Situational Anxiety: Common Remedies and Medications

Dear Ask The Doctor: I have experienced anxiety related to stressful situations since university. I am currently 27 and work in research and design of new health care products and pharmaceuticals which require me to give technical presentations, which I have always despised. Few people like giving presentations, however I can get so anxious and full of adrenaline I have fealt like quiting my job. I'm not an unconfident or unsociable person and I feel this may not be so much a mental issue. I think that while everyone gets nervous before such stressful situations, the slightest trigger sends my adrenaline levels into overdrive. I have been to the doctors about this issue when I was about 23, and not much was done. About 9 months ago I had unbelievably intense headaches that would occur during sex or intense exercise, and I had my blood pressure measured at the doctors at 120 over 80. The issue resolved itself weeks later. My girlfriend recently noticed that my resting heart rate was around 90 to 100 beats per min with and extreemly powerful pulse. I tested my heart rate today at 80, again with a very powerful pulse. I have lead a very active life. From 11 to 15 I trained everyday for swimming, cross country, biathlon, and mountain biking. At univerisity, I weight trained 5 times a weeks for uni competitions. I subsequently trained a lot less, however I currently weight train 2 to 3 times a week for about an hour and incorporate cardio. I am 87kg or 192lbs at 6 foot and am fairly lean. My diet is fairly healthy, although i do drink and smoke socially (at the weekend mainly) around 30 units and 20 cigarettes per week. I have, after a lot of research, taken 30mg propranolol before extreemly stressful situations. I have noticed this helped a lot and had no side effects. I am going to the doctor about this issue in the next month, but don't want it to go nowhere again. I was wondering if I should suggest the fact that I found a beta blocker to work so well for me? or could there be something else, or more serious going on? thanks very much

You may have anxiety issues which makes you tense about certain situations easily. Beta-blockers can be used in your condition. In anxiety, the usual dose should be 5-10mg 1 hour before a stressful situation (e.g. case presentation). It is optional to take the same dose the night before. The maximum dose is 40mg, however, this should be taken with caution because beta-blockers can decrease the blood pressure too low and one may faint. The dose you are using, 30 mg is still okay but be cautious. Your BP is normal (120/80) and if you will take Propanolol it may drop to levels that will cause you to faint. Also, when you are taking propanolol, try to avoid hot showers. Propanolol tends to open up the blood vessels; hot showers (warm temperature) also opens up blood vessels. This additive effect (Propanolol + hot shower) will open blood vessels and the chance of you fainting in the shower is more likely. Try having warm showers or better yet, take Propanolol after a shower, not before. You may try taking 15mg instead of 30mg. If it works for you, stay on that. When you will get to see your doctor soon, tell him that you are currently taking beta-blockers. You may ask him if it will be a good idea to use Propanolol on a daily basis or as needed basis, or maybe he wants to give you another type of beta-blocker. The heart rate fluctuates any time of the day and depending on activity. Try measuring your heart rate 5 minutes after you have been sitting or lying down, that will be a more accurate one. I commend you for having a healthy diet and a regular exercise regimen. You may also try meditation and yoga to help relieve anxiety and stress. It is unlikely you have any other serious underlying condition since your BP and heart rate are still within the normal range. The mere fact that the tension and anxiety was somewhat relieved by Propanolol is a telling sign that your signs and symptoms are anxiety-related. I do hope this helps. Take care always.