Heart Palpitations, Beta Blockers & Anti-Depressants

[GeoCB]

I have been plagued by constant heart palpitations for over 18 months. I have these 24/7 even when I am just sitting reading my paper in the morning and they are particularly bad a night making sleep difficult. My doctor arranged for me to have a 24 heart monitor the results of which showed nothing of concern. However, more to appease me, he has prescribed a low dosage of beta blockers but the underlying cause still hasn't been determined and, because of Covid, I can only speak to him on the phone. I find him difficult to talk to as he always sounds slightly irritated. I also suffer from depression but I stopped taking anti-depressents in January this year having taken them for years. Now I want to start with them again but I see that I cannot take anti-depressents with beta blockers. Any advice will be extremely welcome.

Thank you.

[Hidden]

Unfortunately, it’s not always possible to determine the cause of palpitations: some people just have them. I have an arrhythmia that’s completely under control with medication, but still get daily palpitations (that I never had prior to developing a heart condition) that testing can’t find a reason for. I’ve had two 7 day holters, one of which I was wearing when I had palpitations so forceful they woke me up from a nap, ecgs and an echo, but not only can they not find a sinister reason for them, they can’t find a reason at all.

I took beta blockers (bisoprolol) and a variety of antidepressants for several years. There may be a couple of specific ones that are completely contraindicated, but my understanding is that the primary concern is around blood pressure and the antidepressants changing the way other medications work, particularly with SSRIs, as they tend to increase the body’s uptake of certain drugs. It just means that doctors have to be cautious with the dosage of the beta blocker and/or any other meds that they give you relative to your being on antidepressants. SNRIs can also be taken with beta blockers without issue, and many tricyclic antidepressants, too. People sometimes think this isn’t the case because beta blockers can be used to treat anxiety, but they only treat the physical symptoms related to adrenaline surges such as palpitations, tachycardia and dizziness, they don’t actually medicate the chemicals responsible for anxiety or depression in the same way that drugs like SSRIs do.

[GeoCB in reply to Hidden]

Hi Charlie-G

Thank you for your help and advice. I managed to have a telephone consultancy with a different GP at my surgery. The upshot is I will stop taking beta blockers and switch to the anti-depressants. He feels they might address the palpitations problem in the long run - but I'm not convinced. I feel with telephone consultancies that the doctors want to wrap it up quickly and I am reluctant to push them for more details on the underlying cause.

[Hidden in reply to GeoCB]

Well, if the palpitations are mental health related - which they can be - hopefully the switch will help. It may also just be that your palpitations are one of those benign things that no one can explain, but that the antidepressants might help you to live with them more easily without feeling so anxious. I think if you’ve had all the appropriate tests, you’re not getting any other cardiac related symptoms other than the palpitations, and the palpitations themselves are stable and not changing in either rate, intensity or frequency, this may be a case of learning to live with them, but don’t let anyone just write you off if they change or those concerns persist.

Out of interest, have you tried cutting out lifestyle factors known to cause/worsen palpitations?

[GeoCB in reply to Hidden]

Hi Charlie_G

You may be right - it could be something that I h ave to learn to live with and, perhaps, the anti-depressants will help. I'm having another 24 heart monitor in September (postponed from April because of Covid). I tried (a bit) to drink less coffee and alcohol but that didn't last. Thanks again for your advice.

[Hidden in reply to GeoCB]

Caffeine, alcohol, nicotine, dark chocolate, white chocolate, ginger, meds containing pseudoephedrine, some asthma meds like salbutamol, insufficient sleep and stress. That’s the full list recognised by doctors, although some people also say spicy food. I’ve had SVT for the last 11 years. The first 5 years, I religiously took the meds, but on average had a couple of fairly major episodes of arrhythmia a month. Had my second massive ep that landed me in resus in 2015, and finally decided I should look at what was increasing my heart rate and triggering the ectopics, which in turn then sent me into SVT. For me, it turned out to be caffeine, the chocolates, ginger and pseudoephedrine, as well as over tiredness. I completely stopped all of those and genuinely haven’t had a single ep of SVT in the last five years. My benign palps are noticeably better for it too, although still daily. The prospect might seem a bit harsh, but if properly cutting stuff out turned out to help....it’s an easy thing to at least try. But you do have to be strict. If I stick even a quarter of a teaspoon of instant coffee in my brew, then I’ve got no one to blame but me when it’s pounding out of my chest at 130bpm just walking to the front door.

Anyway, fingers crossed that you get some relief, and if not relief then at least some answers. Good luck.

[Bradee12]

Hey Geo, I'm no Doctor, but sounds like you should get a second opinion at another GP or hospital. It can't hurt to get a second opinion, surely. Doctors are not God and even the best will miss things sometimes.

[GeoCB in reply to Bradee12]

Hi Bradlee12.

I would be easier to get an audience with the pope. They only do telephone consultancies and they don't want to drag them out.

[Bradee12 in reply to GeoCB]

So sorry to hear the troubles u r having.

Mate, have a read of this and click on the link where it talks about the cardiac nurses. They surely will be able to give some good guidance. HTH. healthunlocked.com/bhf/post...

[Bradee12 in reply to Bradee12]

The direct link to call the BHF nurses is here. They provide a telephone number to call. Might be good to write out a few notes before you call so that you can give your story clearly to them. Just a thought...

bhf.org.uk/informationsuppo...

[GeoCB in reply to Bradee12]

Hi Bradee12

Thank you for that info and for taking the time to post it. I may give it a shot and report back. Once again, thank you and a thanks to everyone else on the forum who responded.

[Superdar]

Beta blockers are not fun.......lowered my heart rate to 25!!! Woke up could barely move... . See if there's another choice for your palpations. Hope you feel better!!👍

[GeoCB in reply to Superdar]

Hi Superdar

I'd welcome an alternative to beta blockers but seeing a GP to discuss this at the moment is impossible. They only do telephone consultancies so no chance of checking blood pressure etc or discussing different treatments. So not much I can do at the moment. But thanks for your advice anyway.

[Hidden]

Nerves and anxiety play a big part in it and being so aware of them. I was recomended mindfulness, yoga and to chill basically ;~)

I also suffer from depresion.

Xx

[Dave4097]

I had the same thing and my doctor give me slow release propranolol 80mg, after a week I was getting very snappy at home irritated and sad and depressed then happy I didn't no if I was coming or going. My doctor put me on then after my 3 week box 10mg quick release propranolol. And I take one anytime I feel my heart start. Or my anxiety kicks in and they work great. Depression and mood swings gone! I don't take the 10mg everyday just as and when I need it. But I do get alot of heart jurks and pains in my arms and shoulder. Scares me at times. But I used to get that constant thinking at times I was having a heart attack. Turns out I do have angina, which the beta blocker helps with. Never felt Depression like it with the 80mg high dose. But they are great the weaker ones to help with anxiety and the heart populations ect