GAD and Beta blockers

[deadgecko]

I recently developed GAD, although I don't have a history of anxiety and at the moment my symptoms are exclusively physical. My pdoc suggested potentially taking a beta blocker to deal with the shakes and CNS symptoms (I am very sensitive to Benzos so immediately ruled them out as a viable treatment option).

Does anyone have any insight on whether this line of treatment would be helpful or given the side effects if its best to skip it.

Cheers!

[jholden40]

@deadgecko
Propanolol is the first med that comes to mind - and for the kinds of symptoms you mention. It never did anything for me aside from give me insomnia and a headache On the other hand, I know of some people who found it really useful.

Another option - not a benzo or beta-blocker - is Buspar. Again people seem to have mixed results. I found it useless. Also you've got the SSRIs - a couple of which, Paxil being one, are indicated as treatments for GAD.

This might be useful for you as a guide to meds etc.

http://www.patient.co.uk/health/Anxi...y-Disorder.htm

[citydragon]

Propranolol.. certain snooker players and professional musicians swear by it for its hand steadying properties, and tends to be reasonably benign in terms of side effects, although I know someone with asthma who started on Propranolol and found it exacerbated her asthma symptoms pretty badly. SSRIs, in my humble opinion are pretty nasty things, even though they seem the flavor of the month prescription from UK doctors at the moment, if you're mainly feeling physical effects of GAD, then from my experience (with Citalopram) it gave me weird rushes of anxiety, like a gut feeling that something bad was about to happen. Sounds to me like beta blockers might be worth a try.. YMMV, IANAD etc etc.

[Coheed]

I've suffered from GAD since I was a child in the last couple years its progressively got worse. While I was in a treatment center I was given a beta blocker called atenelol I believe. I believe it is a high blood pressure med but anyway it really didn't do anything for my anxiety. The doctor did tell me I could get pass a polygraph test using them but that's about it. I can't remember the dose I was taking but I think it was a relatively high dose, I would still get the racing heartbeat and other symptoms of anxiety I've dealt with all my life. I wish it did work for me instead of taking benzos but anyway to answer your question I didn't really feel any relief from them.

[deadgecko]

Thanks @jholden40.

I'm currently trialling Buspar, but nothing significant yet. I'm already taking three different anti-depressants (Effexor, Remeron and Wellbutrin) so anything an SSRI would do should be covered.

I'm hopeful the issue will resolve on its own. I'm not really anxious as a person, just a depressive ;-)

I was just hoping to hear about the next step if it continues longer term and the Buspar has no effect.

Thanks!

[Etherealremnant]

@deadgecko - I would honestly try clonidine. It is not a beta-blocker, it is an adrenergic antagonist however so it prevents the brain from releasing adrenaline which is highly effective at relieving constant anxiety.

It is EXTREMELY low dose though (just 100 micrograms is all I needed) and it is a blood pressure med so like beta blockers it can cause hypotension if you use too much.

Propranolol was a nightmare for me. It gave me this weird feeling in my head, made me feel like I had medicine head, and it actually caused me to have heart palpitations and did little for the anxiety besides keeping my heart rate down. Clonidine stopped all the symptoms I was having.

Also I noticed that you're taking Wellbutrin. If you are having anxiety problems I would get off of it. Wellbutrin is extremely bad if you are having anxiety issues because of the way it acts on the brain. You are on quite a cocktail there...

[RedBaron]

I'm on lexapro, and that has been pretty good for controlling my anxiety. Granted, there are still panic breakthroughs in intense situations, but the SSRI action is helpful in controlling anxiety. I hear that it is because it causes your norepinephrine levels to decrease, along with serotonin increasing. Now if only I can stop drinking and taking benzos on and off, and get my GABA levels steady, I'll be golden.
I see lexapro as a better long-term option than cycling through different benzos, especially since you are sensitive and don't want benzos. (Personally, if I were sensitive to benzos, I would try to get them, and take a very low dose. That would help shorten those late-stage dependence tapering problems.)

*This post was auto-merged. The following text was added 9 minutes after the last post:*

I've suffered from GAD since I was a child in the last couple years its progressively got worse. While I was in a treatment center I was given a beta blocker called atenelol I believe. I believe it is a high blood pressure med but anyway it really didn't do anything for my anxiety. The doctor did tell me I could get pass a polygraph test using them but that's about it. I can't remember the dose I was taking but I think it was a relatively high dose, I would still get the racing heartbeat and other symptoms of anxiety I've dealt with all my life. I wish it did work for me instead of taking benzos but anyway to answer your question I didn't really feel any relief from them.

That would be helpful info if one were applying for a government job, but I couldn't anyway due to a little police record thanks to the boys in blue... (dismissed case, but still on the rap sheet).

So, do beta blockers make you less shaky? I know nothing about them. Because I might want to look into it, as I have had anxiety problems with shakiness, that only increases with my anxiety. And do they cure the shakiness problem over time, or are you only physically calmed while you are on the med?

[Etherealremnant]

@RedBaron - atenolol and propranolol both make the shakes worse for me and a few others that I know.

I would seriously look into clonidine. It is cheap like the beta blockers and it seems to have far less side effects. I can honestly say that clonidine works about as well as a benzo and they even gave it to me when I was IN benzo withdrawal. It knocked out most of the symptoms and certainly calmed my nervous system down (they gave it to me because my resting pulse was 180 and my BP was 170/96 - my normal resting is 70 and my normal BP is 110/84 - about 30 minutes after taking it they took my vitals and found that my pulse was down to 89 and my BP was 120/90). It lasted longer than a Xanax or especially Ativan would have and it didn't have a huge and abrupt rebound like both of the above.

As for Lexapro, I didn't like it. It made me feel like I was on speed and gave me insanely bad panic attacks. I much prefered Celexa (which is the racemic mixture of citalopram and escitalopram) - when I started taking Celexa I lost all panic symptoms but as a side effect it turned me into a full-blown alcoholic almost 30 days to the day after I started taking it and I was on a rampage until they took me off of it 5 months later. Didn't have a single panic attack the entire time though!

[RedBaron]

@Etherealremnant I've heard a lot of good things about clonodine, I may have to try it when I have a chance. It's prescription right? Also, is it one of those drugs that you have to take for a little while before it really starts taking effect?

And I've been on lexapro for such a long time, I'm not sure if it is adding extra anxiety or helping alleviate it, but it's supposed to have anti anxiety properties. But it definitely doesn't make me feel like I'm on speed, quite the opposite. Before my body got used to it, I'd take it around 8pm, and then the next day I never wanted to get out of bed. I felt like I could sleep forever

[Etherealremnant]

@RedBaron - clonidine is a prescription med and I would honestly recommend going to an actual doctor to get the prescription because of the fact that is such a low dose. It works as soon as you take it, it doesn't need to build up in your system. It is an alpha-2 adrenergic antagonist. Basically it interrupts the adrenaline release in your body which is why it works for panic attacks and anxiety - panic and anxiety are believed to be related to the flight or fight response. It blocks that activity.

As for Lexapro versus Celexa - it seems to be that one works for one person and the other doesn't. For me Celexa made me tired and Lexapro sped me up. I've known people that can't tolerate one, the other, or both. My body tends to really hate anything that messes with serotonin. Celexa upset my stomach for the first few weeks I took it and Lexapro I got dizzy and threw up every time I took it, even at 5mg instead of the regular 10mg dose. I could not tolerate Paxil or Zoloft at all.

Also, you may want to read this about SSRIs: http://www.thedailybeast.com/newswee...pressants.html

[RedBaron]

@RedBaron - clonidine is a prescription med and I would honestly recommend going to an actual doctor to get the prescription because of the fact that is such a low dose. It works as soon as you take it, it doesn't need to build up in your system. It is an alpha-2 adrenergic antagonist. Basically it interrupts the adrenaline release in your body which is why it works for panic attacks and anxiety - panic and anxiety are believed to be related to the flight or fight response. It blocks that activity.

As for Lexapro versus Celexa - it seems to be that one works for one person and the other doesn't. For me Celexa made me tired and Lexapro sped me up. I've known people that can't tolerate one, the other, or both. My body tends to really hate anything that messes with serotonin. Celexa upset my stomach for the first few weeks I took it and Lexapro I got dizzy and threw up every time I took it, even at 5mg instead of the regular 10mg dose. I could not tolerate Paxil or Zoloft at all.

Also, you may want to read this about SSRIs: Why Antidepressants Are No Better Than Placebos - The Daily Beast

Interesting that these SSRIs can have opposite effects (and possible not work at all, according to that article). Ever since I started Lexapro, it is a fight within my head to get out of bed every morning. There is always something to wake up for, but I'm always wanting to sleep just a little longer, no matter how long I sleep or what time I wake up.
Yet for you, @Etherealremnant , it speeds you up. Maybe I should look for a switch in antidepressents, or just talk to the psych about going off completely. I almost feel like some of my depression symptoms (tiredness, lack of motivation, lethargy, etc) are worsened by the Lexapro, but have no idea how other meds would work. At the same time, I don't want to be messing myself up while trying to make myself better. And here comes the anxiety...

[Etherealremnant]

@RedBaron - The only antidepressants that have actually proven to be clinically significantly better than placebo are imipramine and amitryptiline which are old school tricyclic antidepressants which have a HOST of problems associated with their use up to and including heart failure.

You might want to try to switch to Celexa if you are having problems with Lexapro. The switch between the two should pretty much be effortless since they are essentially the same drug and even though they say that (S)+citalopram is the only "active" ingredient, a lot of people find that (R)-citalopram actually does make a difference - Celexa has both of them.

Maybe look at trying a dose reduction?

What time of day are you taking your Lexapro? Before bed? Maybe try taking it a little bit earlier and see if that helps you with getting out of bed in the morning.

You can also try good old caffeine, if you can tolerate it, to get out of bed.

[RedBaron]

@Etherealremnant first off, you are a hard name to spell out, haha.
I was taking my Lexapro at 5mg (half the pill) because when I first started I was yawning A LOT and having over-sleeping problems, but my psych encouraged me to take the whole 10mg after a few months. It's not as bad as when I started, but my psych doesn't think that the drug is effective enough at 5mg.
He also advised me to take it earlier than before bed to combat the morning grogginess, but it seems to be a problem no matter how early in the evening I take it. If I take it early in the day, I yawn at a consistent rate all day (doesn't look good to others), and I'm still super tired the next morning.
And caffeine does help, but when I say trouble getting out of bed, I mean I open my eyes, and I don't even move a muscle, just lay there thinking "Ok I just hit my alarm button... move... come on, get up... nah I'm tired... no I should get up, I have things to do today... but so tired". And this is after about 10 hours of sleep. I used to average 7-ish hours and had no problem waking up (aside from the usual morning blah).
And then I'll get up later and pour out the cold pot of coffee that was sitting on the burner until it auto-shut-off an hour after brewing.
Once I get moving, I'm generally ok, but seems to take so much inertia to get up to speed, if any of that makes sense.

[Etherealremnant]

@RedBaron - yeah I know my name is hard to spell out LOL you should see people try to pronounce it, its hysterical.

From reading your posts it really sounds like the Lexapro isn't doing anything positive for you. Not wanting to get out of bed, being tired all day, etc - these are all signs of "depression" - have you been noticing any significant changes in eating habits as well?

You could always try slowly adding in Wellbutrin and tapering off of Lexapro. Wellbutrin is a very stimulating drug - I never had problems sleeping on it but I was quite sped up and that seems to be the norm. It also had the benefit of increasing libido as opposed to SSRIs killing it, I lost about 20 pounds, and up until it started giving me panic attacks (my doctor ramped my dose up too quickly) I actually really liked it and tolerated it pretty well.

Sometimes even just an adjunct therapy of 75mg of Wellbutrin tossed in with an SSRI can eliminate a lot of the negative side effects of them.

[RedBaron]

@Etherealremnant you have been very helpful, and I am grateful for you paying attention to my ramblings.
I agree that the Lexapro seems to enhance the depression symptoms, except that I don't get sad on a regular basis anymore. But also a good bit of time has passed since the traumatic incident that sparked all of this, and I've about moved on. these secondary effects are very persistent, though, and annoying more than anything.
I'll talk to my psych about Wellbutrin, as the side effects of Lexapro do seem to be debilitating, and I would like an alternative. But I've been having some increased anxiety as well though. So stimulation would help and hurt at the same time, unless there is something special to it that doesn't up anxiety along with the stimulation. I've been much more worried about routine deadlines in the past several months than I've ever been in my life. And it seemed to happen when the primary symptoms of my depression began to dissipate.
As to weight, I lost about 20 pounds (175 to 155) in a little over a month. I've gained some back, by making sure I eat (and the use of our little green friend).
It's so weird to lose that child-like ambition so easily. I wish I could "carpe diem" like I used to, but it's rare these days.

[Etherealremnant]

@RedBaron - if you get overstimulated easily, try just adding 75mg of Wellbutrin to your regimen and see how you do with it for a few weeks. Wellbutrin also has the added benefit that it starts working in as little as 2-3 weeks as opposed to 4-6 for the other antidepressants.

And you haven't been rambling - I've been there man. I've been considering going back on Celexa myself - that or taking Geodon which I would rather not do - because I'm in a pretty bad "IDGAF" mood lately...

If you think that enough time has passed maybe it is time to look at weaning off of the Lexapro and trying it med-free? I haven't been on anti-depressants since 2009 and I haven't been on anti-psychotics since then either even though they swear I'm bipolar. The only thing I haven't been able to kick is the benzos.

[RedBaron]

@Etherealremnant I'll talk to my psych to see what he thinks. But I definitely need a change, and don't want to go behind his back or anything, because that will just make things more complicated/anxious. It's hard to to just face a psychologist and be like "I feel like what you're doing isn't right", but some specific information would be helpful in talking to him.
Again, thank you for your responses.

And OP, sorry I hijacked this thread for my gain

[Etherealremnant]

@RedBaron - Definitely talk to him and see what he thinks. Most psychiatrists actually respect their well-informed patients more than the less-informed and thus less active in their own treatment. Less work for them, you know?

[RedBaron]

@Etherealremnant oh yeah. I can tell that they appreciate that I know that I have a general idea of what I'm talking about with the treatment. I always do some reading before I try a new substance, prescribed or not.