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    Suggest treatment for anxiety

Posted on Tue, 4 Jul 2017 in Mental Health
Question: I would like to overcome anxiety issues that are causing rapid heart beat and as a result shakey hands. I am a general dentist and when I see a patient that is a personal friend of mine or a close friend of my husband, I guess I want to impress them, but instead, get very anxious and my hands start to shake - big problem for my profession! I have practiced dentistry for over 22 years and this is very frustrating. I consider myself a very good clinician and this anxiety is extremely frustrating and seems to be getting worse.
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Low dose beta blockers can be added to your prescription.

Detailed Answer:
Hello thanks for asking

I can understand your concern. You have mentioned that you are having anxiety especially when you have to see any personal friend or closed one. Anxiety on seeing schedule of patients is also these. These all symptoms have some social anxiety component to some extent.

Klonopin and Xanax are good drugs to control these anxiety symptoms but taking these drugs regularly would result in development of tolerance and dependence. In such situation these is need to add some another drug to your prescription. If the anxiety is persistent and you have the symptoms almost daily then SSRI drugs can be tried.

You have tried Trintellix and how was your experience with that drug? Did that drug result in improvement or anxiety was persistent even while you were taking this drug?

Low dose beta blockers like Propranolol or Atenolol can be added to your prescription. These drugs can be taken on SOS basis too and you can take the drugs before any anxiety provoking event. This would help to reduce the autonomic outburst and your symptoms will be under control. There will be reduction of heart beat and anxiety symptoms. So you can consult your psychiatrist for these drugs.

If needed then regular use of SSRI drugs should be advised.

Thanks, Please provide details in follow up.

Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Seikhoo Bishnoi 6 hours later
Trentellix made me feel very nauseated and shakey. I didn't think I would make it through the day.
What do you mean by SOS? Should I take bystolic every day and is the dose correct? I take 2.5 mg and I weigh 130-135lbs. I am 5'1". I do feel a little anxious and shakey almost every day, especially on Mondays. What SSRI do you recommend? What is your opinion on seeing a therapist?

One more question: would you recommend atenolol or propranolol over bystolic?
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Propranolol can be added to her prescription.

Detailed Answer:
Hello again

Trintellix or Vortioxetine is also a serotonergic drug. These drugs are associated with nausea and gastric upset especially in first week of starting the treatment. But the side effects gradually reduce with time. If you don't want to take this drug then I'd recommend you Escitalopram. It is an SSRI drug and is safe and is used by psychiatrists commonly. The starting dose should be low like 5 mg in morning and this will reduce the risk of gastric side effects. The dose can be increased after a couple of weeks.

SOS basis means when needed or in cases of emergency. Bystolic is Nebivolol and is a cardioselective beta blocker. In my opinion Propranolol would be better for you compared to Nebivolol for anxiety. You can talk with your doctor for that.

Bystolic 2.5 is helping in palpitations but if your heart is normal then I think Propranolol would work better by reducing the symptoms of anxiety and will act in CNS too.

You can see a therapist but you will have to give a lot of time for therapy. First talk to a psychiatrist again and ask for re-evaluation.

Thanks and Take care
Above answer was peer-reviewed by : Dr. Kampana
Answered by
Dr. Seikhoo Bishnoi


Practicing since :2007

Answered : 5181 Questions


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