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Anxiety Community
This patient support community is for discussions relating to generalized anxiety, anxiety and eating, anxiety and sleeping, mood swings, and phobias.
For anxiety presenting with cardiac manifestations, a combination of a beta-blocker and a Benzodiazepine is the best option (which you are currently on). The beta-blocker inhibits the effects of Catecholamines on the Myocardium and autonomic nervous system, and the Benzodiazepine depresses the autonomic and sympathetic nervous systems(s), producing balance during periods of hyperactivity.
Any drug that has the potential to be stimulating (SSRI, SNRI, or Tricyclic) should be avoided. Each of these drugs also carries known cardiac side-effects (in particular, the SNRI and Tricyclic).
-Ryan
Sounds like you have alot of sound advise & really know your stuff.
I take Sectral (beta blocker) which has been good for me with no side effects & klonopin "as needed" & they work good, but I'm still looking for something to keep my system from being so sensitive to adrenalin bursts at weird times when I don't expect them. Anymore suggestions?
"Dear RCA7591,
We truly appreciate your enthusiastic participation in our forums. We are writing to ask that you try to make sure that your comments do not contain medical advice or direction. In the following example you are making recommendations for this person to use certain drugs over others. While your information may be 100% accurate, we ask that you make sure you let people know that this is your “opinion” and that no one should take any drugs without first checking with their personal physicians."
--end quote--
I will take this opportunity to address the message quoted above:
(1) I never once suggested or recommend that anyone take prescription drugs without the supervision of a medical doctor.
All of the drugs that I have suggested or recommended require prior approval and prescription from a physician. My suggestions and recommendations are based on objective facts, taken from one or more of the following sources; (A) The Physicians' Desk Reference, (B) Compendium of Drug Therapy, (C) The Merck Manual, (D) Current Diagnosis and Treatment, (E) DSM-IV, and others. Each of these is a well respected medical publication used as standard reference by the medical community.
(2) Nothing is of my personal opinion unless I clearly state the phrases "in my opinion", or "it is of my opinion", etc. The information I provide is largely based on fact, unless noted otherwise. My response to the original poster is based solely on fact, and I can back such facts upon request.
(3) FACT: The SSRI, SNRI, and Tricyclic family of psychotropics all carry with them the potential for serious adverse cardiovascular side effects. Using said drugs to "treat" diseases presenting with cardiac manifestations may worsen such manifestations, and may result in serious cardiovascular complications including, but not limited to; Hypertension, Hypotension, Premature Contractions from the atrial or ventricular level, Arrhythmia, Extrasystoles, and prolongation of the QT or PR interval on electrocardiogram, as well as other non-specific ECG tracings.
Therefore, *in my opinion*, it must be borne in mind that treating any illness presenting with cardiovascular manifestations with the above mentioned drugs may lead to serious adverse cardiac complications, or the worsening of existing cardiovascular conditions, regardless of their physiological significance or severity.
Quite obviously, and based upon the experience(s) of the other two contributors in this thread, I am not the only person who holds this opinion.
Cordially,
Ryan
Doctors are very vague and don't take time to explain much, so it's nice to get all the help we can get. AND I have found many times doctors have prescribed something that absolutley does not work for me & has a very negative effect. Ex: anti anxiety meds for PVCs-- didn't work for me!!!
Maybe you could add to some of your postings where you are quoting things & that would help others to know & state "i think" if it's your opinion.
thanks Ryan.
Your reaction to Lexapro was typical (increase in the frequency of PVC's), chiefly due to the fact that Lexapro and other drugs in this class are "stimulating", particularly at the beginning of therapy. Such stimulation has a negative impact on the autonomic nervous system. They are more valuable for the treatment of depression than anxiety (and in particular, anxiety which presents with cardiac manifestations such as premature beats). When first developed, SSRI's were only indicated for major depressive disorder (mid 1980's).
The etiology behind the PVC's (as it applies to anxiety states) is largely due to overactivity of the autonomic nervous system (which controls pulse rate, blood pressure, respiratory rate, and the release of endogenous catecholamines). Endogenous Catecholmaines are the body's Adrenaline reserves, utilized during the "fight or flight" response. In a normal individual, their release only occurs during extreme episodes of real danger or threat (ie: a deer jumps out in front of your car). In the abnormal person, the autonomic nervous system is more sensitive, hyperactive, or intermittently overactive. This results in the inappropriate release of endogenous catecholamines, and symptomatology (a symptom profile) results. The symptomatology varies wildly from person to person, but usually some cardiac manifestation is present (with the more likely three being labile hypertension, premature beats, and tachycardia). Other symptoms that are likely to occur are sensations of shortness of breath or smothering, dizziness, lightheadedness, hyperventilation, numbness/tingling of the extremities, visual disturbance, postural hypotension and rarely, syncope.
The "keyed up" autonomic nervous system has been described by many terms, the more common modern terms are "panic disorder" and "dysautonomia". The first disorder is largely psychological, while the latter is more of a combination of psychological and physiological abnormalities.
There is no cure for either condition (panic disorder or dysautonomia), and the goal is to treat the symptomatology and to reduce the frequency of the "attacks". This is usually accomplished using a combination of two drugs; (A) A long-acting Benzodiazepine taken daily, and (2) A non-selective beta-blocker.
Acebutolol is cardio-selective, meaning that it primarily targets beta receptors in the myocardium, but not the remainder of the body. Acebutolol will relieve some of the cardiac manifestations of anxiety/panic/dysautonomia, but it will not provide relief for every symptom. A better option in this case is a non-selective beta-blocker such as Nadolol or Propranolol, as these two target all beta receptors.
The more common Benzodiazepine used is Klonopin, as it carries a 50-hr half-life. When dosed twice daily (at any dosage), it will reach steady-state within two weeks. It is this steady-state level in the plasma that maintains the disorder it is intended to treat. This provides 24-hr coverage for symptoms.
The non-selective beta-blocker and long-acting Benzodiazepine work in concert to achieve "balance" of the autonomic nervous system, either by preventing attacks, or by greatly reducing the frequency and severity of the attacks. No drug combination provides 100% coverage, but this drug combination is highly effective at preventing or reducing the frequency and severity of the attacks.
A typical regimen would consist of Inderal (Propranolol) 40mg BID, and Klonopin (Clonazepam) 1/2 mg BID. As with any drug, they need to be individualized for the particular patient, and the figures given are averages only.
In my opinion, the Acebutolol and PRN use of Clonazepam is not providing you with the full benefit(s) of beta blockade and Benzodiazepine therapy. Ideally, the beta-blocker should be non-selective, and the Benzodiazepine dosed in a manner in which it will reach steady-state. When the combination is used in this fashion, maximum efficacy can then be obtained.
As with any drug therapy, there are some trade off's (side effects), and the benefits should outweigh the risks. The risks of using non-selective beta-blockers are worsening of pre-existing Asthma, the development of Asthma, and the development of type II diabetes. The long term risk to using long-acting Benzodiazepines is dependency, and to a much smaller degree, tolerance.
Drugs to be avoided (in my opinion) are cardio-selective beta-blockers and short-acting Benzodiazepines (Alprazolam, Lorazepam, Oxazepam, Clorazepate). The three reasons being are (1) Maximum efficacy will not be obtained, (2) Increased risk of tolerance with the shorter-acting Benzodiazepines, and (3) Rebound of symptoms.
You can speak with your personal physician about implementing the drug combination as outlined above, or one similar to it.
Disclaimer - You should never discontinue or start any medication, or increase the dosage of any medication without the approval of your personal physician.
-Ryan