures and we're plain old sloppy at old-fashioned deductive reasoning.
The artificial distinction setting excessive performance anxiety apart from non-stigmatized conditions as failures of will, character, or endurance is artificial.
It all boils down to the basic question of who decides for whom what excessive performance anxiety is.
I would answer that it is nearly impossible to give an answer to that question without one person universalizing for all others.
Gregory Smith
Post Edited (2007-12-30 14:30)
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Author: DavidBlumberg
Date: 2007-12-30 14:40
So is there a distinction between a Principal Player who doesn't use them for "regular" playing, but does use them when he/she has a Concerto, or Recital to play?
As far as the "game" it's a matter of playing like the player would in real life, not in an artificially stressed environment such as an audition. There is no comparison of stress in an audition than is actually playing the gig.
Drug samples can be a very good thing, and so can the drug reps to some extent, but the good Doctors are the ones who always do the research on their own and take what the drug reps say with a grain of salt - at least that's what my GP does.
http://www.SkypeClarinetLessons.com
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Author: DaveF
Date: 2007-12-30 15:59
As Gregory Smith so eloquently points out, the ethics of how drug companies seek approval and recognition of their new products is sometimes very, very shady, and shameful.
(Gee, do we have a clarinetist on this BBoard who works in this field who can comment?)
However, I and hopefully most of my medical collegues look at medical literature, particularly drug trials, first by identifying who has funded the trial, and then if any of the investigators are identified as funded by a drug company. It's usually not hard to identify potential bias, and then one must be cautious in interpreting the data.
As Gregory points out, the use of formularies by HMO's and related insurers is a messy business. There is a fair amount of evidence based selection involved, but of course bias towards lower cost. Drug companies have their hands in this offerring deals to get their products on formulary, or to be listed as preferred. I however have to admit, it's rare that I ever find a significant problem being restricted from prescribing what I think is the best agent.
Are doctors skilled and attuned in diagnosing performance anxiety........probably not. However, we as performers can easily self diagnose, acknowledge it, and not feel ashamed. There's help available for those who feel that it's really hindering their performance. I still contend however, that we should be clear that the effect of beta blockers is not perfomance enhancing (like steroids in athletics).
Dave F.
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Author: S. Friedland
Date: 2007-12-30 16:42
A lot of folks are very sensitive about the fact that they use BB's, evident from the above and the other thread a year or so back. If your MD prescribes BB's, take them. if not you are on your own, but should really take care that you are used to them prior to taking them before,( let us say), The Galanta Dances or Mozartiana.
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Author: EEBaum
Date: 2007-12-30 17:26
Sylvain wrote:
"The larger problem is in my opinion, the constant push for perfection in the classical music world. The field has become so tough (maybe it always was). It feels to me that one is always competing against someone or something, when one should enjoy playing music, instead one worries about missing a note. "
Hear hear!
As someone who used to get (and still sometimes gets) pretty jittery fingers during very exposed solo passages, I've come to realize that, at least for me, performance jitters are an indicator of one or more of these factors: I am not adequately prepared; I have not thoroughly explored the possibilities of the music; I am playing notes rather than playing music; I haven't discovered my voice in the piece; I have little or no interpretation to contribute; I am more concerned about how I play the music than how the music as a whole sounds; I have not established a rapport with the other musicians (if any); I am passively going through the motions by memory rather than actively being involved in making the music.
So, for me, jitters are an indicator that I'm going to be playing something badly and/or mechanically. Jitters are a sort of litmus test that tell me a few seconds in advance whether I'm just going through the motions out of habit or actually making music. Which is why I, whether justifiably or not, have preconcieved notions against jitter-meds. In my situation, they'd be used to try to mitigate shoddy playing rather than to remove impediments to good playing.
Your mileage may vary, but that's why I consider the meds a copout. Not pointing any fingers, just explaining where some rash generalizations might come from.
-Alex
www.mostlydifferent.com
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Author: Gregory Smith ★2017
Date: 2007-12-30 17:40
EEBaum said:
"Your mileage may vary, but that's why I consider the meds a copout."
--------------------------------
While you might consider meds a cop-out for yourself, I don't think that you are saying that another with performance anxiety is copping out if they believe that they consider them necessary, correct?
In other words what I think that you are saying is that believing that another would be copping out would be universalizing for others what you believe to be true for yourself.
Gregory Smith
Post Edited (2007-12-30 17:41)
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Author: Mark Charette
Date: 2007-12-30 17:40
EEBaum wrote:
> Your mileage may vary, but that's why I consider the meds a
> copout. Not pointing any fingers, just explaining where some
> rash generalizations might come from.
And you've now contributed yet another uninformed generalization. I presume from your editorial that you never take any performance enhancing drugs such as aspirin or ibuprofen if your fingers ache from practicing for that audition. Yes, it's that simple.
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Author: EEBaum
Date: 2007-12-30 19:04
Gregory:
Yes, that's what I'm saying. And our tendency to suppose that others view the way the same way we do is why I tend to project this ideology on why I think others take it, whether it's accurate or not.
Mark:
Nope, haven't.
I'm just explaining where my gut reaction comes from on this matter. Not saying it's particularly correct or reasonable. It's why I wouldn't use it for myself, and why my initial reaction to someone else using it would be negative. After looking at any individual situation, I'd probably be more understanding. I've just seen a lot of people get really nervous about playing solo, and through a lot of introspection have found out what tends to make me jittery, and seen those same factors among others who play nervous.
What gets me kinda fussy on the matter is when people seem to look to medication as a substitute for seeking out greater musical maturity and awareness, whether that is their conscious intent or not.
Maybe that's not what's happening, but that's my perception on the matter.
-Alex
www.mostlydifferent.com
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Author: Gregory Smith ★2017
Date: 2007-12-30 19:34
EEBaum said:
"Yes, that's what I'm saying. And our tendency to suppose that others view the way the same way we do is why I tend to project this ideology on why I think others take it, whether it's accurate or not."
----------------------------------
Perhaps that is where the logical fallacy lies. How can one suppose that they have the ability to feel or judge exactly (or even to the same degree) what others feel when making these kinds of personal decisions?
I would say that that kind of process is far too subjective to make those kind of assumptions. That's why I would side with your speculation that you may be inaccurate. That's why I personally try not to make those kind of judgements about or for others.
As I had mentioned in the last thread, there's just so much looking inside oneself to see into the heart and mind of one's neighbor, so much attempt to universalize one's own experience.
Yet it's easy to see why people get so aggressively defensive. Occasionally it may be an enjoyment of stirring up trouble. But most of the time it's because someone else has said, in effect, "No, you don't know how your life works, I know how your life works, so ditch that idea and listen to me instead."
If we give no one credit here for anything else, let's at least give everyone credit for knowing more about themselves than the rest of us do.
Gregory Smith
Post Edited (2007-12-30 19:42)
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Author: EEBaum
Date: 2007-12-30 20:35
Indeed. I guess what gets me fussiest is that, for me, having jitters and exploring different approaches to counter the jitters has led me to make lots of personal discoveries musically, things I would never have considered if I hadn't had an abundance of mid-performance "oh crap" moments. Bypassing that process, in my case, would have been a significant hindrance to me musically.
-Alex
www.mostlydifferent.com
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Author: Sylvain
Date: 2007-12-30 21:38
Gregory,
We may have found some grounds for agreement:
--
Just Google tauzin phrma (notice there is no "a" in the middle of phrma) and you'll find tens of thousands of articles on the blatant conflict of interest here and on all the favors Tauzin did for the industry while he held the reins of governmental power. Members of a one-party government apparently believe nothing can hold them accountable.
--
Very, very very scary, yet most of the general public is completely unaware of the drug trials current practices.
In your other post you write:
--
The artificial distinction setting excessive performance anxiety apart from non-stigmatized conditions as failures of will, character, or endurance is artificial. It all boils down to the basic question of who decides for whom what excessive performance anxiety is.
--
I agree with you, at best, this decision is an educated consultation between a patient and a doctor. I believe this can work well for an individual, and would advise anybody who suffers from performance anxiety to seek all options available to him whether they are meditation, or medication.
There are however, certain conditions under which one needs to make decisions on a more global scale. In sports, if the governing body of a specific sport thinks a substance is putting its user at an advantage then they may decide to ban it.
There is no such decision process that needs to be made in the musical world. Although in the context of competitions, perhaps it should. A well dosed cocktail of ritalin and inderal could certainly help some focus and keep their nerves down. Would every individual be helped by the meds? I don't know, but if it were the case then I think we could open the discussion of what is fair and what isn't.
I am aware that this scenario is not the reality of the musical world, and so my side of the argument is not very strong. Nevertheless, I hope that it has some value being discussed even hypothetically. I would certainly like to see more data and studies on the effect of BB and other drugs on musical performance.
From your previous posts I gathered you were not enthused with statistics, but sometimes one cannot avoid them. Wihtout them, Beta Blockers would not even be available today
--
Sylvain Bouix <sbouix@gmail.com>
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Author: S. Friedland
Date: 2007-12-30 22:23
It seems necessary to mention that the news,rumor or not, that beta-blockers are used by many, will affect the young and/or student musician. Really, while we know that the use of them is "out there" we don't know how the young will be affected by this news, or the rumors that these BBs are used at all. What about the young person who hears about their use, and decides to try them?Should a teacher advocate their use?
I think it is really insensitive to even start such a thread, given the way the young are so terribly impressed by the employed. Here are the side effects:
Common side effects:
Drowsiness or fatigue.
Cold hands and feet.
Weakness or dizziness.
Dry mouth, eyes, and skin.
Less common side effects:
Wheezing, trouble breathing, or shortness of breath.
Slow heartbeat.
Trouble sleeping or vivid dreams while asleep.
Swelling of the hands and feet.
Rare side effects:
Abdominal cramps.
Throwing up.
Diarrhea.
Constipation.
Back or joint pain.
Skin rash.
Sore throat.
Depression.
Memory loss, confusion, or hallucinations.
Impotence.
The above effects can possibly transpire and should be considered by anyone taking a beta blocker because they are used by their teacher.
Sherman Friedland
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Author: Gregory Smith ★2017
Date: 2007-12-30 22:40
Sylvian said:
"A well dosed cocktail of ritalin and inderal could certainly help some focus and keep their nerves down. Would every individual be helped by the meds? I don't know, but if it were the case then I think we could open the discussion of what is fair and what isn't."
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I guess that the global question then becomes is it fair to treat excessive performance anxiety? If one doesn't have panic disorder or some other diagnosable disorder, then the med cocktail that you mention would only hamper one's performance.
As the doctor has stated, there is nothing performance enhancing about these medications. Enhancing would mean that you already have everything under control and are achieving some Herculean plateau when taking these medications - like steroids do to the body.
With Inderal and Ritalin, one is making up for a medical deficit - to get back to their own "normal", whatever that normal seems like to them. If one wants to brand that "enhancement" then to be consistent, they would then also have to convince themselves that every medication "enhances" rather than *corrects* for any given individual.
Gregory Smith
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Author: Gregory Smith ★2017
Date: 2007-12-30 22:51
To whom it may concern:
Once again (and this will be my last contribution), if one carefully *reads* both of these long and informative threads, they will understand that NO ONE is advocating usage of this medication without supervision of their doctor, and that the medication should only be relied on *as a last resort*.
Further, if people took the attitude that they should not talk about these things in an open way, then we may as well have "abstinence only" type policies when it comes to furthering our knowledge about important matters concerning our collective health, both personally and professionally.
If one is worried about information getting into the hands of young adults, then by all means, they should take the precautionary measures to do the thing that they deem most responsible.
If anyone here thinks that information about medications are somehow kept secret from those who are impressionable, then they also believe in the "abstinence only" type thinking that clutches the minds of a few groups of individuals.
Good night and good luck.
Gregory Smith
PS. Anyone want to venture a guess as to what drug has these side effects and precautions attached to them?:
Pregnancy Implications:
Have been noted to cross the placenta and enter fetal circulation. Adverse effects reported in the fetus include mortality, intrauterine growth retardation, salicylate intoxication, bleeding abnormalities, and neonatal acidosis. Use of aspirin close to delivery may cause premature closure of the ductus arteriosus. Adverse effects reported in the mother include anemia, hemorrhage, prolonged gestation, and prolonged labor. Aspirin has been used for the prevention of pre-eclampsia; however, the ACOG currently recommends that it not be used in low-risk women. Low-dose aspirin is used to treat complications resulting from antiphospholipid syndrome in pregnancy (either primary or secondary to SLE). In general, low doses during pregnancy needed for the treatment of certain medical conditions have not been shown to cause fetal harm, however, discontinuing therapy prior to delivery is recommended. Use of safer agents for routine management of pain or headache should be considered.
Lactation
Enters breast milk/use caution
Contraindications
Hypersensitivity to any component of the formulation; asthma; rhinitis; nasal polyps; inherited or acquired bleeding disorders (including factor VII and factor IX deficiency); do not use in children (<16 years of age) for viral infections (chickenpox or flu symptoms), with or without fever, due to a potential association with Reye's syndrome; pregnancy (3rd trimester especially)
Warnings/Precautions
Use with caution in patients with platelet and bleeding disorders, renal dysfunction, dehydration, erosive gastritis, or peptic ulcer disease. Heavy ethanol use (>3 drinks/day) can increase bleeding risks. Avoid use in severe renal failure or in severe hepatic failure. Discontinue use if tinnitus or impaired hearing occurs. Caution in mild-moderate renal failure (only at high dosages). Patients with sensitivity to tartrazine dyes, nasal polyps and asthma may have an increased risk. Surgical patients should avoid if possible, for 1-2 weeks prior to surgery, to reduce the risk of excessive bleeding.
When used for self-medication (OTC labeling): Children and teenagers who have or are recovering from chickenpox or flu-like symptoms should not use this product. Changes in behavior (along with nausea and vomiting) may be an early sign of Reye's syndrome; patients should be instructed to contact their healthcare provider if these occur.
Adverse Reactions
As with all drugs which may affect hemostasis, bleeding is associated with this medication. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables including dosage, concurrent use of multiple agents which alter hemostasis, and patient susceptibility. Many adverse effects are dose related, and are rare at low dosages. Other serious reactions are idiosyncratic, related to allergy or individual sensitivity. Accurate estimation of frequencies is not possible. The reactions listed below have been reported:
Cardiovascular: Hypotension, tachycardia, dysrhythmias, edema
Central nervous system: Fatigue, insomnia, nervousness, agitation, confusion, dizziness, headache, lethargy, cerebral edema, hyperthermia, coma
Dermatologic: Rash, angioedema, urticaria
Endocrine & metabolic: Acidosis, hyperkalemia, dehydration, hypoglycemia (children), hyperglycemia, hypernatremia.
Gastrointestinal: Nausea, vomiting, dyspepsia, epigastric discomfort, heartburn, stomach pain, gastrointestinal ulceration (6% to 31%), gastric erosions, gastric erythema, duodenal ulcers
Hematologic: Anemia, disseminated intravascular coagulation, prolongation of prothrombin times, coagulopathy, thrombocytopenia, hemolytic anemia, bleeding, iron-deficiency anemia
Hepatic: Hepatotoxicity, transaminases increased, hepatitis (reversible)
Neuromuscular & skeletal: Rhabdomyolysis, weakness, acetabular bone destruction (OA)
Otic: Hearing loss, tinnitus
Renal: Interstitial nephritis, papillary necrosis, proteinuria, renal impairment, renal failure (including cases caused by rhabdomyolysis), increased BUN, increased serum creatinine
Respiratory: Asthma, bronchospasm, dyspnea, laryngeal edema, hyperpnea, tachypnea, respiratory alkalosis, noncardiogenic pulmonary edema
Miscellaneous: Anaphylaxis, prolonged pregnancy and labor, stillbirths, low birth weight, peripartum bleeding, Reye's syndrome
Postmarketing and/or case reports: Colonic ulceration, esophageal stricture, esophagitis with esophageal ulcer, esophageal hematoma, oral mucosal ulcers, coronary artery spasm, conduction defect and atrial fibrillation (toxicity), delirium, ischemic brain infarction, colitis, rectal stenosis (suppository), cholestatic jaundice, periorbital edema, rhinosinusitis
Overdosage/Toxicology
Symptoms of overdose include tinnitus, headache, dizziness, confusion, metabolic acidosis, hyperpyrexia, hypoglycemia, and coma. Treatment should be based upon symptomatology.
Drug Interactions
Substrate of CYP2C8/9 (minor)
ACE inhibitors: The effects of ACE inhibitors may be blunted, particularly at higher dosages.
Carbonic anhydrase inhibitors and corticosteroids have been associated with alteration in serum concentrations.
Heparin and low molecular weight heparins: Concurrent use may increase the risk of bleeding.
Methotrexate serum levels may be increased; consider discontinuing 2-3 days before high-dose methotrexate treatment or avoid concurrent use.
May increase the risk of gastrointestinal adverse effects and bleeding.
Platelet inhibitors (IIb/IIIa antagonists): Risk of bleeding may be increased.
Probenecid effects may be antagonized.
Sulfonylureas: The effects of older sulfonylurea agents (tolazamide, tolbutamide) may be potentiated due to displacement from plasma proteins. This effect does not appear to be clinically significant for newer sulfonylurea agents (glyburide, glipizide, glimepiride).
Valproic acid may be displaced from its binding sites which can result in toxicity.
Verapamil may potentiate the prolongation of bleeding time associated with aspirin.
Warfarin and oral anticoagulants may increase the risk of bleeding.
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may enhance gastric mucosal damage).
Food: Food may decrease the rate but not the extent of oral absorption.
Folic acid: Hyperexcretion of folate; folic acid deficiency may result, leading to macrocytic anemia.
Iron: at doses of 3-4 g/day, iron-deficiency anemia may result.
Sodium: Hypernatremia. Avoid or use with caution in CHF or any condition where hypernatremia would be detrimental.
Benedictine liqueur, prunes, raisins, tea, and gherkins: From potential accumulation.
Fresh fruits containing vitamin C: Displace drug from binding sites, resulting in increased urinary excretion of the medication.
Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity). Limit curry powder, paprika, licorice; may cause salicylate accumulation. These foods contain 6 mg salicylate/100 g. An ordinarily American diet contains 10-200 mg/day of this OTC drug.
THE ANSWER? ASPIRIN.
Post Edited (2007-12-30 23:36)
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Author: FDF
Date: 2007-12-30 23:12
Sorry, to put this thread on a less articulate level, but ….
I started taking beta blockers after my heart attack, I’m 70, and was concerned that my fingers would not work as well over rapid passages, also I didn’t want my tennis reactions any slower.
I discussed this thread with my wife who has practical and down to earth responses to my concerns. She pointed out that beta blockers are not illegal if a doctor’s prescription is given, as opposed to the illegal use of baseball players using steroids, nor are they life threatening, as opposed to the use of steroids. Side effects differ, and if a person has made the choice to use beta blockers, they are also capable of deciding if the side effects are worth the trouble. As far as my finger speed is concerned, so far it’s not been a problem.
So, apparently there are no health problems or legal issues, only questions about ethics or professionalism. Presuming each individual has a choice, I guess it’s up to the person seeking relief from stress or stage fright.
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Author: Sylvain
Date: 2007-12-30 23:30
> I guess that the global question then becomes is it fair to
> treat excessive performance anxiety? If one doesn't have panic
> disorder or some other diagnosable disorder, then the med
> cocktail that you mention would only hamper one's performance.
This last sentence is at the heart of our disagreement (if there is one). There is no data (or at least not sufficient data) for me to accept the fact you state. When talking to my psychiatrist friends, they all agree that taking ritalin would help almost everybody focus better and longer. I know of fellow researchers who have use it to go on sleepless nights to meet deadlines. The one study that I read on beta blockers, although flawed, suggested that 9/10 individuals performed better with an audience while on meds.
> As the doctor has stated, there is nothing performance
> enhancing about these medications. Enhancing would mean that
> you already have everything under control and are achieving
> some Herculean plateau when taking these medications - like
> steroids do to the body.
To you, you'll correct if I'm wrong, enhancing means bringing the player back to his practice room potential. On this definition, I can agree. On the fairness of bringing somebody back to his practice room potential through meds in an openly competitive environment, I am less sure we agree, as what I read suggests almost anyone can benefit from the meds, and do not believe everyone should take meds before a competition, even if it is to bring them back to "normal".
> With Inderal and Ritalin, one is making up for a medical
> deficit - to get back to their own "normal", whatever that
> normal seems like to them. If one wants to brand that
> "enhancement" then to be consistent, they would then also have
> to convince themselves that every medication "enhances" rather
> than *corrects* for any given individual.
Maybe you are right, but this isn't what I am debating. I am arguing that unless proven otherwise through a careful study, I am inclined to believe there is a possibility that almost any one performs better in a stressful setting (audition, concert,..) if one uses beta blockers than if one doesn't.
If using these medications can benefit everyone, then knowing if one should use them is not only a medical question, but also an ethical one, at least in certain contexts, where stress and pressure are considered part of the "test".
Here is a very silly example of my point:
I drink coffee everyday to help me stay awake and alert. Does it put me at an advantage with regards to my coworker who don't drink coffee? To this I answer who cares, it helps me perform my job better.
But if I enter a competition that involves solving as many crossword puzzles as possible in 72h, should the amount of caffeine ingested be controlled among competitors? To this question I answer maybe, we should look into it, because caffeine helps stay awake.
I've gotten so off topic that I am not really contributing to the thread anymore. This is my last post.
--
Sylvain Bouix <sbouix@gmail.com>
Post Edited (2007-12-30 23:35)
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Author: Ed
Date: 2007-12-30 23:52
Chris says:
Quote:
I believe you will find almost no professional performance musician who disagree with the use of beta blockers. It is hard for an amateur player to understand the demands and pressures of consistent performance.
If any professional performers on this board disagree I invite your thoughts
Read my comments on the top of the thread. I have played as a professional for close to 25 years. I have never used them, and would not, much as I would not choose to use steroids if I were a professional athlete. It may be the way I think about things and a choice that I would make. It may be what is right for me. It may not be what is right for someone else, merely my point of view.
Post Edited (2007-12-30 23:56)
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Author: cpark
Date: 2007-12-31 01:47
Ed,
Thanks for your comment. I'm not stating that all pros use them, only that professionals have an understanding and almost never would frown upon others using them.
Are you saying you regard them as steroids, giving your colleges who take them an unfair edge?
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Author: DavidBlumberg
Date: 2007-12-31 02:50
But the contention here is that beta blockers are nothing even remotely akin to steriods. Steriods DO give an unfair advantage as they make you perform sports at superhuman levels. If you could take a pill that suddenly made you tongue at 164 whereas you could only do it max at 132 than yes it would be an "unfair advantage".
Beta Blockers even out the fight or flight mechanism so that it doesn't get in the way of a stressed performer.
Just like an antidepressant helps to clear the cloud in someone who is depressed.
http://www.SkypeClarinetLessons.com
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Author: clarnibass
Date: 2007-12-31 05:15
>> If you could take a pill that suddenly made you tongue at 164 whereas you could only do it max at 132 than yes it would be an "unfair advantage". <<
Actually, I think that would still be fair. At least if that pill was legal. If it wasn't, then that's about something totally different (whether you object to everything that is ilegal). Anyway the difference is that playing music is not a sport. Many musicians make/made great music using or not using many different types of drugs. When you go to a concert you come to hear good music (hopefully), you don't come to see who wins.
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Author: Ed
Date: 2007-12-31 15:19
To clarify my comments- I don't know what the results would be of taking beta blockers, as I never have used them. I have had anxiety in performance over the years, as most people I know have. Some of it of course, has adversely affected performances, auditions, etc.
My point is that I have chosen to perform as I do (for good or for bad) and allow my body and mind to do what it can without introducing drugs to help aid my performance. Luckily, I have been able to work through much of my anxiety through work and practice. Maybe things would be different if I had chosen to take Inderal or other substances, who knows?
My reference to steroids was that IF I were in that sports, I would feel that same desire to work using my natural abilities. I didn't intend any other connection.
But then again, David, where do I get those drugs that would help me tongue at 164? Nobody ever told me about those! :-)
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Author: DKP
Date: 2007-12-31 15:34
I've lurked these boards forever, but as someone who has used beta blockers for clarinet-related performance anxiety I feel the need to respond. First, I would like to point out that the whole tangent regarding drug tests, pharmaceutical companies, and doctors' subsidized lunches is completely irrelevant in the case of beta blockers, as these drugs have been demonstrated to be generally safe and effective in their original purpose as heart medication for potentially life-threatening conditions as well as for performance anxiety.
I certainly advise anyone considering beta-blockers to go and discuss it with their doctor, not just try a pill from the guy sitting next to you. Believe it or not, many doctors care about your health and don't want you using completely unnecessary medication or ones which your body might seriously reject.
Furthermore, beta blockers taken for heart-related problems are taken in MUCH higher and REGULAR doses, whereas someone prescribed them for performance anxiety will take an extremely small dose on the day of the audition/gig. Granted any dosage may cause side effects -- and certainly when considering taking these drugs you should take that into account. For all I know a 5-mg pill could kill you, but the odds seem slightly better than dying on the freeway en route to see the LA Phil.
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Author: LCL
Date: 2007-12-31 16:35
A beta blocker has been prescribed to help control my high blood pressure since 1978. First it was 40 mg of Inderal, 3 times a day and then more recently 400 mg of Toprol XL, once a day. I have played the clarinets since 1956 and use the plural since I own and play them all from the Ab Sopranino down to the BBb Contra bass. Even though I would say the beta blocker helps stage fright, it does not completely eliminate it, at least in my case. And it should not ever be stopped abruptly, or so I have seen advised. Of course I don't know if that caveat is dose dependent.
Regards and Happy 2008 to all,
LCL
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The Clarinet Pages
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