Advice for Propranolol

[squatncrunch]

Hello all, unfortunately my anxiety got the best of me the other day and I had a terrifying panic attack. Thought those were a thing of the past. This one was like no other and had me really scared. I went to the ER and had an EKG/ECG. All came back normal, although in April I went in for constant palitations (strong beating kind) and they did pick up a sinus arryhtmia, which was only slight when measured. I was told not to worry, all other heart functions sounded normal per stethescope.

My recent trip to the ER for PA had the doctor prescribing me 40mgs of Propranolol, I know this is used for palpitations and anxiety. My issue is having my blood pressure drop too low as a an effect from Propranolol. Mine is always around 96-110/53-61, kinda on the low side already. Why would he prescribe me this dosage? I have not taken any of the RX, too afraid. My Bp was low on the visit so I do not understand why he missed this. I'm looking for any advice on this. Also, is it normal to have a crazy panic attack and have a low BP? Not complaining, must be better than a high BP but I just don't get it. Thanks for any and all help. BTW, this was Pattaya Memorial in case anyone has suggestions as to where I should go for these palptations, think I need to try a new place.

[Sheryl]

Palpitations are a normal feature of panic attacks and since cardiac problems have already been excluded I wouldn't worry specifically about them. A "sinus arrythmia" just means that your heart is beating slower or faster than usual (would be faster in your case) but not outside physiologic range. It is not a sign of a physical disorder but rather a normal byproduct of the panic attack.

I think you are right to be concerned about propanolol given your low BP. There are newer, nonaddictive alternatives which do not have a BP lowering effect, venlafaxine being perhaps the best. I suggest you see a psychiatrist specializing in panic disorders, the doctor who treated you in the ER was likely not one. Also, I suggest you get some short-term counselling as the combination of therapy plus medication works better than either one alone.

See the pinned mental health list for therapists. Most are in Bkk but Carl Janowitz used to have hours in Pattaya, not sure if still the case http://bangkoktherapy.com/contact/contact.aspx Fort psychiatrist, while there are ones in Pattaya I am not aware of any that are Western trained and specifically specialize in panic/anxiety disorders so I suggest going into Bangkok and consulting this UK-trained doctor at Bumrungrad:

https://www.bumrungrad.com/doctors/Spain-Uneanong

Venlafaxine and similiar meds work very well but takes a little time so don't lose heart if results aren't immediate.

Good luck.

[squatncrunch]

Thanks Sheryl, I will absolutely look into Venlafaxine. I have seen Dr. Carl before, I liked him and would definitley see him again, nice guy. Thanks for all of your help, Sheryl on these forums. You truly do a wonerful service with your expertise and medical knowledge.

[cheeryble]

Squatncrunch the most important thing I ever learned about panic attacks....from a psychologist at the highly reputable Maudsley Hospital..... is that although it feels like the end of the world they ALWAYS pass.

If it's a severe attack with vertigo and the like the feedback loop of fear will break faster and calmness will arrive faster, could be in minutes or a few fives of minutes.....BREATHE STEADILY and wait for it to pass. Talk to someone or call a friend to pass the time a little more easily. Do a little job like removing unused numbers from your phone.

If more general anxiety may take a bit longer but WILL PASS.

I think it's very important to build up trust in this temporary nature of panic.

Nothing bad.....apart from the nasty feeling.....will happen to you. It will pass and, especially if it was severe, you will then feel very calm and peaceful indeed.

Don't add secondary worry about your heart it will take care of itself.

Try to breathe steadily, concentrate on that as if you hold your breath in gulps it will exacerbate your physical sensations from gases not being transferred to/from the blood properly causing weakness and maybe odd sensations and vertigo. Just breathe out the in breaths will come automatically. Whatever, just don't hold your breath........BREATHE......

Edited July 5, 2015 by cheeryble

[chubby]

well if you go to an ER, the dr. is just fixing up the problem he sees, to stablize the complaint, and temporarily lower BP is not going to hurt you ; unless your symptomatic of the low BP i suppose and fall and hurt something.....

[squatncrunch]

@Cherryble, thanks for the breathing reminder. It IS the most important tool in quickly reducing a panic attack. I have plenty of nice guided breathing meditations and body scan meditations downloaded to help me along. The cycle of fear is terrible and learning to stop it dead in its tracks is key.

@Chubby, I am symptomatic of low BP, even during bouts of panic. I feel bad bothering an ER doctor with this problem, there are enough people with real physical health problems/accidents that truly need the help.

[chubby]

what symptom?

[squatncrunch]

@Chubby, I regularly have BP on the low side, that's why the rx Propranolol is not a good option for me, it lowers bp, could really have some scary adverse effects on me.

[Sheryl]

With a BP ranging 96-110/53-61, 40 mg of propoanalol is definitely not a good idea.

[chubby]

low numbers aren't really a Sx, if it was short term, to get over the anxiety, perhaps it might be OK, i don't wanna look up what is the typical dose, i'm sure sheryl may be right over the long term