Why was I prescribed Propranolol for anxiety and when it is a beta blocker?

[sobs1962]

Anyone know why a beta blocker which is for heart problems would be prescribed for anxiety and especially as it causes such serious problems with T4 to T3 conversion in hypothyroidism patients. Are doctors misinformed or just incapable of updating their knowledge, or being dictated to by the drug companies?

[bantam12]

Propanol is commonly prescribed for anxiety. I have to take a beta blocker for heart problem and it doesn't effect my thyroid meds, no conversion issues at all and in fact I take them at the same time.

[legsgran in reply to bantam12]

Me too.

[humanbean]

As far as doctors are concerned the sequence of events is usually something like this :

Patient gets anxious about something, heart rate and blood pressure (BP) rise, propranolol reduces heart rate and blood pressure, patient feels less anxious, and then patient goes away.

What doctors rarely think of is this sequence of events :

Patient has nutrient deficiencies, depending on the deficiency this may cause heart rate and/or BP increase, most people associate fast heart rate and high BP with anxiety, doctor assumes that anxiety is the only problem and prescribes beta blockers.

However if the patient's nutrient deficiencies get fixed the heart rate and BP may return to normal without beta blockers.

I had a few episodes of heart rate being about 150 when my iron and ferritin were in my boots. I fixed the deficiency myself (which took a long time) and, although my HR and BP sometimes do occasionally rise, the degree of increase is much less than it used to be, and I probably need more exercise rather than beta blockers.

[sobs1962 in reply to humanbean]

As far as I know I have never had any problems with high blood pressure or high heart rate,so this makes no sense to me. I just want to get off it fast and try a natural organic supplement instead.

[humanbean in reply to sobs1962]

I'm surprised you were given beta blockers then, to be honest. They are the usual signals used by doctors to declare someone to be anxious.

If you haven't suffered from fast heart rate or high BP be very, very careful with your beta blockers. When my heart rate got up to 150 when my iron and ferritin were very low indeed I was put on just a low dose of beta blockers and I ended up with a BP of roughly 93/47 and a heart rate in the low 50s.

I live on a short, gentle hill and the bus stop is at the top of the hill. When I was on the beta blockers I was nearly fainting by the time I got to the bus stop. I gave up the beta blockers after that. Nowadays I take half a one once in a blue moon if my heart goes uncomfortably fast. I got my last prescription about two years ago and I still have about half the prescription left.

Beta blockers can be dangerous.

[legsgran in reply to sobs1962]

They often give beta blockers for anxiety - I don't know the chemistry, but it does have a marked calming affect. My mother has anxiety and was put on them and it worked very well. Personally, I would rather have a beta blocker any day than a drug like Citalopram or similar which is the usual drug (SSRI) they give you for anxiety as it is (despite what they say) hideously difficult to withdraw from. Beta blockers are usually given for a short time (weeks rather than months) to deal with short term anxiety. It depends on how bad your anxiety is - all drugs have some sort of side effects and you just have to look at the 'cost - benefit ratio'. I would try the vitamin supplement route always first in any case, it can make a huge difference to mood.

[Lalatoot]

Ssri type medication for anxiety such as citalopram can affect the absorption of levothyroxine and folks on ssri medication for anxiety sometimes need a higher dose of levo to counter this.

[dhlazaro in reply to Lalatoot]

If they'd just use SYNTHROID that might not have happened

[Angel_of_the_North in reply to dhlazaro]

That comment makes no sense

[jimh111]

It is a recommended treatment for anxiety but I would want to get to the root cause of anxiety and address it. It is not a good treatment for hypothyroid patients. Ask the doctor to consider a treatment that doesn't affect thyroid hormone activity. Possibly a form of counselling if it hasn't been tried as it doesn't involve medication.

[sobs1962 in reply to jimh111]

I have been waiting for two and half years to start some form of specialised psychotherapy ideally Dialectical behavioural therapy and was offered Transference Focussed Psychotherapy but it was not right for me. I have Severe recurrent depressive disorder which according to my psychiatrist is treatment resistant,generalised anxiety disorder and although no official diagnosis also Borderline Personality Disorder. I don't know if my thyroid problems are making all this worse but since I stopped drinking my mental health has actually deteriorated despite being told that alcohol was making my problems worse.

[jimh111 in reply to sobs1962]

Purely from a thyroid aspect propranolol is the wrong treatment. It has complex effects on thyroid hormone action which is an added complication you don't need. I would ask your doctor for a different medication to control anxiety. The side effects of propranolol disruption of thyroid hormone could make your other treatments more difficult. I can only comment on thyroid issues, I'm a thyroid patient not a doctor.

[Naomi8 in reply to sobs1962]

Using alcohol to self-medicate anxiety is very common.Unfortunately it can lead to alcohol dependence & all the problems that go with that-including tolerance & denial.

I am 70 & have lived with anxiety & periodic depression since a toddler.I have used an SSRI in the recent past.At present I am coping using daily mindfulness,yoga & exercise.Due to the pandemic,my symptoms are growing worse again.I may resort to Sertraline to help me through,but not until I reach the point at which my anxiety tips me into depression,where I get stuck in an even more nightmarish world than living with daily anxiety.People who have not experienced chronic severe anxiety have no idea what we experience.

[SlowDragon Administrator in reply to sobs1962]

Anxiety is common when Ft3 is low

Propranolol lowers Ft3

It becomes a vicious circle

Propranolol lowers magnesium too and when hypothyroid we are frequently very low in magnesium

Gluten intolerance extremely common when hypothyroid and this can cause anxiety too

Many hypothyroidism patients are low in Thiamine (one of the B vitamins) Alcohol also lowers thiamine

thyroidpharmacist.com/artic...

adf.org.au/insights/alcohol...

Resistant depression linked to low Ft3

Only start one supplement at a time

Perhaps magnesium first

Test vitamin D, folate, B12 ferritin

[vocalEK in reply to sobs1962]

Are you sure you have BPD? I found this page that differentiates quite well between narcissism and borderline personality disorder. bridgestorecovery.com/blog/...

[sobs1962 in reply to vocalEK]

Definitely, a narcissist loves everything about themselves, I despise myself.

[greygoose]

Anxiety and depression are both hypo symptoms, but doctors are reluctant to admit it. They prefer prescribing things they get financial incentives for, like beta blockers and antidepressants, rather than concentrate of optimising the treatment for hypo.

Have you had a blood test recently? It could very well be that you are under-medicated for thyroid. If you have the results and ranges, post them here, and let's have a look.

[dhlazaro in reply to greygoose]

Get name brand its so much better! Synthroid my copay for 90 days is USD $3.50

[helvella Administrator in reply to dhlazaro]

There is nothing magic about AbbVie Synthroid. It is just another make of levothyroxine.

Along with every other make of levothyroxine in the USA, around 2001 Synthroid had to re-apply as a "new drug" because none of them were produced to acceptable manufacturing standards.

Then again, around 2014, they tightened the specifications further.

Some people prefer Sandoz, others Unithroid, or one of the others. Finding an acceptable make, getting the right dose for the patient, and keeping to that make are key. Whether that make is Synthroid, or another make, is not itself important.

[greygoose in reply to dhlazaro]

Are you replying to me or the OP? Either way, your reply is not appropriate because it relates to thyroid treatment in the US, which we know little about. The OP is in the UK, and I'm in France. Things don't work the same way in either country as they do in the US. We don't have copay and we don't have Synthroid, and neither things would make any difference to the OP's original question. Are you sure you've posted on the right thread?

[Angel_of_the_North in reply to dhlazaro]

This is a UK forum - no Synthroid, no co pay (whatever that is), no cost as we've already paid through taxes and anyway it's exactly the same active ingredient as any other brand. Do you work for this pharmacy? If so, you might do better advertising them in the USA.

[Shazy-B]

I was prescribed a slow release propranolol a few years for anxiety, by day 2 I was in A&E with a severe adverse reaction, my heart rate was on the floor and I literally couldn’t move, adrenaline was constantly surging through my whole body. It caused a complete thyroid storm and my anxiety was the worst it had ever been....I thought I was dying and that’s not an exaggeration! This medication is not good for people with thyroid issues mixed with anxiety and I would avoid at all costs. Get your labs done ASAP including Folate, palpations and dizziness is common of low folate and can be mistaken for anxiety symptoms. Look into mindfulness practice to help regulate your breathing and also some CBT, both of these have helped me immensely and my anxiety is 95% better, I still have the odd wobble (given what’s currently going on) but I am virtually living a relatively normal life which is something I would never have thought possible a few years ago. Stay strong you can overcome this I promise you 😊

[mandyjane]

It might be a good idea to post your bloods for people to comment to see if we can give you some help to get your thyroid treatment optimal. Mindfullness as people have mentioned is good for anxiety as well as really helpful for issues related to BPD. CBT can be really helpful and it might be worth you reading some books about stoicism as this is a helpful philosophy and very much where CBT was born. I would avoid counselling until you're anxiety is better managed as talking often raises anxiety levels . Jon Kabot Zinn does some really good led mindfulness to help deal with pain and suffering. 'Mindfulness meditation for relief of pain' being one I use. It is as relevant for emotional pain as it is for physical.

The most important thing is to get your thyroid hormones sorted. I have dissociative identity disorder and like many people who have this much of my childhood was horrific. I felt for many years that this was the cause of all kinds of issues in my life that were actually down to poor thyroid care. Incompetent doctors have done more to ruin my life than a whole network of abusers. I was as Jon kabot zin puts it 'thriving in the face of the full catastrophe of the human condition' until doctors started to deny me much needed thyroid hormones. I was having such a lot of fun and getting up to all sorts until my thyroid issues started to emerge. Yes doctors are misinformed. I think they might be capable of updating their knowledge but have buried their heads in the sand so far they dont know they need too and yes they have allowed and chosen to be dictated too by drug companys. Avoid male psychiatrists at all costs, they are utter control freaks. If you really have to see one, try to see a female.

[BeckieC]

Hi. I've also been prescribed propranolol for anxiety. I find they work well to calm me when I have my occasional moments.

I don't take them all the time and I don't have the side effects I got with anti anxiety meds like citralopram. I like still being me, which I wasn't on SSRIs.

I have the odd day of panic attacks and anxiety, it's not a constant thing. If I feel it coming on, like me being on edge, I'll take them that day.

I think they are good for people who don't need anxiety meds all the time. I haven't noticed an effect on my levo absorbtions, but then, I always leave a few hours between meds.

I would have struggled much more, these past few weeks, without them.

Maybe just try one when you feel anxiety come on. Taking two doses in a day works well for me when I'm struggling. Other days, I don't take any.

I hope this helps,

Take care,

Rebecca

[SlowDragon Administrator]

Three extremely senior thyroid specialist endocrinologists had no idea either

[Tina_Maria]

Beta-blockers are not licensed for anxiety, but they are frequently prescribed for it - this is called an 'off licence' or 'off label' prescribing.

Usually, beta-blockers are used as a short term treatment for anxiety, such as e.g performance anxiety, or general anxiety in patients where other anxiety medication may be less appropriate.

The name is derived from their action, they block the effects on epinephrine, also called adrenaline, on the beta-receptors. As a result, the heart rate is slowing down, which confers a calming effect. As anxiety can cause an increased heart rate or blood pressure, this is quite effective, as blood vessels are dilated, hence less pressure on the vessel and the blood pressure reduces.

Anxiety in thyroid patients can be seen, especially when receiving too low concentrations of their drugs or too much. Beta blockers are frequently used to slow the heart rate in patients with hyperthyroidism (together with carbimazole). They can also help with relieving anxiety in hypothyroid patients, but as it has been pointed out, this can interfere with the thyroid medication so caution needs to be taken.

If someone experiences anxiety whilst being treated for hypothyroidism, this could actually be an indication that they receive too little treatment and may need an increase in dose. Therefore its essential to check levels on a regular basis to be sure sufficient hormones are given, which avoids having anxiety and the need for beta blockers.

[BonnieG123]

I looked it up and yes it can be used to treat hyperthyroidism. I was prescribed Cymbalta for nerve pain when it is actually an anti anxiety med. just like our POTUS is saying that a drug prescribed for RA, plaquenel (sp?) better known as hydroxychloroquine, combined with Zithromax, May be a cure? To get over having the corona virus. I don’t usually believe a thing he says but I’m hoping this can help those who are sick. Best regards!

[Poniesrfun]

I wasn’t aware of the propranolol - thyroid connection before. I always appreciate the quality information provided here but as a skeptic I had to look it up. liebertpub.com/doi/abs/10.1....

I find this more than a bit disturbing - on our thyroid cancer forum (in the US) patients report being overmedicated on levothyroxine to keep their TSH suppressed to lower the potential for recurrence. When they complain about overmedication symptoms they are often prescribed propranolol or another beta blocker and/or additional anti-anxiety meds. I hadn’t realized this could actually worsen their symptoms.

I was taught by physicians I worked with that, except in rare extenuating circumstances, giving additional drugs to eliminate the side effects of the first medication is wrong, lazy and bordering on malpractice.

It appears that some physicians (specialists or not) have taken the legitimate usage of the drugs for thyrotoxicosis and applied it to symptoms of overmedication or milder hyperthyroid without taking the time to do appropriate testing and diagnosis.

Medicine used to require critical thinking.

Patti in AZ

[SlowDragon Administrator]

How far have you got on cutting down propranolol?

[sobs1962 in reply to SlowDragon]

I'm off them completely now took my last dose of 40 mg on Thursday last week. Came off them by switching to regular 40mg tablets and reducing the dose by 40 mg each week over 3 weeks.

[SlowDragon Administrator in reply to sobs1962]

Very good.