August 10, 2012 7:39 PM   Subscribe

Do you take or have experience with propranolol for anxiety or behaviour management?

I was prescribed propranolol for anger management. I tend to get angry with authority and administration (not violent). My doctor (psychiatrist) felt that propranolol might help. I went to a meeting, got angry, but was calm. It was disquieting. I have a tendency to take offence to things I find stupid. I find a lot of things stupid, which is part of the problem. Another part of the problem is I am usually right. This is not a matter of being right about petty things, but things of major consequence. The motto of my unit is, "Listen to Anon, he is always right;" they are not joking or teasing me. I feel like an idiot when I have an outburst. I cannot control myself. With my peers and subordinates, I am not like this. I am rational, calm, and kind.

I asked the doctor for valium or something similar. He said no. I am also seeing a psychologist for behaviour modification, she suggested that I try to not attend the meetings, but that is not an option (I am also an administrator). She also suggested that I leave administration. That is a problem for me, since I cannot deal with administrators! I need to be in control since I do not trust others who have control over me.

Additional problems: depression, anxiety, and on...

Anyone have any suggestions? I am going to see the psychiatrist again in a week or so.
posted by anonymous to Health & Fitness (10 answers total) 2 users marked this as a favorite
Someone close to me was prone to angry outbursts -- ones that onlookers referred to as "freaking out." He'd easily get annoyed and then infuriated with anyone or anything that was wrong or not good enough by his standards. He's been enormously helped by the mood stabilizer Lamictal (lamotrigine). I was at his house for dinner this week; he dropped a freshly baked pie on the floor as he was taking it out of the oven, said something about the 5-second rule, and carefully picked it up He was a little bummed, but that's all. A few months ago, we'd all have had to go home because he'd have been blazing with rage, throwing things, and horribly morose in the aftermath.

I tried propranolol for my own anxiety several years ago; while it didn't help me, it also didn't have bad side effects at the low dose I used. So I'd say it's worth a try, but start low and slow. If you're taking enough that it lowers your blood pressure significantly, you could feel speedy for a few days after giving it up. Also if you take a significant amount, it can worsen depression. But it wears off pretty fast, so it's still reasonable to try it.

I never had anger problems, but my depression and anxiety have been brought under control with the use of Celexa. SSRIs can do wonders for some people.
posted by wryly at 7:57 PM on August 10, 2012 [1 favorite]

Clarification: by "worth a try," I meant that it's worth using for some weeks to see how it goes. I know what you mean about it being unsettling when a drug changes your reactions significantly. That can diminish over time, you could get used to it, you could take less, etc. I realize you did try it for a bit.
posted by wryly at 8:11 PM on August 10, 2012

I went to a meeting, got angry, but was calm. It was disquieting.

Can you clarify whether it was you who felt it was disquieting, or whether the people around you found it disquieting?

I hope this doesn't come across as condescending, but normally when I have my impulses under control and I am emotionally well, when I become angry I am able to remain quite calm on the surface and it is very rare that something would make me angry enough for me to be unable to control my reaction. I think this is normal, and the drug is simply helping you control the behavior even if you can't completely control your emotional reaction. I can see how it would feel strange to remain so calm in the face of anger, but it seems like it would be better than doing something that makes you feel like an idiot and is probably very unpleasant for the people around you. It also seems like a good stopgap to use while you work through your problems with authority, control, and trust.

I also think that you're worried about being vulnerable and feel that if you're not regularly displaying your anger, other people will take advantage of you and hurt you. It sounds like you already have a lot of insight into this fear, which is great! Like I said above, the medication might be a good stopgap for you to help you socially and avoid you feeling ashamed of yourself while you work through the root of the anger.
posted by the young rope-rider at 8:33 PM on August 10, 2012 [2 favorites]

Just a note about Valium (since you mentioned it) - those drugs are very good at relaxing someone, but they are not a good long-term solution because they are very addictive and lose their effectiveness over time. I often see people talking about their anxiety on MF mentioning that their psychiatrist didn't prescribe Valium with some surprise or annoyance and I wanted to reassure you that avoiding Valium for long-term anxiety issues is pretty good modern practice.

The way propanolol works is to stop the nervous system agitation that accompanies anxiety or stress (which can feed back into itself and cause more stress etc) - it doesn't actually adapt the underlying cognitive processes around the stress. This doesn't mean that it's useless, it's just not going to solve everything. Have your therapists talked to you about Cognitive Behavioural Therapy or the like? It seems like you need to be taught some strategies to calm yourself down in a crisis - talking yourself through why you are so angry and whether there isn't a way to deal with it. Ask about being taught some deep breathing exercises by your therapists - I thought they were a stupid idea until I actually saw someone using them in practice. They can do a lot to calm a person down.

You are doing pretty well already though if you have found professionals to help you through this. Wanting to change is a pretty critical step to success. Good luck!
posted by chiquitita at 8:42 PM on August 10, 2012

Everyone else gives excellent advice, but I wanted to second that you might want to ask your doctor about Lamictal. I'm on a pretty high dose for bipolar disorder (with zero side effects), but my husband was put on it after similar and rather terrifying outbursts of anger when we first met-- he's been on a lower dose for almost our entire relationship and the him on it is the "real" him, if that makes sense. MeMail me if you want to talk more about our experience with it.
posted by mireille at 9:09 PM on August 10, 2012

I started taking propranolol around four months ago to control an essential tremor that's plagued me my whole life. I began at a lower dose and gradually worked my way up to where I'm taking two pills in the morning, two in the evening, and two more as needed during the day - sorry, I'm not sure the exact dosage at the moment.

It worked like an absolute charm with no noticeable side effects, a good thing since I have naturally occurring low blood pressure and beta-blockers are basically blood pressure meds. My tremor, which would make itself known in all sorts of ways but would definitely become more pronounced in situations where my anxiety and/or stress levels were elevated, all but disappeared. Inconsiderate strangers have stopped saying, "why you shakin', huh?" and my loved ones and friends have remarked that I no longer vibrate constantly.

I've never had anger management issues, but an interesting side effect (actually, not a side effect at all) the meds have is to level out an underlying and constant level of anxiety that I'm not sure I knew was even there. It's been HUGE, completely changed my whole existence. In short, I love propranolol and wouldn't change what it does for me for anything in the world. Your mileage may, of course, vary. Feel free to drop me a line via Memail or the email address in my profile if you've got any questions.
posted by item at 12:11 AM on August 11, 2012 [2 favorites]

I have taken 20mg of propranolol 3 times a day for years now. It is great.

I would describe myself as an angry person in general, but that's getting less and less now. I haven't always necessarily given my anger too much credence, I'm just saying that it's always been there.

When I find that I'm getting just really really mad, really bitter, really contemptuous towards those close to me, to the point where I'm in danger of saying or doing something destructive, I look at my watch and realize that actually it's gone propranolol o'clock. If there's a real issue there and it's not just free-floating physiological anger (ADHDers are often angry because anger is "hot" and it gives our hectic minds something to focus on) I will figure it out rationally in good time.

Valium would make you dopey and is addictive. If you want to keep making good decisions and being a clear thinker, my non-expert opinion is that propranolol is the better thing to try, and it will protect your blood pressure from all that anger and anxiety too.

It seems like it would be worth investing in some talk therapy to help you think through how much of your mistrust of others is valid and how much of it is misplaced. From your post, I get the sense that you might have a more negative view of others and their motives than is quite fair.
posted by tel3path at 4:46 AM on August 11, 2012

I was prescribed propranolol for a while, about ten or so years ago, during a period on my life where, after I'd recovered from an unpleasant illness (Ménière's), I was suddenly struck by a plague of panic attacks and overwhelming fight-or-flight hyper-adrenal reactions to normal everyday situations. I took my medication course as prescribed, and whilst the propranolol did eliminate the inexplicable anxiety seizures, I have to admit to really not liking the medicine: for me the cure was worse than the affliction. I felt disengaged, emotionally distanced, withdrawn from my surroundings; the landscape of feelings that were recognisably 'me' felt flattened somehow, and although my 'panic' emotions were turned off, a lot of my other feelings felt very uncomfortably muted too. Buy hey, in the end that went away too, and ultimately I realigned myself after I stopped with the pills, so I guess it worked in the long run.
posted by hydatius at 8:05 AM on August 11, 2012

I was prescribed Propranolol for anxiety. I found it very helpful, but as you noted it affects your physical responses rather than your thought processes. This means you are still likely to get angry but not to get swept up in the physical response to your anger. I think the advantage of it over Valium is you are still alert and still able to function at your usual level (at least that has been my experience).

The question to ask yourself is a) will taking Propranolol make you calm in a way that will stop outbursts and b) are you happy taking it with the knowledge you will still experience the anger but have a better control over it?

It may be that still having the angry feelings is a worth-while trade off for not being too affected by medication to be able to function at a normal level.
posted by Laura_J at 9:58 AM on August 11, 2012

I took it so I could actually step foot in a dentists office. The fear was still there but it was much more managable. In contrast, valium did nothing for my dental phobia.
posted by kathrynm at 5:12 PM on August 11, 2012

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