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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by gdog on July 17, 2001, at 15:14:03
hi all,
a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc. does anyone know anything about this? information would be great! thanks,
gdog
Posted by PaulB on July 17, 2001, at 16:08:59
In reply to beta blockers for anxiety/panic? , posted by gdog on July 17, 2001, at 15:14:03
> hi all,
> a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc. does anyone know anything about this? information would be great! thanks,
> gdogI was initially prescribed Propranalol for anxiety. Of all the beta-blockers used I think Propranalol is quite common.
Norepinephrine is the neurotransmitter that controls adrenaline levels and by blocking the alpha-adrenergic receptors Beta-Blockers may help control papitations such as hands shaking and racing heart beat.
I think because of this they lack the robust anti-anxiety effects of other medicines and may be more suited for performace-anxiety rather than negative thought patterns underlying the anxiety. They have no habit forming potential though.
An additional note; Some Beta-Blockers may cause/worsen depression.
>PaulB
Posted by Elizabeth on July 18, 2001, at 8:53:40
In reply to beta blockers for anxiety/panic? , posted by gdog on July 17, 2001, at 15:14:03
> a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc.
That's exactly what beta blockers do, yup (they're also used to treat high blood pressure and certain cardiac arrhythmias; people with asthma generally can't use them). The most commonly used one is called propranolol (all their names end in -olol).
-elizabeth
Posted by emme on July 18, 2001, at 10:24:15
In reply to beta blockers for anxiety/panic? , posted by gdog on July 17, 2001, at 15:14:03
Hi. I've been using a low dose of atenolol to control the physical/jittery symptoms associated with general anxiety. I find it really helpful. It takes the edge off of things and I don't seem to have any side effects from it.
Emme> hi all,
> a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc. does anyone know anything about this? information would be great! thanks,
> gdog
Posted by MB on July 18, 2001, at 11:53:23
In reply to Re: beta blockers for anxiety/panic? » gdog, posted by Elizabeth on July 18, 2001, at 8:53:40
> > a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc.
>
> That's exactly what beta blockers do, yup (they're also used to treat high blood pressure and certain cardiac arrhythmias; people with asthma generally can't use them). The most commonly used one is called propranolol (all their names end in -olol).
>
> -elizabethI just watched a really stupid (and pretty funny) movie about kareoke (called "Duet"). Anyway, there's a scene where a woman gives one of the characters a beta-blocker for his stage fright. It made me laugh, I had forgotten about beta-blockers. A pdoc gave propranolol for anxiety once...it was a funny, yet unpleasant experience: I felt like I weighed 300lbs and like my body had swollen up into a sphere (like the Stay-puff marshmellow man from Ghostbusters--LOL!). I had to drink a pot of coffee just to function (which, sadly, counteracted the beta-blocker--heh heh). Oh, well...
Posted by JohnL on July 18, 2001, at 19:00:59
In reply to beta blockers for anxiety/panic? , posted by gdog on July 17, 2001, at 15:14:03
> hi all,
> a friend just told me that she takes blood pressure meds - she called them beta blockers - for her anxiety associated with ritalin. she said they easily resolve the physical symptoms associated with anxiety, like palpitations, racing heart, shakes, etc. does anyone know anything about this? information would be great! thanks,
> gdogDefinitely. This is an often overlooked remedy that can work very well.
Posted by Elizabeth on July 18, 2001, at 21:01:22
In reply to Re: beta blockers for anxiety/panic? , posted by emme on July 18, 2001, at 10:24:15
> Hi. I've been using a low dose of atenolol to control the physical/jittery symptoms associated with general anxiety. I find it really helpful. It takes the edge off of things and I don't seem to have any side effects from it.
That's interesting. I found propranolol (10-20 mg) helpful, but not atenolol (50-100 mg). I guess you have a lot of peripherally-expressed anxiety symptoms?
-elizabeth
Posted by emme on July 19, 2001, at 9:30:48
In reply to Re: beta blockers for anxiety/panic? » emme, posted by Elizabeth on July 18, 2001, at 21:01:22
> > Hi. I've been using a low dose of atenolol to control the physical/jittery symptoms associated with general anxiety. I find it really helpful. It takes the edge off of things and I don't seem to have any side effects from it.
>
> That's interesting. I found propranolol (10-20 mg) helpful, but not atenolol (50-100 mg). I guess you have a lot of peripherally-expressed anxiety symptoms?
>
> -elizabethHi. What is meant by peripherally-expressed? My anxiety symptoms are often more physical than mental (not that mental worry is *never* there!). I tend to feel overstimulated, as if I've had caffeine. Thyroid tests all come out nicely normal, and there are no other physical problems, so anxiety it is. I'm not sure why my doctor chose atenolol over propanolol, but it's worked well for me. It does seem like these drugs are a nice option to make people with anxiety symptoms more comfortable. I wonder how often they're used for this.
-Emme
Posted by Elizabeth on July 19, 2001, at 13:02:45
In reply to Re: beta blockers for anxiety/panic? , posted by emme on July 19, 2001, at 9:30:48
> What is meant by peripherally-expressed?
Expressed outside of the central nervous system. What you call "physical" as opposed to "mental." (I don't believe that sort of distinction is meaningful, personally.)
> I'm not sure why my doctor chose atenolol over propanolol, but it's worked well for me.
Atenolol is cardioselective -- less likely to cause or worsen depression.
> It does seem like these drugs are a nice option to make people with anxiety symptoms more comfortable. I wonder how often they're used for this.
Pretty often, I'd say.
-elizabeth
Posted by SalArmy4me on July 20, 2001, at 1:36:49
In reply to Re: beta blockers for anxiety/panic? , posted by PaulB on July 17, 2001, at 16:08:59
Paauw, Douglas S. MD. Did We Learn Evidence-Based Medicine in Medical School? Some Common Medical Mythology. Journal of the American Board of Family Practice. 12(2):143-149, March/April 1999:
"Myth 4: beta-Blockers are an important cause of depression.
Early reports of possible beta-blocker-induced depression surfaced soon after the beta-blocker propranolol became available in the 1960s. A frequently cited reference is a letter published in the British Medical Journal in which Waal [22] reported that 20 of 89 patients on propranolol volunteered or exhibited depressive symptoms. Forty percent of these cases were classified as grade 1 depression-symptoms of irritability, insomnia, nightmares, and fatigue. No control group of patients was evaluated to ascertain the prevalence of these symptoms in patients treated with other antihypertensive medications or in nonhypertensive patients. Pollack et al [23] described a series of 3 patients who developed symptoms of depression after starting propranolol and concluded that depression coming after the administration of propranolol was a real phenomenon.A number of studies have concluded that there appears to be no increased prevalence of depression in patients on beta-blockers. [24-29] Schleifer et al [24] evaluated for evidence of depression 190 patients who had sustained a myocardial infarction. The patients were interviewed 8 to 10 days after the infarct and again at 3 months. No antianginal or antihypertensive medication including beta-blockers was associated with an increase in depression. Using a psychiatric interview and psychologic assessments, Carney et al [25] evaluated 75 patients undergoing elective cardiac catheterization. One half of the patients in the study were receiving beta-blockers. Thirty-three percent of the patients who were not receiving beta-blockers met Diagnostic and Statistical Manual or Mental Disorders, ed 3 (DSM-III) criteria for depression, and 21 percent of the patients taking beta-blockers met criteria for depression.
In a study of depression in new users of antihypertensive medications in the Harvard Community Health Plan medication registry, the rates of depression were no higher in those taking beta-blockers than in those taking other antihypertensive medications. [27] Using the records of the Saskatchewan prescription drug plan, Thiessen et al [28] studied the rates of antidepressant prescriptions written after beta-blockers were prescribed and found that 6.4 percent of beta-blocker users received a prescription for an antidepressant within 30 days compared with 2.8 percent of the reference group. A similar study design by Hallas [30] showed no increase in antidepressant prescribing after patients received a beta-blocker.
A great deal of concern about the possibility of beta-blockers causing depression was generated by early case reports and subsequent case series. None of these reports evaluated the frequency of depression in a control group. Confounding the issue is the side effect of fatigue, which is frequently reported in patients on beta-blockers. [31] Patients might have depression incorrectly diagnosed if fatigue is the only depressive symptom. Depression occurring after major medical illness such as an myocardial infarction is common. As several studies have shown, [24,25] depression is common in patients with coronary artery disease regardless of what specific medications they are taking. Unfortunately, no large controlled prospective trials have addressed the issue of depression in patients taking beta-blockers. The beneficial effects of beta-blockers should not be overlooked in patients who have a history of depression, as the small possibility of a depressive effect caused by the beta-blocker might well be outweighed by its beneficial effect..."
Posted by PaulB on July 22, 2001, at 8:34:24
In reply to Beta-Blockers do Not Cause Depression » PaulB, posted by SalArmy4me on July 20, 2001, at 1:36:49
> Paauw, Douglas S. MD. Did We Learn Evidence-Based Medicine in Medical School? Some Common Medical Mythology. Journal of the American Board of Family Practice. 12(2):143-149, March/April 1999:
>
> "Myth 4: beta-Blockers are an important cause of depression.
> Early reports of possible beta-blocker-induced depression surfaced soon after the beta-blocker propranolol became available in the 1960s. A frequently cited reference is a letter published in the British Medical Journal in which Waal [22] reported that 20 of 89 patients on propranolol volunteered or exhibited depressive symptoms. Forty percent of these cases were classified as grade 1 depression-symptoms of irritability, insomnia, nightmares, and fatigue. No control group of patients was evaluated to ascertain the prevalence of these symptoms in patients treated with other antihypertensive medications or in nonhypertensive patients. Pollack et al [23] described a series of 3 patients who developed symptoms of depression after starting propranolol and concluded that depression coming after the administration of propranolol was a real phenomenon.
>
> A number of studies have concluded that there appears to be no increased prevalence of depression in patients on beta-blockers. [24-29] Schleifer et al [24] evaluated for evidence of depression 190 patients who had sustained a myocardial infarction. The patients were interviewed 8 to 10 days after the infarct and again at 3 months. No antianginal or antihypertensive medication including beta-blockers was associated with an increase in depression. Using a psychiatric interview and psychologic assessments, Carney et al [25] evaluated 75 patients undergoing elective cardiac catheterization. One half of the patients in the study were receiving beta-blockers. Thirty-three percent of the patients who were not receiving beta-blockers met Diagnostic and Statistical Manual or Mental Disorders, ed 3 (DSM-III) criteria for depression, and 21 percent of the patients taking beta-blockers met criteria for depression.
>
> In a study of depression in new users of antihypertensive medications in the Harvard Community Health Plan medication registry, the rates of depression were no higher in those taking beta-blockers than in those taking other antihypertensive medications. [27] Using the records of the Saskatchewan prescription drug plan, Thiessen et al [28] studied the rates of antidepressant prescriptions written after beta-blockers were prescribed and found that 6.4 percent of beta-blocker users received a prescription for an antidepressant within 30 days compared with 2.8 percent of the reference group. A similar study design by Hallas [30] showed no increase in antidepressant prescribing after patients received a beta-blocker.
>
> A great deal of concern about the possibility of beta-blockers causing depression was generated by early case reports and subsequent case series. None of these reports evaluated the frequency of depression in a control group. Confounding the issue is the side effect of fatigue, which is frequently reported in patients on beta-blockers. [31] Patients might have depression incorrectly diagnosed if fatigue is the only depressive symptom. Depression occurring after major medical illness such as an myocardial infarction is common. As several studies have shown, [24,25] depression is common in patients with coronary artery disease regardless of what specific medications they are taking. Unfortunately, no large controlled prospective trials have addressed the issue of depression in patients taking beta-blockers. The beneficial effects of beta-blockers should not be overlooked in patients who have a history of depression, as the small possibility of a depressive effect caused by the beta-blocker might well be outweighed by its beneficial effect..."Paul B > Impressive research. I metioned beta-blocer induced depression because I felt slowed-down and an increase in depression on Propranolol. I try and comment on medications that I have had experience with and that was my experience. Other than that I had read that beta-blockers particulalrly Propranolol may be associated with depression although fatigue may be misinterpreted in some cases(like you said). If you are interested, anyone?, there is some debate at psychopharmacology tips where there is mixed evidence on the topic.
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