it really puts the "succ" in "succinate"

May 29, 2010 9:26 AM

Is there anything I can do to offset the side effects of beta blockers?

Last week my endocrinologist put me on beta blockers, specifically 25mg/day of metoprolol succinate ER (Toprol XL), to help deal with the anxiety, high heartrate (consistently around 100bpm) and palpitations I had been having due to being on a very high dose of Levoxyl (300mcg/day) as part of thyroid cancer management. The expectation is that I'll be at the high dose for the next year or so. Doc said that exercise shouldn't be a problem, but to be aware that it might be hard to get my heartrate up. Ok.

The day after starting the meds I went for a bike ride (about 10 miles; I was doing a lot of biking before the meds). At the end, I felt like I was going to pass out and die (very unusual for me after a ride). Now, anything even remotely like exercise gets me winded and tired.

Now I'm just a big, weepy zombie who is suddenly feeling completely hopeless about everything. Suddenly pining for an ex from years ago. Really, brain? Did you have to go there? But hey, my resting heart rate is low and no palpitations. Yay?

I've learned over the last few years to manage my acute depression through exercise, especially while I've been in the middle of a very long unemployment, but now I'm too exhausted to even leave the house (which amplifies my depressed state! I'm like a sad Ourobourous.) On top of all of that, I'm feeling a resurgence of an agoraphobia that I thought was long dead. Is there anything short of antidepressants that can help or is that really my only hope of getting through the next year of this?

posted by Cat Pie Hurts to health & fitness (12 answers total)

I don't know about the medications, but if you stay on the beta blockers you might substitute yoga for the exercise that's tiring you out. Not an aerobic workout, but can leave you feeling relaxed and nicely stretched out.
posted by yarly at 9:33 AM on May 29, 2010

When I was on beta blockers a couple of years ago, for symptoms going along with hyperthyroid, I didn't have the feelings of sadness and hopelessness you describe (at least not that I can remember) but I did feel really really pooped at first, and exercise was incredibly exhausting. That side effect, at least, got much better in just a couple of weeks. It didn't feel like I was overcoming it by getting back into shape from a new baseline, either -- it was more that my body got used to it, and then I was back to normal.
posted by redfoxtail at 9:43 AM on May 29, 2010

It's unusual, from what I know, for beta blockers to cause depression. Call to doctor is absolutely warranted. Also possible that different one wouldn't have this problem.
posted by Maias at 9:45 AM on May 29, 2010

The first 7 days of beta blockers for me were terrible. I felt like I was walking underwater. EVERYTHING was exhausting and overwhelming and I couldn't even figure out a plan. Being on a high dose of thyroid supplements and the beta blockers are totally messing with your hormones. The levoxyl itself might increase anxiety and combined with sudden-onset exhaustion of being on beta blockers for the first time, it's not all that surprising to me that you got weepy and nostalgic for a happier time. Having said that, call the doc to discuss your reactions and how you're feeling. It's good to be in touch about these things. But you might need to hang in there - the beta blocker sluggishness was really acute for the first week or so, and then disappeared. DO NOT stop taking them suddenly without your doctor knowing.
posted by barnone at 9:54 AM on May 29, 2010

The agoraphobia might not be the beta blockers talking -- it might be the levoxyl dose. High thyroid can increase anxiety issues in bad ways. You need to talk with your endocrinologist or whoever is treating you. There are other anti-anxiety meds out there.

Maybe you and your doc can discuss another combination -- like a lower dose of the beta blocker, combined with an as-needed anxiety med; who knows what would be the right thing here. But tell him that the anxiety is becoming crippling and you need to figure out another plan.

Again, do not go off those meds without the doctor's approval, or add anything to the mix. You don't need to suffer through a year of this -- get your doc on board for some solutions. Best of luck.
posted by barnone at 9:58 AM on May 29, 2010

I know when I started metoprolol (and I'm doing 25mg twice/day), the first couple weeks were the hardest. I was already on a another blood pressure med, which really had no side effects for me. But the metoprolol - oiy. The first couple weeks were the hardest. I would be sititng at work and just feel light headed, doing nothing. Getting up in the morning, if I moved too quickly, I just about passed out. Once I actually stumbled into the wall. But after a couple weeks, my body adjusted, and I'm fine.

As for the sadness -- depression is a side effect. It's a rare one, but by neuro (I take BP meds to control migraines among other things) keeps asking me about it, so I guess it's a big deal.

Give it two or three weeks, and if things don't get better, talk to your doc. There are other beta blockers out there that have a completely different set of side effects, so your doc might be able to get you trying something else.
posted by cgg at 10:00 AM on May 29, 2010

I am a 200 pound, six foot tall maie. I take Toprol XL... almost 10 times the dose that you take, for high blood pressure. It seems odd you would be so affected by such a small dose. Read up on the most powerful drug, placebo, and definitely take your exact question above to your doctor that prescribed it. As another reader said, I think you might need a few weeks to adjust.
posted by nogero at 10:23 AM on May 29, 2010

I just started on beta blockers for migraines and I noticed the warnings did mention depression especially if it's pre-existing; if it's really becoming problematic it's something you should talk to your doctor about.
posted by Wuggie Norple at 11:44 AM on May 29, 2010

Yes, this might resolve in a couple weeks as others describe, but do not wait that long to contact your doctor; that's a fairly immediate need. You might require a different beta blocker or an adjustment of your dose.

Meanwhile, is it possible to get out for some less intense exercise, such as walking at a moderate pace? You said that you're too exhausted, but if you could force yourself to start, it might ameliorate the depression somewhat. Just don't take it to the point of feeling like you'll black out.

Just how low is your resting pulse rate now, by the way?
posted by wjm at 12:47 PM on May 29, 2010

A few years ago I was prescribed 100mg metoprolol by hospital docs after a somewhat random (and ultimately benign) rapid heartbeat episode. I felt like total crap on it -- hated, hated, hated it. Couldn't think straight, like a fog had enshrouded my head -- basically sat around non-functioning all day. (Exercise not even an option.) Worse still, the doctors didn't seem to take my complaints all that seriously. Sure, the drug was working insofar as keeping my pulse and BP "good", but everything else sucked.

After about a week I couldn't stand it anymore, went to convenient care clinic. They basically said, stop taking it, go see your primary care doc and explain. Did, eventually switched to atenolol. Side effects much less noticeable, lasted only a short time, have been taking it for several years since with no other ill effects. Work out regularly, no problems.

So long story short: echoing that there are many beta-blockers out there; if you decide that metaprolol and you hate sharing a body, get your doc to try something else. It can be done.
posted by thebordella at 2:11 PM on May 29, 2010

I'm probably coming in a bit late on this, but here goes. I was on atenolol for years, then lost a lot of weight, after which I found my resting heart rate was about 50 bpm. My blood pressure was pretty low too, but the worst of it was the absolutely AWFUL feeling I would get from even the lightest exercise. Brisk walking would just make me feel lousy and tired. Don't mention bike-riding, that was out of the question! I found myself dreading even walking around the block.

The feeling like you are going to "pass out and die" is very common with beta-blockers. Just think about it - you're exercising, using your muscles - they need blood right? But your heart can't pump fast enough to supply it. This is why anything other than really mild exercise makes you feel so lousy.

I agree with the others upthread - not all beta blockers are the same, so I would ask the doc if you could be swapped to another. Nthing not stopping suddenly - if you do decide to come off the meds, wean yourself off - 1/2 tab for a few days, then 1/4 tab for a few days. Then be prepared for the heart flutters, especially when doing anything active! It takes about a week for the drug to be totally out of your system.
posted by humpy at 5:01 AM on May 30, 2010

wjm - my RHR is in the mid-60s.

Don't worry; I have no plans on stopping the meds.

I'm giving my doctor a call on Tuesday to discuss everything but just knowing that this is likely a temporary thing has done wonders for my mood and my outlook. I forced myself outside and onto the bus yesterday. Today, I pushed myself out the door and did some suburban hiking at a large shopping center. At the end of the walk, which was about a mile, I felt like I was going to pass out, so I chilled out on a bench until I was good to go, so it looks like I'm going to have to pace myself and not jump whole hog back into exercise. I can do that.
I'm feeling really good about everything now (and somehow, I've even managed to keep from emailing my ex!)


Thanks everybody!
posted by Cat Pie Hurts at 8:01 PM on May 30, 2010