Asthma, Beta Blockers and Panic/Anxiety Disorder

So you’re one of the 34 million people in the United States that has been diagnosed with asthma. ^[1] And panic and anxiety, especially during these economic times, have grown to be the most common mental illnesses in America, affecting as many as 40 million Americans. ^[2] That’s more than 10% of the population. Which means that over 3 million Americans out there are suffering from both asthma and panic or anxiety. And one of the troubling issues with anxiety disorders is the problems they can create with your heart. Specifically, palpitations or irregular heart rhythms. ^{[3][4][5][6][7]} For people suffering from anxiety or panic disorders, heart rhythm disturbances are the most common complaint, being reported 80% of the time by patients. ^[3]

You’ve been treating the panic or anxiety with an SSRI (Selective Serotonin Reuptake Inhibitor) like Zoloft and have been able to pretty much smooth over the rough patches most of the time. But you’ve noticed that your heart rhythm has again become unpredictable; you go to your doctor, run some tests and discover that you now have SVT. The go-to class of drugs for most cardiologists in this case is beta blockers, but depending on the severity of your asthma (and your arrhythmia), beta blockers may be dangerous for you, as they can cause asthma attacks. ^[8]

Complicating matters is your SSRI medication for anxiety. SSRI’s can inhibit the metabolism (consumption/elimination) of beta blockers, concentrating them in your body which can lead to complications as severe as requiring the implantation of a permanent pacemaker. ^[9]

So what’s an anxiety-stricken, palpitating, asthma sufferer to do? Here are a few options:

• If your asthma is well controlled, ask your doctor about cardioselective beta blockers such as atenolol or metoprolol. This kind of beta blocker is designed to only impact the heart and not the lungs. However, as the beta blocker dose increases, the selectivity decreases, meaning you would be more likely to suffer asthma attacks even using a cardioselective beta blocker. ^[8]
• Start the beta blocker at a lower initial dose and closely monitor cardiac function, particularly when increasing or decreasing dosage of either beta blocker or antidepressant.
• To avoid the interaction of beta-blockers and SSRIs, use of beta-blockers that are mainly eliminated by the kidneys such as atenolol, acebutolol, betaxolol, carteolol, and nadolol may be considered. ^[9]
• Ask your doctor about calcium channel blockers. Although the mechanism they use to treat tachyarrhythmias is different from beta blockers, if your heart is structurally normal (no tissue damage from myocardial infarction, for example), a calcium channel blocker may work for you.
• If your arrhythmia symptoms are bad enough, you may be a candidate for a catheter ablation, which is often curative and is becoming a first line treatment option for some tachyarrhtyhmias. ^[10][11]
• Try a different class of antidepressant. Tricyclic antidepressant have been used for decades, though they’ve fallen into disfavor due to the success of SSRIs and other classes of antidepressants. Bupropion (Wellbutrin, Zyban), buspirone (BuSpar) are also alternatives your doctor should consider. If the symtpoms of panic are seldom but acute, Xanax or some other benzodiazepine might also be an efficacious treatment option.

References