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metoprolol and anxiety

stephanxiety profile image
16 Replies

Hi all,

I recently started metoprolol for tachycardia and pvcs, it helps tremendously with this but my anxiety has seem to have gotten worse. Don't think it is due to the beta blocker, think its more the anxiety over the dizziness the medication causes. Does anyone take anything with metoprolol for anxiety? I also have panic disorder.

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stephanxiety
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16 Replies
jeanjeannie50 profile image
jeanjeannie50

Sometimes beta blockers can take your blood pressure down a little too low and that can make you feel dizzy. Have you a machine to check what level yours is? Beta blockers generally subdue us a little, but our dislike of taking any pills can sometimes cause anxiety, especially when we first take them.

I've been taking a very small dose of Metoprolol = 2 x 12.5mg daily for many years and to be honest it's the only one that works for me. I was once given a stronger dose in hospital and collapsed because it took my BP down too low. What dose are you on?

It may be an idea to have a chat with your GP and tell him you are feeling dizzy since starting to take them.

Jean

stephanxiety profile image
stephanxiety in reply to jeanjeannie50

Hi ! Thank for you for the reply

I am also on 12.5mg 2x a day.

My blood pressure is good, it is around 110/70

I just get random bursts of dizziness that causes me to have a panic attack 😔

jeanjeannie50 profile image
jeanjeannie50 in reply to stephanxiety

I also take Flecainide along with my Metoprolol. For me it has been the most helpful drug of all.

Try increasing your water intake a little more to see if this helps prevent your dizziness, as becoming dehydrated can be a cause. I do this by drinking as much as I can when taking pills.

With heart arrhythmias it's important when waking and getting up at night, not to immediately leap out of bed, but to sit on the side for a short time to allow the harder pumping your heart has to do, to slowly adjust from your body going from flat to upright.

Wishing you well.

Jean

Ppiman profile image
Ppiman

I have sympathy for anyone who suffers from anxiety and panic attacks. I live with the first but luckily have managed to keep the second at bay for many years now. One of the worst aspects is that the effect of these things varies such a lot between sufferers, since some cope well. People who don't suffer from it in a debilitating way can't begin to understand it, yet, because everyone has some degree of anxiety, often think they do. Worse, sometimes the sympathy is tinged at least with notions of "strength" and "weakness", which really doesn't help at all.

From your post, I doubt the cause of the panic attacks is metoprolol - at least, directly. The beta-blocker is likely a "trigger" in the sense that it lowers your heart rate and creates occasional dizzy feelings. This then precipitates the cascade that is a panic attack.

If my experience is anything to go by, it's a matter of recognising this and mentally intervening before the cascade causes mental and physical meltdown. This is what I learned to do years ago: tell myself just at the point the fear begins that I'm okay and have "been here before many times and lived to tell the tale". It works reasonably well.

In terms of drugs to help, well - there aren't any really. Doctors seem to have a mindset regarding treating anxiety that revolves around three fixations: i) a passion for CBT (30-40% effective); ii) a dislike of the only tried and tested anxiolytic available, i.e. diazepam (very effective for emergency use, but can be risky long term) ; and iii) a strong preference for SSRI antidepressants (which have doubtful effects on anxiety and can create appalling withdrawal issues and, sometimes, terrible side effects).

So far as I can discover, the safest and most effective anti-anxiety drugs is still diazepam. But this potentially useful and still unique drug has received such a bad press because it was massively over-prescribed (just as SSRI drugs seem to be now...), and it definitely can cause dependency in certain individuals (maybe 30%) and can also lead to rebound anxiety (which I get from it, so I mostly avoid it). It remains, however, uniquely helpful and psychiatrists seem happy with it, whereas GPs are not. I gather even the WHO recognises how useful it is. But... the chances are you'll be given a prescription, instead, for citalopram and fluoxetine.

I hope you can find a way to control the feelings. They can be awful to live with.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

I know you seem to disdain magnesium supplementation but I have found it has banished anxiety and panic attacks since I started taking 300mg divided into 3 doses.

Ppiman profile image
Ppiman in reply to Auriculaire

I know it must seem that way, and I am rather passionate about the scientific method and double-blind studies, but I don't really disdain anything. I've actually been taking a top quality magnesium supplement for a couple of months, which was sent to me to review by the manufacturer. I had high hopes, but it has had no effect, whatsoever, sadly. I'm also taking Vitamin D as that was recommended; but, again, no effect whatsoever.

I envy those, like you, who can succeed with alternative therapies. I have long tried hard with various of these over many years (homeopathy, "nutraceuticals" and dietary changes or supplements), but, so far (and though still trying...), have failed. I so wish it were otherwise. I have known many others over the years who have also tried and failed, so I'm not alone; and, it needs to be said that science supports a general lack of efficacy except for a placebo response.

I was fascinated today to read of the "nocebo" response. That was a new term for me!

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

My vit D supplementation was prescribed by my GP. I was tested and found to be severely deficient despite taking the 400iu a day considered by SACN in the UK to be adequate, eating oily fish nearly everyday, eggs 3 times a week. And living in a pretty sunny place. How much vit D are you taking? Have you had your blood levels tested? Taking a set amount is no good without knowing your baseline . The magnesium supplementation does not stop my afib attacks. I had one last night. But they don't bother me as much and I am far less symptomatic - it no longer feels like a bunch of frogs are having a fight in my chest!

Ppiman profile image
Ppiman in reply to Auriculaire

Hi - my vitamin D levels have always been okay, thankfully, but my calcium, although fine, was around the lower level, so it was suggested I take extra vitamin D, which, I gather helps calcium absorption. The recent news that Covid-19 seems much worse in sufferers with low Vitamin D levels prompted me to start taking it again, even though the science is rather shaky.

The evidence for taking very high doses of vitamin D is also not startlingly good so far as I can tell, but it certainly has some very vocal advocates and the Internet, of course, is awash with all kinds of misinformation. Measuring Vitamin D (and, indeed, magnesium) levels is also rather less than a perfect science owing to the way the vitamin is distributed and stored in the body.

After years of trying and failing with supplements, I now tend towards the view that a well-balanced diet, a decent body mass index, and outdoor walks are likely to be the best for health.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

You say your vit D levels have always been ok. On what do you base this? If it is that your level is over 50nmol/l ( the level at which the UK declares adequacy )then they are not necessarily ok. European countries on the whole regard leveis between 50 and 75 nmol/ l as inadequate. Do you know your actual level or are you just accepting your GPs word that your level is ok?

I would very much like to know on which criteria you base your statement that the science is shaky round the recent studies correlating low vit D with greater liklihood of contracting covid and worse outcomes . In what way is the the Reina Sophia trial of calcifediol shaky? The failure to measure vit D levels before administering calcifediol is unfortunate but given the very large doses that were used the base level would be less relevant. Measuring anything in the body is probably less than a perfect science. That does not mean that no valid info can be gained from such measurements. Has your increased vit D ingestion increased your calcium levels? Perhaps you needed more calcium in your diet.

Ppiman profile image
Ppiman in reply to Auriculaire

I do get what you are saying, but maybe my scepticism comes from my having spent many years, before becoming a teacher, in the pharmaceutical industry. I hadn't read the trial you refer to but have now. It was a fascinating read and I don't know how I missed it. In terms of the science being "shaky", all I would say is that the use of a metabolite of cholecalciferol in such a high dose cannot correlate with any kind of oral intake of the vitamin to be meaningful.

The trial looks very interesting, but it does not show that high oral doses of vitamin D will be helpful, only that high doses of calcifediol are. The use of calcifediol is not the same as the oral use of cholecalciferol, for example.

To draw an analogy, the use of intravenous magnesium will stop atrial fibrillation, but the use of oral magnesium does not.

I shall, however, now continue taking my high dose vitamin D supplement! Thanks for bringing the trial to my notice.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

I am prescribed calcifediol by my GP in drops. Before starting this treatment I had cholecalciferol in loading ampoules of 200,000 iu or 400,000iu usually twice a year . But I found that after about 3 months my levels would drop. It is difficult to buy D3 in the chemists here so I would get English friends to bring some from Boots . However even on 3,000iu a day I could not make it into the normal range. I told my GP I no longer wanted the loading ampoules twice a year and asked about the daily drops he had mentioned before thinking that they were cholecalciferol. He prescribed them but insisted on one last loading ampoule to bring me into the normal range. When I got the prescription I was surprised because I had never heard of Calcifediol and had to look it up. Each drop was 200iu and 4 drops were prescribed. I have been on this for several years now and have dropped the dose to 3 drops. It gives me a very high level of vit D round about 60ng/mL. I think my problem must have been with my liver not transforming the cholecalciferol to Calcifediol very well. The use of Calcifediol in the Reina Sofia trial was for reasons of urgency. It takes 3/5 days for cholecalciferol to be transformed so the use of Calcifediol gives a head start. I think you are wrong about the use of Calcifediol in such a high dose not being comparable to the use of cholecalciferol. The equivalent doses of cholecalciferol can be worked out. The University hospital at Angers is doing a trial with 200,000iu or 400,000iu of Zymad in covid patients (I have had these ampoules) but I do not think it has reported yet. The problem lies in the UK not being prepared to provide testing followed by such loading doses to people who are very deficient. Use of these ampoules is common here. My ex GP in England told me years ago that they were not allowed to prescribe them because they were imported from France and expensive. I took some English friends down to our local lab a few years ago to get their vit D level tested as blood tests are much more straightforward here than in UK- for a start the results arrive in the post the next day! Her result was rock bottom even by UK standards. She showed the result to her doctor who agreed yes it was very low and to go and buy some in Boots. No advice on how much to take. Here she would have been prescribed a treatment. On a totally anecdotal level I sent my daughter in London a spare bottle of drops . She got covid and took a loading dose of 10 drops and said she started to feel much better!

Ppiman profile image
Ppiman in reply to Auriculaire

My experience of UK doctors is that some can be conservative and take a while to accept some new ways of thinking. It's possible that the developing science around vitamin D levels might be one of these. There's a corollary, I suppose, with what kinds of blood sugar levels count as "diabetes" or even "pre-diabetes" when, not so long ago. such levels would have been ignored; LDL and HDL levels and the use of statins is a little similar, as is the more recent interest in systolic blood pressure, which was once rather ignored so long as diastolic was below 90mm. But doctors might be right to be conservative as there is no agreement over what level of vitamin D is "normal" or "healthy", and, of course, doctors are also guided by NICE, which, despite some thinking politicians control it, does, of course, follow the science and respond rationally.

My own reading of the science around vitamin D shows it to be developing and unclear. In your own case, then I suppose you might have some metabolic cause of the low levels, as you say. With prolonged clinically low levels, wasn't your calcium metabolism also affected? I've heard the argument that the RDA for vitamin D was worked out to be sufficient to prevent calcium metabolism problems and rickets, not for other health issues. That's possible - but taking "mega" doses of vitamins is, for me, a worrying thing to do, unless some health benefit clearly ensues. The idea that we have a "weak" immune system that vitamin D can cure also bothers me since the first thing that happens when the immune system is poor is that opportunistic pathogens take hold, notably, candid. Clearly, whatever their vitamin D levels, most people are not suffering with candidiasis.

So, I remain a little sceptical but interested and hopeful.

Steve

Auriculaire profile image
Auriculaire in reply to Ppiman

Perhaps if one looks at the vit D levels of Africans still living a traditional lifestyle ie hanging about in the sun all day with very little clothing one might have an idea of what a natural level of vit D is. Also life guards at swimming pools. Studies show that these run about 45 -50 ng/mL for Masai herdsman ( who probably wear more clothes these days than 100 years ago) and sometimes as high as 80ng/mL for the lifeguards. If the latter are Caucasians then their skin would make more than that of melanin rich African skin. Enough to last them through the winter. I would recommend to you the book on vit D by Michael Holick who is one of the foremost vit D researchers in the world. It is very interesting

As for NICE re vitD they tend to follow the guidance of SACN whose sole parameters for vit D levels are what is necessary to prevent rickets and osteomalacia . They have completely ignored all other aspects of vit D action , ignored much of the scientific literature on vit D cherrypicking negative studies despite poor design. This is in complete contrast to their recommendations to increase statin consumption for primary prevention-a move that was opposed by many doctors. Call me paranoid but I suspect untoward influence from the pharmaceutical industry.

Ppiman profile image
Ppiman in reply to Auriculaire

I have a very different view of NICE but I do take your point. The statin corollary isn’t really a fair one to make, I’d say. As for drawing conclusions from other peoples or races, I’m not so sure about the scientific relevance of that.

If one looks at native peoples and their diets, I’m sure it won’t be only vitamin D we’ll decide we need to increase. There’s a whole range of differences some in favour, but much against. To focus on vitamin D levels in such peoples might yet prove to be very useful, but so far, the science isn’t as conclusive as some suggest.

I’m still taking my daily double high dose though!

Steve

Jeekee9 profile image
Jeekee9 in reply to Auriculaire

I realize this is an older post but I cannot stop laughing about your analogy to a "bunch of frogs having a fight in your chest". I also have AFib and that is exactly the way it feels but I have never been able to put it into words so well. Thank you for making me smile and I hope that all is well with you. 😊

Messej profile image
Messej

Anxiety and metropolol

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