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Anxiety Community
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Best medication for debilitating stagefright?
by vercimber, Mar 22, 2007 12:00AM
I am a 27 yr. old male whose interests have lead me into the world of college teaching and conferences (reading my papers in front of large audiences). Ever since I can remember, I have had HORRIBLE stage fright, acute anxiety, near-panic. Recently I've been diagnosed with concentric left ventricular hypertrophy, kidney stones, complex partial seizures, etc., so my anxiety has been compounded. I have access to both Toprol XL and Xanax, and I'm curious which one will help mediate some of my stage fright symptoms (I told intend to take them all the time; only when I know I'll be afraid). I'm sure both will help, but can someone recommend one over the other and offer reasons for doing so?
Much appreciated.
Much appreciated.
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Seeing as how you have LVH, I would imagine that your blood pressure is chronically elevated (and I would hope that you're taking some form of antihypertensive daily to treat it).
For treatment of stage fright, Inderal is highly effective. Inderal is a non-selective beta-blocker which blocks adrenaline (and in turn, the panic effects of excess adrenaline). Toprol is a cardio-selective beta blocker, and is best suited for the treatment of hypertension. Toprol has no proven value for anxiety/stage fright.
Inderal can be taken PRN (as needed). Perhaps you can discuss Inderal with your doctor.
Xanax is also a good PRN choice, but if you are delivering a complex speech to a large crowd, it *may* mess with your memory and alertness. You don't want to come across as "stupid" or "stoned" when making your presentation. When Xanax and other benzo's are used PRN, this is a definite possibility. This is not seen with daily use, only PRN use.
Contraindications for Inderal are heart block greater than the first degree, bradycardia (heart rate lower than 60 at rest), and asthma. Otherwise, it is a very safe drug.
-Ryan
The Xanax was prescribed merely because these highly disparate problems have made life a bit more difficult. I am worried about the addictive qualities of benzodiazepines (and their subsequent withdrawal effects), especially since I have taken the Xanax every day for about a week (I have needed it, as far as I could tell). Tomorrow, I have to read in front of 500 people, and while the material is complex, I know it thoroughly. I'll talk to my doctor about Inderal.
(1) You have a cardiac condition of which the etiology is uncertain at present time. Hypertrophy and a Carotid "Bruit" is not normal for a person of your age. In my opinion, you should find an independent cardiologist and undergo a complete cardiac work-up consisting of the following:
A - Nuclear stress test to evaluate for ischemia
B - Echocardiography (TTE) with bubble study to evaluate for shunting
C - Cardiac MRI
If any of these tests are abnormal (in particular, the stress test), cardiac catheterization is warranted.
There are three common reason for LVH: (1) Organic disease, (2) Chronic elevated blood pressure, and (3) Cardiomyopathy.
An ejection fraction of 89% is extremely high, and in itself raises some concern. High cardiac output is associated with disease. The typical ejection fraction for someone of your age is 63% (normal 50% - 65%). You need to be evaluated (ideally, ASAP)
In the mean time, if your blood pressure is consistently over 140/90, it needs to be treated aggressively. Failure to treat the HBP will result in further hypertrophy (thickening) to the left ventricle.
For initial treatment of HBP, I would recommend Atenolol 50 mg daily, and Benicar 20 mg daily. Atenolol is a cardioselective beta-blocker, and Benicar is an angiotensin receptor blocker. In concert, these two drugs will lower your blood pressure and remove some of the "workload" off of the left ventricle. If the cause for the hypertrophy can be established, the damage may partially reverse itself.
Your symptoms of lightheadedness and others point to a cardiac origin, and anxiety is common in cardiac conditions. My main focus would be on treating the underlying disorder, instead of focusing on the anxiety produced from the symptoms.
To answer your other questions:
(1) Can Toprol be taken PRN? No, Toprol XL is an extended release tablet designed to maintain blood pressure. For maximal effect, it must be taken one or two times daily, everyday.
(2) Xanax addiction - I would recommend that you speak with your doctor about an alternative benzodiazepine, Klonopin in particular. Xanax has a short half-life, and must be dosed several times daily to prevent interdose anxiety. Klonopin is taken twice daily, 0.5 mg BID. Once you achieve a steady-state plasma level of Konopin in your system, it will act as a maintanence drug against anxiety. If you are currently using the Xanax more than twice a week, chances are you need long term therapy. Xanax is the worst possible choice for long term management of anxiety states.
But as stated above, I believe that your anxiety is secondary to an underlying cardiac etiology. I would act on this immediately.
There is one more simple test that I would recommend as well: A work-up for Pheochromocytoma (adrenaline secreting tumor). Here, plasma metanephrines, along with fractioned urine metanephrines and catecholamines are measured by blood and urine collection (24 hr). This should've already been performed in a person with your findings.
Good luck, and search out a knowledgable cardiologist.
-Ryan
Just out of curiosity.....what medical field are you in? Are you an GP, Cardioligist, Psychiatrist, Nurse???? You are very knowledgeable and I learn a lot from you. Just want to say thanks!!!