Exam Anxiety and the Use of Beta Blockers and Ritalin Among Young People: A Study

“Beta blockers?” 19-year-old Erik, who has just got on his bike after his HAVO biology exam, looks indignant. Coffee, yes, he and his classmates from the Coornhert Lyceum in Haarlem do, this period. As a result, everyone ‘tight’ each other from the caffeine for the local ‘ophypet’ – do you know this, do you know that? – before the exam starts. And yes, he has heard of an illegal trade in Ritalin, a drug that increases concentration and is intended for people with ADHD.

Every year when the school exams start, the Stichting Farmaceutische Kengetallen (SFK), which keeps track of the dispensing of medicines at pharmacies nationwide, sees a striking peak. In that case, doctors are substantially more likely to prescribe propranolol to young people. This beta blocker lowers blood pressure and heart rhythm – and can therefore provide more rest and less stress.

Every month there are about 1,000 to 1,500 dispensations of propranolol to 15 to 21-year-olds, much less during the summer holidays and 2,100 dispensations in May. Except in the corona year 2020, according to figures requested by NRC. Then the central exams were canceled due to the risk of infection and propranolol was only administered 700 times in May. After that, the numbers rose again to almost pre-corona levels.

May 2021: 1,700 dispensations.

May 2022: 1,800 dispensations. Figures for 2023 are not yet available.

For more than 176,000 exam students, the number of provisions remains limited – 1 percent. And how much harm can such a drug actually do to young adults?

Stage fright

Not much, says a spokesman for the Dutch College of General Practitioners (NHG). She refers to the NHG treatment guideline, which states that propranolol can be taken incidentally “in case of exam or stage fright”. 10 to 40 mg, 0.5 to 2 hours “before performance”. The drug has been proven effective in “short-term anxious situations”. However, the patient should try the medication in advance because of possible side effects, such as sleeping problems, fatigue, shortness of breath or cold hands and feet.

Ferdinand van der Does, general practitioner in Rotterdam, mainly prescribes the beta blocker in his practice for patients with stage fright. He himself has – unintentionally – sometimes benefited from it. Years ago, Van der Does took it himself because of a cardiac arrhythmia and then he experienced the side effects: “I suddenly turned out to be no longer afraid to perform with my clarinet, and the tension of speaking at conferences, which I always found scary, was also suddenly gone.”

If a younger patient with exam anxiety asked about it, he would also be inclined to prescribe propranolol. “I can imagine that some exam candidates can really suffer from a panic attack or a blackout and such a remedy helps with that.” This beta-blocker has a short-term effect, is not addictive and is generally well tolerated, including by younger people.

Online trade

There is another substance that young adults use to not succumb to the pressure to perform: Ritalin. Van der Does: “And that is completely different stuff.”

In front of the Coornhert Lyceum, an 18-year-old woman nods “preferably no name” to her black shoulder bag. “I have it with me now.” Not that Ritalin helped much today, the biology exam didn’t exactly go well for her. But it does put you in a pleasant “hyperfocus”.

The 18-year-old is prescribed it because she has ADHD. Yet she only uses Ritalin during the test week, “then the effect remains the greatest”. But she also has friends who buy it and use Ritalin during test weeks without having ADHD, and that does lead to problems. “I see some girls thinking: oh dear, I can’t live without it anymore.”

According to research from 2021, about 4 percent of young students make improper use of ADHD medication. Jolien Dopmeijer, a researcher at Trimbos, the knowledge institute for mental health, is concerned about them. “If you have ADHD, Ritalin calms you down, otherwise it’s a pick-me-up. Your heart beats faster, your concentration increases, you become alert. But for that your body has to work hard and that is a risk for people with – unknown – health problems. You can also become dependent on it, get palpitations, sleep problems.”

There has also been a trade in Ritalin online – and in ADHD diagnoses. Although Trimbos research shows that most students get the drug from people they know, says Dopmeijer. Whether its use has increased or decreased in recent years is unknown.