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622511 tn?1373575103

SSRI/SNRI's

Hello Dr. Williams,

I am new to the forum and although I have many issues to inquire about, as a person, like many in this forum, has suffered from what "initally" began in 1992 at the age 38  was recurrent episodes of PSVT, and oddly enough then the  onset of what seemed to be just unifocal -isolated PVC's that  have appeared to progress to Multi-focal and Multi-form PVC's, a few years after they started in about 94/95' The PSVT episodes I used to get, would linger for many hours  "sometimes" during an episode, which I later learned from my Cardiologist (that is them lasting so long) was from the alcohol I ingested several hours "prior" to an episode of PSVT. Now, I rarely get a breakthorugh episode hense the innitiation of a BB, Tenormin, in my case, and if I do get an break through episode, it subsides within minutes instead of hours. Of course, I attribute this reduction in frequency AND duration to both the BB and the discontinuation of being a former binge drinker BUT I have been abstinant from any alcohol use for several years now. Nevertheless, The PVC's , especially the intermitant very nasty runs that come and go, I know are here to stay and it took me many years to tolerate them, as I will never "totally" accept them, especially when they come in clusters or runs. I have been through the gamut of testing over these 15 years and through trial and error on many meds, for the anticipatory anxiety/panic associated with both "pre and post" episodes. After the sampling of the many MEDS. over the years, I settled on Tenormin and Klonopin ( mostly PRN now after the institute of an SSRI/SNRI ) again, after so many trials of different meds. Sorry, for such a long post but I wanted to clarify "my" specific  conditions/symptoms, so I can maybe get some help/advice from others in this forum in the same horrific boat. I have tried many SSRI's and (now am on SNRI) and noted that some of them definately seem to aggravate or even possibly trigger my PVC' s. I was on cymbalta that seem to have NO effect on my heart rhythm but because of some other side-effects, I asked the doctor to try me on "effexor" ER. I took ONE tablet and  the PVC's started a few hours later but I was in Bigeminy and Trigeminy and without a doubt in my mind, I am certain it was the effexor and NOT just a coincidence.  If one has to be on an SSRI/SNRI (and god knows I tried them ALL) which one is LESS likely to affect the hearts conduction system? Does anyone know from their own experiance? Lastly even though I only took the one dose, my GP took me off and said he wanted to try a Brand New one on me called Prestiq (50mg) said it was similar to cymbalta yet I just read it was more similar to "effexor"! Yikes! I took my 1st dose earlier tonight NO unusual runs or PVC onset, YET? Can you advise on which SSRI/SNRI is best for anxiety/panic that is or may be less likely to induce or  just even aggravate a so-called "benign" but 14 year rhythm disorder, especially PVC's, not so much a little tachycardia that some of these SSRI's are known to precipitate, as I am more bothered by the PVC's, as are most people that have them.

Thanks so much to ALL.
NotaHypo
4 Responses
255722 tn?1452550141
Hi there.  First of all, I want to make sure you know that this site is not monitored by the doctors.  To post to the expert forum, you will need to go to the following address:  http://www.medhelp.org/forums/show/91  This is not a "live" link.  You will have to copy and past the url into your address line to get to the site.

Now that we've gotten that out of the way :-) let me say WELCOME to the forum.   I think you will find that there are many on this site with similar experiences to yours and who can lend a helping hand, an empathetic ear, and some sound advice when you need it.   As I said in another post recently, the words of wisdom from others who experience these things gives us confidence, and the confidence fights off anxiety thus allowing the dreaded PVC's to slacken a bit.

My story (in a nutshell) is that I suffer from PVC's and have for 8 years.  Prior to this development I also had been diagnosed with neurocardiogenic syncope (a fainting disorder associated with severe bradycardia).  As with many sympathetic nervous system disorders and cardiac rhythm disorders, anxiety plays a role in altering the "normal" rhythm of the heart and while anxiety may not be the original cause of the disturbance, it certainly doesn't help matters much does it?

I have taken two SSRI's.  I've taken Paxil, which in some instances seemed to INCREASE my discomfort and I've taken Prozac which is my preferred medication.

Here's my two cents.  SNRI's make no sense to me in fighting rhythm disorders.  Norepinephrine underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy stores, and increasing blood flow to skeletal muscle.  In other words, blocking its "re-uptake" and allowing MORE of it to flow through your system is EXACTLY counter to what is needed to reduce heart rate and slow the "firing" of your rogue cells.  It's kind of like throwing water on a grease fire.

All cells in your heart are capable of initiating a contraction of the muscle.  Usually, this job is allocated to specific cells in your SA node.  However, increased adrenaline and other stress factors can cause other cells outside of the SA node to give off contraction signals and you experience a premature contraction.  EVERYONE gets this from time to time.  However, some of us have overacheiving cells that want to KEEP helping out and instead cause us grief (like the peewee football player so excited to run with the ball that he scores a TD for the wrong team).  To increase the levels of norepinephrine, the hormone that is directly tied to increasing heart rate and blood pressure, by not allowing it's reuptake, you are in effect telling your rogue cells to keep right on going!!!!

Beta blockers are taken to BLOCK the receptor sites for epinephrine and norepinephrine thereby reducing the force and frequency of premature contractions.  If you are taking a beta blocker to reduce PVC's and an SNRI at the same time it seems to me (not a doctor mind you) that you are shooting yourself in the foot.


And, no you are NOT a hypo!!!  :-)  Yeah, I got it.  You are a normal guy with a difficult to deal with rhythm disorder....we ALL get it.  Good luck in finding the correct blend of medications to help you through.  Let us know if we can be of help to you!!!

622511 tn?1373575103
I believe that is the "full version" of your medhelp nickname? Anyway, I thank you for your very thoughtful insight and sharing your own experiences and opinions with me. I concur with what you say. I learned quite a bit about my own condition after 14 years of the onset of MVP, PVC's and breakthrough PSVT. Of source, I don't want to bore you with my problems. I just figure that like other forums and sites I've been to, especially,when this all  started in 1992, I learned quite a bit from many others afflicted with the same issue(s). I also learned much about my own condition over the years and I also am no doctor by any stretch of the imagination either. Even after 14 years you've think you learned all there is to learn, not so. Because I am always finding new or innovations in either medicines and treatment options. I am very curious about cyro-ablation vs. RF-ablation. Even though it is still in it's infancy and I have been on the fence for 12 of those 14 years about an EP study and ablation but after reading more horror stories than pleasant stories or outcomes of people following "multiple" ablations, I never got the guts to pursue that option. I figure if I can put up with them for 14 years coming and going and I they haven't killed me yet, why open a can of worms! At the same time it would be nice to get off the meds that are just reducing the symptoms or/and frequency since I wonder what it would be like to feel NORMAL again at even at 53 since "combination" of the meds. that have ONLY offer me essentially just a band-aid approach are NOT worth the side-effects. I don't know why my GP has put me on an SNRI when I am NOT really depressed but more anxious and prone to GAD and occasionally a seldom panic attack. I guess they want me to try and avoid taking Benzos on a regular basis with my Tenormin. I need both, unfortunately. I tried ALL the SSRI's and found that I still have breakthrough anxiety, tremors, constipation, Chronic Insomnia, and some of them even agitated me more! Anyway, I have reviewed and compared all the SSRI's /SNRI's and how they affect me and it seems that ONLY Paxil XR , Zoloft were the best for me, and believe it not, Cymbalta that I was just on and only went off because of the severe Constipation and Insomnia mainly but it never seem to bother or exacerbate my PVC's, even though that affects both neurotransmitters,  norepinephrine AND serotonin. So,I wonder if I should go back to that or just revert back to Paxil ER or Zoloft, and the LOW doses I was taking, that seem to help. Ironically, Paxil, Effexor, Zoloft, among others are said to prolong the QT interval, which could also be a factor for excitation of these foci and in my case a probable bypass tract, which I know is highly amenable to ablation but for PVC's NOT so much as my two doctor relatives have told me,as well as, my cardiologist, especially if they are coming from the left side of the heart. So, it is unlikely had I opted for ablation, I will cure both the PSVT and the multi-form/focus PVC's and I don't know what feels worse! The runs of PVC's are still alarming to me, I have to admit even after 14 years. I become callused to them but NOT totally. Well, I would like to add you to my friend list, if that's ok and we can talk more. Yes, you are absolutely right about coming here and getting reassured that "benign" PVC's and the like are more common than you think and that alone gives the sufferer piece of mind.

Thanks again Pal..
221122 tn?1323014865
I just read through this lengthy post and believe we might be twins separated at birth. I seem to have EXACTLY the same symptoms as you, am on the same meds and have the same reaction to the SSRIs and SNRIs you have tried.  My doctors think I am a hypochondriac, which is why they tried me on the latter.  I find it hard to convince the people around me that I just happen to have a lot of problems that are REAL!  When I get a cold, I suffer with it, because NOTHING gets my heart going like a nice dose of decongestant, and even antihistamines.  I have suffered through tons of problems that normal people (husband included) pass of as an annoyance and pop some Clariton-D!  My body would just rebel.  

This board is absolutely filled with the most informed people I've met.  I've been on expert forums where the doc answers and have rec'd the same answers I do from my own doctor.  I'd rather ask here, or research it myself.

Great answer, dolfnlvr!
622511 tn?1373575103
Your right and unless we "inform"each other since only the people like us, going through it can know and be totally able to relate, we are stuck with lame answers and many treatment options that are NOT the right choice. I have learned over 14 years of what began as PSVT and now the more frequently disconcerting PVC's and their various triggers (for myself that is) that you have to be your own health advocate these days, not excluding doctors but at the very least, contributing to there treatment approach and telling them when a MEDICATION OR THERAPY is NOT working for you! If they think you are a HYPO then go onto another doctor that will listen and take you more seriously. Trust me, I have been through the windmill as far as doctors, and gamut of tests, forget about it! So, I always play a role in my treatment plan and am NEVER shy about telling a doctor, whether it be a GP, Shrink, or specialist, what I think and how I feel from the lousy cocktail of meds I have been put on. I also have never felt the least remorse for dropping a doctor that is dismissive of my complaints or speaking up to them because of his/her regimen and the meds. they might have put me on that just didn't work OR definately worsened my condition. Look I know there is NO magic bullet, even RF and the Newly approved Cyro-ablation, as well as, the NEW magnetic catheter tip they use in an RF ablation procedure that just was profiled on CBS news here in New York/ New  Jersey this past weekend, although looks promising, there are NO gurantees that they will find anything when they do the study nor can they precisely ZAP all Foci (for PVC's) or even concealed accessory pathways or any culprit tissue for Atrial or Ventricular Arrhythmias. Why do you think so many RF-Ablations fail or have to be repeated numerous times only to still leave the patient/sufferer with some PVC's or Tachycardia in the end, thus, having to STILL take medication. That is WHY I choose NOT to go that route and am still on the fence about any type of ablation until they can guarantee me they won't destroy my AV or SINUS nodes! Hence the need for a pacemaker! So, all I have left is Beta Blockers, CCB, anti-anxiety meds. Benzos and SSRI's/SNRI's which can contradict therapy. Bottom line, I believe when we as individuals find the right combo of BB's, Benzos (for PRN usage and breakthrough episodes), and MAYBE the right SSRI (until they come up with something new) we might just stumble (through trial and error unfortunately) over the best combo of meds "if we are lucky" that at the very LEAST, will help us COPE and hopefully significantly reduce and control certain arrhythmias and the sometimes severe anxiety/panic associated with them or coexist with MVP and these sometimes very bothersome Arrhythmias.
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