Suggest remedy for severe depression, insomnia and palpitations after taking Metoprolol

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Posted on Fri, 19 Jun 2015 in Hypertension and Heart Disease
Question: I have CAD, 54 yrs old, four stents. After my last two stents, the doctor put me on meta prolog tartate, although I'm not sure why because I never had really high BP. I am very tired all the time, severely depressed, insomnia, and now have palpitations which I never had before. Why would the doc prescribe it if I don't have high blood pressure and would it be safe to wean off to see if it is causing these symptoms? I can't get in to see doc for another month.
doctor
Answered by Dr. Karen Steinberg 1 hour later
Brief Answer:
Used for heart problems, needs slow wean to get off

Detailed Answer:
Hi XXXXXXX thank you for using Healthcare Magic. I assume you mean metoprolol tartrate, which is a beta blocker drug used both for hypertension and heart disease. It is often recommended as a preventative drug for people who have coronary artery disease, such as yourself. Another drug that is recommended as a preventative is low-dose aspirin. You definitely should be taking that if you have no contraindications to it.

Your doctor most likely prescribed metoprolol because of your CAD. Side effects include fatigue and depression, in particular. Many people have to go off it for those reasons. However, it is very important not to stop it suddenly. You have to decrease it gradually to be sure there are no withdrawal effects, which can be dangerous sometimes.

The safest way to do this is to contact your doctor and tell him/her you are having severe side effects and want to get off it. You don't necessarily have to see him/her. S/he can advise you on the weaning schedule and may have to prescribe different doses to slowly reduce it. It's important to work with your doctor on the reduction schedule and also s/he knows best why this medicine was prescribed. It's possible it was prescribed for another problem and/or another medicine can be substituted if s/he feels that is best for your medical situation.

Hope this answers your query. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Karen Steinberg 8 hours later
Yes, I am taking a low-dose aspirin. I forgot to mention that. Also Plavix and Lipitor. The metaprolol tartrate I am taking is only 12 1/2 mg twice a day. Is that a sufficient dosage to cause these problems? I am very sensitive to any kind of medications. I know the doctor is going to say my symptoms are a result of depression or menopause, which I am so tired of hearing. I feel like I know my body and something is definitely not right.

You said it is often used as a preventative for people with CAD. Do you mean preventative for a heart attack or worsening clogging? How exactly does it work? I know it slows down the heart rate, but what specifically does slowing the heart rate do that is preventative? Thank you for your time.
doctor
Answered by Dr. Karen Steinberg 2 hours later
Brief Answer:
Preventative for heart attack

Detailed Answer:
Hi, XXXXXXX Metoproplol works by slowing the heart rate and decreasing the force of the heart's contraction, so that even with partially blocked arteries, the amount of oxygen going to the heart is adequate. It's kind of like resting after running and developing chest pain- the rest allows the heart to relax and "breathe easier."

You are on a relatively low dose, but you say you are sensitive to meds so this still could be the metoprolol. I would be particularly suspicious if you just recently started it and the symptoms started after that. Insomnia is also a side effect, so you do have many of the common ones.

You are on the appropriate drugs for your CAD, which I assume must be pretty significant. That is why it is important to work with your doctor in getting off this medicine carefully, even if your symptoms are being tossed off as menopause or depression. Metoprolol can aggravate depression, so you can use this fact in a discussion with your doctor about getting off of it. You can insist on getting off it and get him/her to taper it properly. S/he may suggest another medicine instead, knowing your condition and whether it is necessary.

Definitely mention the palpitations right away. It may be that your symptoms are related to another problem, either with your heart or something else. People with significant CAD can develop arrhythmias (disturbances in the electrical system of the heart that causes it to beat), some of which can be dangerous. Your cardiologist needs to be informed promptly of the palpitations so that appropriate action can be taken.

Talk to your cardiologist right away about the palpitations. You shouldn't wait a month for your next appointment. Hope this helps.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Karen Steinberg 33 minutes later
I have been on the medication since July of last year after my last two stents. The palpitations started immediately, I assumed because of the surgery and didn't think about it being caused by the medication. They aren't constant but come and go every few weeks. I can't pinpoint it to a specific cause. I mentioned it in my four-month followup, and his response was, well, the palpitations aren't anything to worry about and medications for the palpitations is worse than the symptoms. I was on 10 mg Lisinopril previous to the metaprolol and didn't have any palpitations. Needless to say, I haven't been very happy with this group of cardiologists. It's a large group and I feel like a file number when I go in instead of a patient. I'm pretty young, 54 years old, and other than the CAD, in pretty good health. I've gained about 10 pounds since last year despite healthy eating and exercise, which I don't feel good exercising like I did before. I weigh 154, but I think my ideal weight is around 130. Everything is a chore now. I just don't think someone my age should feel so sluggish and uninvolved emotionally all the time. It's kind of confusing -- do I feel this bad because of the CAD or because of the medication... Thanks for your help. Maybe I need to find a female doctor who doesn't attribute everything to menopause or depression....
doctor
Answered by Dr. Karen Steinberg 1 hour later
Brief Answer:
Depression can occur with both meds and heart disease

Detailed Answer:
Depression has been associated with heart disease, so part of the depression could be from your CAD. The metoprolol could be aggravating it. The depression sounds severe, and eliminating the metoprolol may help a little. If your doctor doesn't think it's critical in your case, ask him to stop it or prescribe another that doesn't aggravate depression.

Weight gain, insomnia, fatigue, sluggishness, inability to engage emotionally all are symptoms of depression. You might want to consider talking to your regular doctor about treatment for it. Why have the extra suffering? You can also tell your cardiologist that you agree you have depression, but you know that metoprolol aggravates it and could he please help you taper it off so you don't have that extra stressor.

It's reassuring the palpitations are only occasional and the cardiologist doesn't appear to think they are significant. They are more likely due to your CAD and not the metoprolol.

If you are not comfortable or confident in your cardiologist, it might be advisable to look for one that you are comfortable with. Being unhappy with your care can only aggravate your depression, other symptoms, and impede your healing. Maybe it's time to try somebody new.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Karen Steinberg

Internal Medicine Specialist

Practicing since :1981

Answered : 824 Questions

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