I was just RX Tenormin (Atenolol) 25 mg/day for anxiety. I think I am too scared to take it. It's not even FDA approved for anxiety. I have taken SSRIs (Prozac, Luvox, Paxil, Zoloft, Celexa) SNRIs (Effexor, Wellbutrin) as well as benzodiazepines (Xanax, Klonopin) a mild tranquilizer (BuSpar) and a serotonin modulator (Desyrel) all at different times with varying effects. I'm sure the beta blocker will help with heart palps, but I am pretty sure that it will make my dizziness even worse. I have this weird dizziness a lot of times that I can only compare to the feeling after you've been in a boat for a long time and you get out and hours later you still feel like you are rocking, or when you were a kid and you got really high up on a swing and you're coming down. It's all cool when there is a reason for it, but I can be sitting still and it hits me. I still think something is up with my inner ear that may be causing the dizziness, I've had two DR's look in it all they say is that there is a lot of scar tissue. (I had tubes and a surgery on the troubled ear when I was a kid) Maybe I should go to an otolaryngologist and not a GP? I also have a weird pulsating hum in my ear for about 4 months now and my DR just told me it was my heartbeat. I think my brain is coming down through my ear like that poor guy on Discovery Health the other day. So can generalized anxiety disorder cause weird dizziness? Should I try an old school tricyclic like Tofranil? Beta blockers worth a try? I'm sick and tired of being sick and tired!
Beta blockers are good blood pressure drugs. They have been shown to decrease mortality in people with heart disease and are usually started if a patient is not already on them after a heart attack. I have heard of propranol another beta blocker being used for social phobias like public speaking. What is your pulse. 130/82 isn't bad but they say prehypertension starts at 120/80 so I don't think it could hurt to drop you down a little bit. They also slow the heart rate a little. What does your heart rate normally run? With all the drugs and stuff you kind of sound a little like a hypochondriac.
http://www.emedicine.com/med/topic3121.htm Social Phobia Last Updated: March 28, 2006 Rate this Article Email to a Colleague Get CME/CE for article Synonyms and related keywords: social phobia, social anxiety disorder, anxiety disorder, performance anxiety, fear of social situations, Mental Status Examination, MSE, avoidance behavior, social isolation, stage fright, social panic, panic attack AUTHOR INFORMATION Section 1 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Author: Kiki D Chang, MD, Director, Pediatric Mood Disorders Clinic, Assistant Professor, Department of Psychiatry, Division of Child Psychiatry, Stanford University School of Medicine Kiki D Chang, MD, is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, and Association for Academic Psychiatry Editor(s): Mohammed Memon, MD, Medical Director of Geriatric Psychiatry, Department of Psychiatry, Spartanburg Regional Hospital System; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories; Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry, Assistant Professor, Department of Medicine, Froedtert Hospital, Medical College of Wisconsin; and Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA Disclosure INTRODUCTION Section 2 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Background: Social phobia, also called social anxiety disorder, is an anxiety disorder involving intense distress in response to public situations. Individuals with social phobia typically experience symptoms resembling panic during a social encounter. These situations may include speaking in public, using public restrooms, eating with other people, or social contact in general. Patients fear being humiliated or embarrassed by their actions and may become intensely anxious, with increased heart rate, diaphoresis, and other signs of autonomic arousal. These physical symptoms may cause additional anxiety, often leading to a conditioned fear response that reinforces the anxiety of public situations. Social phobia is considered a disorder if it is severe enough to adversely affect social or occupational functioning. That is, individuals with true social phobia go to great lengths to avoid social situations, usually to their own detriment. The fear of embarrassment is ego dystonic, and patients with social phobia are distressed by their symptoms. Pathophysiology: The pathophysiology of social phobia is unclear. However, theories have arisen based on the efficacy of pharmacologic agents used to treat social phobia. Thus, serotonergic functioning might be involved because serotonergic reuptake inhibitors help alleviate symptoms. Similarly, some researchers believe in an adrenergic etiology because of the success of propranolol therapy. Neurocircuitry involving the amygdala, a structure involved in fear, may be involved. Frequency: In the US: According to the US national comorbidity survey from 1994, social phobia is the third most common psychiatric disorder in the United States. Prevalence has been estimated at 7%. The prevalence of social phobia appears to be increasing among white, married, and well-educated individuals. Internationally: Lifetime incidence is estimated at 7-12%. Mortality/Morbidity: Social phobia often leads to extreme social isolation in children and can be a precursor to depression. In adults, academic and occupational functioning also may be affected; often, people with social phobia have significant trouble forming relationships with others. Sex: In the general population, females are affected more often than males; however, in clinical samples, cases involving males are more prevalent. The reasons for this prevalence are unknown. Age: Social phobia typically manifests in early adolescence (ie, aged 11-12 years) but may appear in younger children or older adults. Untreated childhood social phobia typically continues into adulthood. CLINICAL Section 3 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography History: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for social phobia are as follows: The person has a marked and persistent fear of one or more social or performance situations in which he or she is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Children must show evidence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer settings, not just in interactions with adults. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed panic attack. In children, the anxiety may be expressed as crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. The person recognizes that the fear is excessive or unreasonable. In children, this feature may be absent. The feared social or performance situations are avoided or are endured with intense anxiety or distress. The avoidance, anxious anticipation, or distress in the feared social or performance situation interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships; alternatively, the patient has marked distress about having the phobia. In individuals younger than 18 years, the duration is at least 6 months. The fear or avoidance is not due to the direct physiological effects of a substance (eg, drug of abuse, medication) or a general medical condition and is not better accounted for by another mental disorder (eg, panic disorder with or without agoraphobia, separation anxiety disorder, body dysmorphic disorder, pervasive developmental disorder, schizoid personality disorder). If a general medical condition or another mental disorder is present, the fear in one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others is unrelated to it; for example, the fear is not of stuttering, trembling in persons with Parkinson disease, or exhibiting abnormal eating behavior in persons with anorexia nervosa or bulimia nervosa. The phobia is specified as generalized if the fears include most social situations; also consider the additional diagnosis of avoidant personality disorder. Associated features include depressed mood; somatic/sexual dysfunction; addiction; and anxious, fearful, or dependent personality. Physical: A thorough Mental Status Examination should be included, with the following areas specifically assessed: General appearance: The patient may be noticeably uncomfortable or anxious in the office. The patient may be hesitant or have difficulty speaking. However, in one-on-one situations, the patient may not demonstrate significant social anxiety. Mood/affect: Because depression is commonly comorbid with social phobia, the patient may report depressed or anxious mood and may appear to have a depressed or anxious affect. Speech: The patient may speak softly and with hesitancy. Thought processes: Thought processes are usually normal, and thinking is goal directed. Perception: Auditory or visual hallucinations are not elements of social phobia. Thought content: The patient may be preoccupied with what others are thinking about him or her. Delusions are not present, but preoccupation with the scrutiny of others may approach delusional levels. True paranoia or fixed delusions are not consistent with social phobia. Cognition: Cognition is normal. Suicidal/homicidal ideation: This is not common with social phobia per se, but the social isolation associated with social phobia can lead to despair, depression, and suicidal ideation. Causes: Genetic factors may contribute to social phobia. Pedigree analyses suggest that first-degree relatives of probands with social phobia are 3 times more likely to have social phobia than controls. However, specific genes have not been isolated. An inhibited temperament in childhood has been linked with the development of social phobia in adolescence. DIFFERENTIALS Section 4 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Panic Disorder [Pervasive Developmental Disorder: Autism] Other Problems to be Considered: Agoraphobia without history of panic disorder Separation anxiety disorder Generalized anxiety disorder Specific phobia Schizoid personality disorder Avoidant personality disorder Anxiety disorder not otherwise specified Performance anxiety, stage fright, and shyness Substance abuse/dependence Depression and Anxiety Resource Center Depression and Anxiety Resource Center View all Depression and Anxiety Articles Depression and Anxiety CME Depression and Anxiety Multimedia Library Quick Find Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Click for related images. Related Articles Panic Disorder [Pervasive Developmental Disorder: Autism] Continuing Education CME available for this topic. Click here to take this CME. Patient Education Anxiety Center Anxiety Overview Anxiety Causes Anxiety Symptoms Anxiety Treatment Panic Attacks Overview Hyperventilation Overview WORKUP Section 5 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Lab Studies: Basic laboratory studies are prudent and might include a serum CBC count with differential, an electrolyte evaluation, liver function tests, and thyroid function tests. TREATMENT Section 6 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography Medical Care: A combination of pharmacotherapy and psychotherapy is usually indicated for persons with social phobia. Pharmacotherapy Selective serotonin reuptake inhibitors (SSRIs): SSRIs are quickly becoming the standard first-line medication for social phobia. Paroxetine received US Food and Drug Administration (FDA) approval for this indication in 1999 and was the first SSRI to gain such approval. In 2003, sertraline received FDA approval for short- and long-term (20-wk) treatment of social phobia in adults. Venlafaxine, a serotonin/norepinephrine reuptake inhibitor, was also approved for the treatment of social phobia in 2003. Studies suggest that other SSRIs also may be effective. No FDA medications are approved to treat social phobia in children younger than 18 years; however, numerous open and controlled studies support the efficacy of SSRIs in this population. Benzodiazepines: Benzodiazepines may be effective for social phobia, but they are more dangerous (lesser safety profile). Alprazolam and clonazepam have been used successfully. Buspirone: Some studies suggest efficacy in persons with social phobia. Gabapentin: New studies suggest efficacy. Propranolol: Beta-blockers have been used to block the autonomic response in persons with social phobia. Preventing symptoms such as tremor and increased heart rate may lead to successful performance in social situations despite anxiety.Monoamine oxidase inhibitors (MAOIs): Phenelzine has been demonstrated to be effective in controlled studies. The dietary restrictions required when taking MAOIs reduces their popularity. Moclobemide, a newer reversible MAOI, has had some efficacy in persons with social phobia. Psychotherapy Behavioral: Behavioral psychotherapies, such as gradual desensitization, may be useful in persons with social phobia. This technique involves gradually exposing the patient to simulated situations that normally cause anxiety in the patient. By mastering the situation without anxiety, the patient is eventually able to tolerate more situations that previously induced anxiety. Cognitive: Cognitive and insight-oriented therapies have proved useful in treating social phobia. Individuals with social phobia often have significant cognitive distortions related to what other people could be thinking about them that might respond to restructuring.
I don't really have social anxiety. I get freaked out at home just as much. I am a hypochondriac but that doesn't mean that I don't feel like shit from worrying. It sucks. I'm sure I need some behavioral therapy, but I also live in a small town with shitty doctors and I don't think they care much about what they are doing. My pulse is usually around 100 resting... it has gone up to 160 with panic attacks.
That's pretty high. Normal is 60-90. Sounds like you should at least try the beta blocker. It can't be good on your heart to always be working that hard. Have you been tested for other possible reasons for tachycardia. Have they done and EKG on you to better characterize the tachycardia?
This all started about 10 years ago when I was 19 or so. I went to the ER and was treated very badly. I was accused of being on coke when at the time I hadn't even seen the shit. The EKG was normal. Last year, I had another EKG which was also normal and was brushed off. I have only seen a GP. I know EKG's are good at finding problems, but they can't find everything. I think I need one of those Holter monitors. I had blood work done last year... My fasting triglycerides were 90 and my cholesterol was 155. My sodium level was the only thing weird and it was low. My TSH was 1.49.
The EKG can show whether it is a supraventricular tachycardia meaning the heart depolarizes from the atria to the ventricles like it should. Have you been having any kind of heavy menstrual bleeding or bloody bowel movements where you could have become anemic? Did you start any new drugs about the time you started getting tachycardic? Have you had any palpatations?
Well let me see - you have had excessive menstrual bleeding for months...anxiety attacks, dizziness.....and no help from multiple psychotropic meds.... Hormonal imbalances are the number one cause of anxiety and panic attacks in women in my experience. Doctors give you a bunch of meds that help the anxiety, but they miss the hormone problem and basically treat symptoms and not causes. I would consult with a hormone specialist (endocrinologist?), and have a full hormone panel done right away. I bet that straightening out your hormones fixes the problem. As far as the new med, I think you are pretty smart to question it. I would do the horumone thing with a specialist first. Hope it gets better. Anxiety sucks.
I suspect the beta blocker was given to control the fast heart rate. She did not say whether she has had heavy menstrual or bowel bleeding. If so this good reduce the oxygen carrying capacity of the blood and to compensate the heart beats faster in an attempt to oxygenate the tissues. It is premature to suggest she should go to an endocrinologist. She needs a good internal medicine guy. They get better training than family practice which is what it sounds like she is going to. Internal medicine guys are some of the most knowledgeable physicians in general because they deal with all the problems serious enough to land people in the hospital and then order consults. Anemia is just one possible cause. There are many possible causes and I was attempting to rule out one through questioning. It is a cop out to immediately attribute the fast heart rate to anxiety without first trying to find a good medical other than psychological reason because if it isn't psychological then not catching the real problem could create a much bigger problem down the road.
If she is anemic from bleeding then the source should be identified whether a GI bleed or heavy menstrual bleeding. A simple blood test looking at the red blood cells will tell if she is anemic. The hemoglobin will be low and she will have small red blood cells as in microcytic anemia. The source of the bleeding would be identifed and dealt with wheter from a gastroenterologist through endoscopy or a obgyn. Iron would be prescribed to help replenish the red blood cells. It is not advisable to take iron supplements unless anemic as too much iron in the body causes it to be deposited in the tissues where it can cause damage to such organs as the pancreas and the heart know as bronze diabetes due to the pigmentation in the skin and diabetes caused by burning out the pancreas. Occurs without iron supplementation in patients with hemochromatosis who have a genetic defect causing them to absorb to much iron and also people with hemolytic blood disorders that have to undergo periodice transfusions.
let me repost since I messed it up. Well let me see - you have had excessive menstrual bleeding for months...anxiety attacks, dizziness.....and no help from multiple psychotropic meds.... Hormonal imbalances are the number one cause of anxiety and panic attacks in women in my experience. Doctors give you a bunch of meds that help the anxiety, but they miss the hormone problem and basically treat symptoms and not causes. I would consult with a hormone specialist (endocrinologist?), and have a full hormone panel done right away. I bet that straightening out your hormones fixes the problem. As far as the new med, I think you are pretty smart to question it. I would do the hormone thing with a specialist first. Hope it gets better. Anxiety sucks. Dan, I agree with the anemia thing, but she has had problems for a long time. The trip to an internist is a good idea. I don't thing that all these symptoms are psychological in origin.
Dont forget the power of the mind too, you may be continually forcing yourself into this cycle without being aware of it more positive self reinforcement needed? Dont worry yourself so much and part of it will go away. sure it can be chemical, but it doesnt always have to be
Also one of the first signs of dehydration is tachycardia. A pheochromocytoma could cause one by releasing catecholamines but that would be more rare.
If I were to work it up I would start with 1. The hear - EKG holter monitor. Identifies the extent of the problem and any possible abnormal electrical activity giving heart rate throughout the day and night while sleeping 2. Volume status - Fractional excretion of sodium, urine and serum electroyte, kidney function with BUN and creatinine, urine and serum osmolarity 4. Possible anemia - Complete blood count with hemoglobin and hematocrit (also can relate to volume status) 3. Adrenal function - 24 hour urine test for metabolic byproducts of catecholamines (i.e. metanephrine) for possible pheocrhromocytoma 4. endocrine- thyroid stimulating hormone was already normal so if nothing else pans out I might check thyroid hormone (T4), If volume status is abnormal might check Antidiurectic hormone levels.
As far as going to the ER. The job of the ER is to make sure you aren't dying within the next week or so. It's good to remember that. If they think you are dying they will admit you to the hospital to what they believe is the appropirate service i.e. neurosurgery, cardiology whatever. Otherwise trhey figure you should be going to your primary care or if you have the type of insurance where you can go directly to a subspecialist you might be able to do that if they accept you as a patient. This may be a little exaggerated but there is some truth to it. Other services sometimes make fun of what the ER people do but they are pretty good at making sure you don't die in between giving you enough time to get to a regular doctor. Internal medicine docs are usually better than family medicine docs. General practice is really kind of an outdated term. You can't expect to get definitive care from an ER doc on something that isn't really within their area of specializATIon which is to stabilize patients and move them on to other doctors who are the ones who really do something and know about their particular area.
For example is you are having chest pain or passing out they will probably do an EKG and test for cardiac enzyme elevations to see if you are having a heart attack or a heart rhythm which could be dangerous. If they determine that you are having one of those they may admit you to the hospital to the cardiology service. If you are having a problem like what you describe and aren't immediately dying i.e you said you have been having it for years then you go to a regular doctor whose job it would be to find out what is going on and provide evidence that that is in fact why you are having the symptoms. As far as cocaine the ER regularly does toxicology screens because a lot ot the patients they get are drug abusers, and drunks who have managed to get themselves into bad shape through abusing some substance i.e got compleelty wasted and had someone break a bottle over their head, snorted a bunch of cocaine and started having chest pain ect. ect.
