anxiety BIG TIME

[wmac]

I know this it the anxiety forum so bare with me. Ok I suffer from heart arrthymias mainly nonsustained ventricular tacycardia. But I am ocd and have general anxiety disorder, just anxiety all the time. Knowing that im ocd I have a tendency to think about it too much yes. Been to all the cardios and ep docs tried two ep studies and couldnt induce my arrythmia so they say its not life threating. Want me on beta blockers but my problem happens at rest and I did try the beta blockers and I then had the worse episode ever it was documented as well. Ok so its to the point I cope anymore. They want me on beta blockers, but one doc mentioned that maybe i should take care of the anxiety end of it first. So I have had zoloft in my dresser for almost a year now my general doc says that I should try that and I wont be so obbessed about the heart and I could evently live normal again. I wont go anywhere do things get to far from hospital because of my fear of my heart stuff. I did however read side effects to zoloft and it said could cause heart racing im thinking why would I take that thats the problem to begin with. Im ready though. I know zoloft wont stop my heart problem but will it really help with my anxiety and help me on the road to recovery. The cardios say I can do nothing about the heart meds but I cant live like this anymore. If I do take Zoloft how long will it take before it works, Im also a real lightweight when it comes to meds.  I freak about side effects. I have been depressed because of this too I just want my life back. I just want something that when the heart does go nuts im not going to freak and wait for the next time like I always do. Will zoloft help me?
wmac

[RCA7591]

Hello,

Provided you have a structurally normal heart (which apparently you do, having had a negative work-up), NSVT is not a life threatening condition, although the sensation that it produces can be extremely disturbing (speaking from experience).

What you have developed is a heightened sense of awareness with regard to your heart function, a specific form of anxiety which occurred secondary to the onset of NSVT. Anxiety in itself can trigger an NSVT event. Anxiety releases endogenous catecholamines (the body's adrenaline reserves), which in turn, stimulates the sympathetic nervous system (the part of your nervous system that regulates heart rate, blood pressure, and respiration).

There are two conditions in which cardiac and psychological manifestations coexist. Those two conditions are Neurocirculatory Asthenia and Dysautonomia.

The goal in treating either condition is to reduce anxiety, which in turn, prevents or minimizes the inappropriate release of endogenous catecholamines. The second goal is to prevent or reduce sympathetic hyperactivity.

The best anxiolytic in the case of cardiac manifestations is a long-acting Benzodiazepine (Klonopin). To reduce sympathetic hyperactivity as it applies to the triggering of a NSVT event, a cardio-selective beta-blocker is the best choice.

My recommendation would be a combination of Klonopin 0.5 mg, bid (twice daily), along with Atenolol 50 mg, qd (once daily). You can discuss this option with your cardiologist.

The drugs are largely ineffective in monotherapy, but combined, the efficacy is very high.

I would not suggest Zoloft, as SSRI's (regardless of which one is implemented), may be stimulating, and may worsen the cardiac manifestations. Stimulation is to be avoided, as it increases sympathetic stimulation (which you want to prevent or reduce).

SSRI's also carry the risk of adverse cardiovascular complications, and are contraindicated in NSVT. They may also alter the QT or PR interval, increasing the risk of recurring NSVT events.

Good luck.

-Ryan

[wmac]

My gp wanted to switch me to klonopin from ativan. I take .5mg in morning and the same at night. I know its probably not doing me any good at such a low dose. but how can I take klonopin twice daily if its long acting . I understand its 12hr. The betas slow my hr down to where it made my problem worse. I was reading on the heart forum the doc there also said to treat the anxiety first and he suggested SSRI's. Do you NSVT as well? Or are you a doctor? You sound like one. I just want my life back and to feel better. The thing is that ativan and klonopin can make one more depressed. Which im already dealing with depression.
thanks
wmac

[RCA7591]

Smart GP.

Ativan carries an eight-hour half-life, and is indicated for intermittent use only. Klonopin on the other hand is indicated for the long term treatment or mangement of anxiety disorders.

Ativan, at your current dosage of 0.5 mg, bid, does not reach steady-state. Steady-state simply means that the plasma level of the drug is maintained over a 24-hr period. For Ativan to reach steady-state, it would need to be dosed tid (three times daily). However, due to the short half-life of Ativan, tolerance is a major problem. Therefore, it is indicated for short periods of time only.

Klonopin carries a 50-hr half-life, but the effects are only beneficial from 12-18 hours. Therefore, it is dosed twice daily (in which case steady-state is maintained). The risk of tolerance with Klonopin is far lower, and rare. Therefore, Klonopin is the drug of choice for long-term treatment.

I'm not a *medical* doctor, and I have dilated cardiomyopathy. As a result, I've had numerous episodes of NSVT, PVC's, and other abnormalities. All are under good control with beta-blockade.

All beta-blockers decrease the pulse rate, reduce cardiac output, and increase stroke volume. Titration of the dose to meet your needs is possible. Atenolol 25-50 mg would be a good starting point. Atenolol is also cardio-selective, acting mainly on the myocardium only. I wouldn't give up on beta-blockers just yet.

Benzodiazepines can worsen depression, but using antidepressants where cardiac manifestations are present is risky. I would try the Klonopin in place of the Ativan, along with a beta-blocker. If the depression is secondary to the chronic anxiety, treating the anxiety may improve the depression. As a matter of fact, most people confuse anxiety for depression.

-Ryan

[wmac]

So if klonopin is a 50 hr half life would two doses a day be overdosing? My GP said for me to take 1mg of ativan twice a day but im nervous to then he said then take .5mg three times a day but nervous to do that to.I get very nervous about meds. I freak out major anxiety but im comfortable with ativan I know I dont have side effects or a reaction to it. So if im ok with ativan I should be fine with klonopin too then right? I have read where antidepressants can cause the heart palps and etc.... that is why I have put them off. The beta blocker I used was toprol xl started out as 1/4 the first and second day and half the third day. then six hours on the nose later I had a 26 beat run of nsvt... yikes scared me to death. the toprol was 12.5mg  so by taking it the way I did it was such a low dose that I took. Now the cardio suggest flecainide and im like no way no way. the another cardio suggest cardizem. but I already have low bp so im nervous. The betas scare me cause they slow the heart rate and thats when I have my runs anyway. Now the one cardio says for me to take nadolol and I dont want non selective. cardio selective is what I want if I take any at all. I just dont know what to do at this point. How long are your nsvt runs and how often do you get them?
thanks
wmac

[wmac]

So if klonopin is a 50 hr half life would two doses a day be overdosing? My GP said for me to take 1mg of ativan twice a day but im nervous to then he said then take .5mg three times a day but nervous to do that to.I get very nervous about meds. I freak out major anxiety but im comfortable with ativan I know I dont have side effects or a reaction to it. So if im ok with ativan I should be fine with klonopin too then right? I have read where antidepressants can cause the heart palps and etc.... that is why I have put them off. The beta blocker I used was toprol xl started out as 1/4 the first and second day and half the third day. then six hours on the nose later I had a 26 beat run of nsvt... yikes scared me to death. the toprol was 12.5mg  so by taking it the way I did it was such a low dose that I took. Now the cardio suggest flecainide and im like no way no way. the another cardio suggest cardizem. but I already have low bp so im nervous. The betas scare me cause they slow the heart rate and thats when I have my runs anyway. Now the one cardio says for me to take nadolol and I dont want non selective. cardio selective is what I want if I take any at all. I just dont know what to do at this point. How long are your nsvt runs and how often do you get them?
thanks
wmac

[RCA7591]

No, the half-life of the drug is 50 hours, the therapeutic effect varies from 12-18 hours (call it 12). Even though the half-life is long, it must be dosed at least twice daily, or steady-state cannot be maintained.

I would not continue using the Ativan, nor would I increase the dosage of Ativan, or increase the frequency. Tolerance is a real concern with Ativan.

If you tolerate Ativan, you will have no problem with Klonopin (or any Benzodiazepine).

Toprol is only partially cardio-selective. Atenolol is more cardio-selective. Corgard (Nadolol) is non-selective. Cardizem is a calcium channel blocker, which may actually induce the NSVT.

I rarely suffer from NSVT anymore (about once every three months), typically in a run of 20. Prior to the beta-blocker (I use Atenolol), the runs would occur three or more times a week. The combination of Klonopin/Atenolol worked (and continues to work) very well for me.

-Ryan

[wmac]

So the docs dont worry about your nsvt your cardiomyopathy? I would think that you and they would be freaked. what is your ef? Does this worry you at all how do you get past the anxiety of all of this? Im going nuts.
wmac