Does propranolol lose its effectiveness?

[Jane D.]

I have taken propranalol on an "as-needed" basis for social phobia for about seven years now, and have found it to be a lifesaver, allowing me to speak in public, date, etc.,. Prior to that, I avoided any kind of public speaking and many social situations because my heart would race, my hands and voice would shake...I'd look like a nervous wreck, which only sap my confidence and make me more embarrassed and more nervous. In college, I'd drop classes if I had to give a speech, and my social anxiety definitely interfered with my dating life. Propranaol's made a huge difference. I generally take about 40 to 60 mg. an hour and a half before the "dreaded event" and it's worked well. I still feel nervous, but without the visible symptoms, I don't suffer the embarrassment and can make it through the situation, which for me is half the battle.

I also tend to have some generalized anxiety, which has been on the upswing lately for a variety of reasons, and suffer migraines regularly (at least 3 times a month in recent months). My general practitioner recently prescribed daily propranalol (80 mg extended release) to prevent migraines. I've recently begun taking it and think it is helping in migraine prevention. But, here's my concern: if I take it every day, will it lose its effectiveness for social phobia? Will my body get used to it and not be affected by it in the same way? In other words, if I'm already taking propranalol every day, and take an extra dose before a "dreaded event", will it still continue to lower my heartrate and alleviate my nervous symptoms? I admit, it's probably a "crutch" at this point (and I also am in psychotherapy to help deal with it), but, given how miserable I used to be pre-propranalol days and how much more restricted my life was, I don't want to take the risk that it won't work. I know some drugs like Xanax lose their effectiveness with time and you need to take more and more.

I like the idea of having relief for my migraines, but if it comes at the expense of propranalol's effectiveness, I will stop taking it daily and only take it, as I had been, in social situations. My general practitioner says it's ok to take more propranalol prior to a speech, etc. When I asked her about whether its effectiveness would be hampered, however, she said she wasn't sure and prescribed Xanax on an "as-needed" basis as my "crutch." But, I'm confident with the propranalol and not sure about Xanax (esp. its ability to control the shaking, etc.)

I'm really not sure what to do. On the one hand, I like the idea of migraine prevention, since none of the treatments really work well. But, on the other hand, I like knowing my trusty beta-blocker will work. Any thoughts?

[Roger Gould, M.D.]

Because of the nature of a beta blocker, it is very unlikely that it will lose its effectiveness, but to be sure, it would be easy to stop the extended release the day of the "dreaded' event, and use the proprnalol as before.  Xanx is not a good substitute because it also effects your mood in a way that may negatively effect your performance.

[Try_to_be_social]

For prevention of migraine, please check out the site on <a href=http://www.upstate.edu/neurology/haas/hpmirx.htm>http://www.upstate.edu/neurology/haas/hpmirx.htm</a>. For propranolol and social anxiety, please refer to <a href=http://www.dr-bob.org/babble/20030907/msgs/258326.html>http://www.dr-bob.org/babble/20030907/msgs/258326.html</a>. Inderal will continue to help your stage flight as before even if you were on Inderal prophylaxis for migraine, because the additional dose will give you the desirable effects. Inderal will not eliminate all the anxiety in public speaking... Inderal may sometimes create problems, e.g. if you forgot to bring it with you or if you could not take it in time when you are suddenly, say, introduced to a stranger or the feared situation happened less than 1.5 hours. Xanax can replace Inderal for social anxiety and will not create tolerance when taken occasionally as required and is superior but drowsier. CBT is essential for both social and other types of anxiety but cognitive-behavioral group therapy is even better for social anxiety. Other treatment choices are antidepressants, such as SSRIs. Since you are still suffering from social anxiety interfering with your life and are developing “some general anxiety,” you may need something more than Inderal and your kind of psychotherapy.

[Try_to_be_social]

Although the cause of social anxiety is not fully understood, it is the interplay between genetics, family modeling, neurobiology and cognitive behavioral factors. Genetic predisposes an individual to social anxiety. S/he may model on parent/s, who may suffer from social anxiety. S/he may be overprotected/rejected by the parent/s, causing her/im to fear the world. S/he view the world as negative and defeating place, a mindset full of negative cognitions. S/he judges her/himself harshly and perceives others’ negatively evaluation. S/he avoids social judgment, thus reinforcing the belief of a bad world and others’ judgment. Cognitive-behavioral therapy is to untie such dead knot of negative judgment of others by challenging such belief, performing experiments to disprove it, developing realistic response to it, replacing misconceptions with rational thoughts that others in fact love her/im….

[susans]

Did anyone gain weight from Inderal on the 80 extended release dose?