May 22, 2012 6:58 PM   Subscribe

My doctor prescribed Lopressor in place of an anti anxiety medication. Should I get a second opinion?

A little background: I'm a pretty anxious person. While it rarely manifests as physical symptoms I have what seems to be a million thoughts coming and going at once. It's very easy for me to "space out" while performing tasks to entertain these whimsical thoughts. Sometimes it's enjoyable having these reflections but it's also very distracting. I'm constantly reading other people/situations, their reactions, and over analyzing what it all means. It's very draining, it often wrecks my mood, and it's time consuming. It's noticeable how it's effecting the quality of my day to day life now.

For example if I were to go shopping for a book, I'd become so overwhelmed by the options that I'll often return empty handed. If I'd managed to decide between two books I could literally be perfectly still staring at the books side-by-side for 30 minutes with a giant anxious debate going on inside my head. Getting both books would not even be a comfortable option because I feel like a single choice just has to be made. That anxiety level is pretty much an everyday hurdle and it's not usually anything physical like a rapid heartbeat or jitters; it's really all just racing thoughts and feelings.

After trying some natural remedies like meditation, yoga, and cutting back caffeine with little or no effect I chose a medicinal option. So here's the problem:

I currently do not have a psychiatrist or therapist to prescribe anxiety medication so I visited my physician. He asked what my physical symptoms were and I described it as more as an emotional and mental response than physical. I'd mentioned that I'd been prescribed low levels of Xanax and Zoloft years ago (on different occasions) for short amounts of times that were effective and non invasive for me. I wasn't necessarily requesting Xanax I just wanted to know what my options were and what would be most effective for my level of anxiety. The doctor was quick dismiss the idea of similar drugs like Xanax and prescribed Lopressor instead. I'm concerned because I don't believe that this medication is going to benefit me at all. My doctor even said it's not going to do anything for my mood or anxiety but that it'll only help lower my heart rate and slow the physical symptoms of anxiety. I'm in my early twenties and uncomfortable taking a medication to lower my blood pressure when I don't have high blood pressure from the start and it's not going to benefit the reason why I'd needed it either. I'm a little confused why the doctor chose this route. I believe it's because medication like Xanax have such a bad reputation for addiction or misuse, that those who would benefit may be overlooked. He mentioned that I'm so young I shouldn't need benzo medications, however I'd rather have something effective that I can use responsibly for results than popping a pill that's useless for me. With my last Xanax prescription I took one pill (in halves) once every week or so and felt great. I'm a little upset because I feel that my needs and concerns were ignored.

I really like my doctor and understand medical concerns, but I have no history of substance abuse and I've use a benzo drug before with great results. Would it be appropriate for me to revisit my doctor right a way to express these concerns? I'm curious what would be the best thing to say to get that conversation moving towards something that will benefit my needs. Would it also be appropriate for me to flat out request any particular medication that would work for me? Is Lopressor often prescribed to treat the type of anxiety I've described? Also, is there anything equally effective for treating anxiety that could help?

(Therapy is not something I'm entirely interested in right now as I've been to plenty in the past. I also don't want to see a therapist just a for a simple prescription. I'm pretty comfortable with my life but I get triggered and random bouts of anxiety and I'd like to have more control over my thought process.)
posted by xbeautychicx to Health & Fitness (16 answers total) 3 users marked this as a favorite
I would give the different medication a shot. Maybe you'll get just as good, or better, results with it? Then, armed with experience, you can return to the doctor and discuss the positives and negatives of the experiment.
posted by gjc at 7:04 PM on May 22, 2012 [1 favorite]

You need a psychiatrist. Not for therapy, but because psychiatrists are specially trained in medications affecting the brain, and will be better able to work with you to find medications that works. You didn't seem to list any reason not to see a psychiatrist (like insurance), just that you didn't, so if you have concerns about what your GP prescribed, go to a psychiatrist.
posted by brainmouse at 7:04 PM on May 22, 2012 [3 favorites]

Have you been evaluated for ADHD?
posted by lalex at 7:04 PM on May 22, 2012 [2 favorites]

Do you have a deep attachment to this doctor? If I don't like the quality of care I'm getting from my physician, I look for a new physician.

Also: Yes, it is acceptable to say, "I have a previous diagnosis of this condition, and would like to continue receiving this medication." That's what I did when I changed insurance plans and had to get a new general practitioner. She said, "OK," and wrote me a prescription.
posted by croutonsupafreak at 7:07 PM on May 22, 2012

Beta-blockers, like metoprolol/Lopressor, are commonly prescribed to treat anxiety. Anxiety disorders are extremely common and many, many drugs are used to treat them. You could give the Lopressor a chance, or seek a second opinion from a psychiatrist if you're only interested in taking a benzo. With Lopressor, there's really not a risk for drug dependence like there is with Xanax, which could be one reason your physician didn't write the script for Xanax despite your implied request. In fairness to the physician, I'm assuming he's a GP/internist and therefore deals mainly with physical conditions. If you need treatment for a mental health concern, it makes sense to see a specialist - in this case a psychiatrist.
posted by pecanpies at 7:14 PM on May 22, 2012 [5 favorites]

I'd also give the beta-blocker a chance, for the reasons stated above. Many doctors don't like to prescribe the benzodiazepines for the reasons many have posted. Also, do you know that SSRIs are prescribed for anxiety as well as depression? So that's another option if the Lopressor doesn't work well for you.

The obsessional thinking you're talking about (inability to make a choice, etc.) is a kind of thing people do to avoid the "physical" anxiety per se. So maybe that's why you don't feel it in that way so much. I'm wondering how 1/2 a benzo' per week can be so helpful if you're experiencing these obsessional thoughts etc. every single day.

I wonder, if you do try the Lopressor, would you possibly report back here or MeMail me? I'm very interested in hearing if this medication helps you or not.
posted by DMelanogaster at 7:38 PM on May 22, 2012

Second opinions never hurt. I was all worried about doing this at one point, afraid my doctor would get upset that I was questioning him, afraid my insurance wouldn't pay. The visit cost me $5 (plus the copay). I went away feeling much better about my choices.
posted by cjorgensen at 8:09 PM on May 22, 2012

The problem is you went to a GP. Obviously this medicine is not what you need, and this guy does not know what he's talking about. It is ridiculous to prescribe a blood pressure medicine when you are young and have good reason to believe your problems are caused by anxiety. Everything points to it being a psychological problem, not a physical one, even if it does manifest in physical symptoms. So a blood pressure med is not going to treat the cause, and probably not even be very effective for the symptoms, and likely have some troubling side effects. This doctor just seems clueless, and frankly irresponsible. Benzodiazapenes have nothing to do with age, and I'd actually guess a huge proportion of them are prescribed to young people.

You don't need to go to a therapist to get prescribed psych meds, (which benzos like Xanax are) you need to go to a psychiatrist. Psychiatrists do not generally offer therapy, they are medical doctors who prescribe psychiatric medications. They may recommend a psychologist or therapist, but you are under no obligation to go. Even a better informed GP might prescribe you the proper medication for anxiety or a give you a good referral. Ask about Klonopin (clonazapam.) it is the mildest and least addictive of the benzos, but very effective.
posted by catatethebird at 9:02 PM on May 22, 2012 [1 favorite]

Just another voice chiming in to say go to a psychiatrist. Primary care physicians mean well, but you should really go to a psychiatrist. Psychiatric pharmacology is a very complicated thing with a lot of quirks and nuances that most GPs won't know about. I've heard far too many horror stories about primary cares prescribing medication for mental health issues that did not go well (& even lived through one catastrophic experience myself). I'm not saying your current doc is wrong or anything bad will happen, but personally, I wouldn't start taking medication for anxiety until I was evaluated by a psychiatrist (& even then there may be some trial & error involved). Best of luck!
posted by katemcd at 9:52 PM on May 22, 2012

I take metoprolol, but for a heart condition and not anxiety. I think I have pretty severe anxiety, though, it's just largely untreated because mental health care is complicated where I live. I agree that metoprolol mostly treats the physical symptoms and not mental ones. I still stay up late at night worrying and wander stores unable to decide what to bring home for dinner, but I can take out the trash without a fight or flight response.
posted by Arethusa at 10:40 PM on May 22, 2012

his quick dismissal of what has worked for you is not a good sign. Did you feel uncomfortable to bring that up with him?
If so, find a new primary care doctor.
IMO, stay away from the shrinks. Most of the mare members of the biggest group of prostitutes for Big Pharma around
posted by dougiedd at 1:02 AM on May 23, 2012

The problem with most benzos is that they act quickly but build tolerance rapidly; after a while they tend to lose their effectiveness. Xanax is good for emergency situations like panic attacks, but it's not really commonly implemented as a long term solution so much as a short term crutch until other medications take effect. I've had it prescribed once to me by an ER doc, but every other doctor since then has more or less rejected the idea and refused to write a prescription for it, so I sort of understand where you're coming from.

However, I would really recommend looking into antidepressants, as many of them are also very effective in treating panic/anxiety. They had to increase the dosage three times to get to the right level of strength for me, but my anxiety and panic responses have been significantly restrained through judicious use of sertraline. You mentioned you've been on it before, so perhaps it would work well again? You'd also be unlikely to encounter any suspicion from the doctor about drug abuse and etc, since people don't really try to get high on antidepressants.

If you feel like your PCP isn't listening to you, it may be a good time to start searching for a new PCP as well.
posted by Estraven at 4:08 AM on May 23, 2012

I am on a beta-blocker and have been since I was 26 -- and I have very low blood pressure! A rheumatologist/psychpharmacologist put me on it for POTS (which is what was causing the low blood pressure) primarily, but mentioned it might bring down hyper-vigilance associated with PTSD/anxiety. We have upped the dose to get me through bad periods of anxiety, nightmares, etc. I even took a big dose after I was in an accident -- it actually has a memory dampening effect on a traumatic experiences. None of my GP's have actually ever been aware of this use of beta blockers. A lot of anxious people (especially those who benefit from benzos; that's me, too) find SSRI's and SNRI's too activating. (My prescriber theorizes this is because we have trouble breaking down the serotonin and dopamine in our brains -- we might have too much, not too little.)

Honestly, I think your GP is ahead of the game in having beta blockers (used off label) in his tool box. Chronic management on benzos (especially when they're "asked for by name," sigh) is a really dicey proposition, even with a psychiatrist these day, but you'd have more luck there. You'd also have more luck there if you were "compliant" (also sigh) with the treatment. It's not as wacky as it sounds. I am just a patient, but I know several other patients on beta blockers for panic attacks / PTSD / GAD / social anxiety (I hang out with writers). Seems to help them too.
posted by sweltering at 6:29 AM on May 23, 2012 [3 favorites]

Why are you questioning your doctor when you haven't even tried his prescription?

I take a beta blocker for migraine prevention and to lower my blood pressure a bit. It noticeably reduces my anxiety. The anxiety-reducing effect appeared immediately, much more quickly than the anti-migraine effect, and is more consistent.

Give the Lopressor a try right now, and make an appointment to see someone who might start you on an SSRI if the Lopressor's not enough for you.
posted by artistic verisimilitude at 9:56 AM on May 23, 2012

Beta blockers can be used at different dosages. Propranolol, for example, is used at a lower dosage for anxiety (generally 20-40 mg - I use 10 mg in a pinch and find that effective) and at higher dosages for lowering blood pressure (up to 320 mg). So give it a shot before dismissing it.

Just as a gentle warning, if you go back and ask for benzos again without trying this script, or go to another doctor and say the same thing, the chance that you're going to be prescribed a benzo is probably even lower, because (fairly or not) you'll be seen as drug-seeking. And a lack of substance abuse history is no defense against benzo problems - I was prescribed Klonopin, took it as directed for six weeks, and then went through an absolute hell of six months of withdrawal. Physical dependence, not drug craving. Some people never have problems with them, some do - and most doctors want to limit their use for good reason.
posted by jocelmeow at 11:01 AM on May 23, 2012

I noticed a couple of people have mentioned SSRIs as another way to treat anxiety. I don't disagree, but also wanted to mention that there are anti-anxiety meds that are not benzos. For example, the drugs BuSpar and Vistaril are two drugs used to treat anxiety that aren't benzos. They have virtually no potential for tolerance or dependence, unlike benzos. IANAD and am not recommending that you try these drugs; I bring them up only to point out that there are now more than ever many options for treating anxiety, and that a qualified psychiatrist would be helpful in finding out what works best for you.
posted by pecanpies at 1:06 PM on May 23, 2012

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