The People's Perspective on Medicine

Anxiety & Stopping Alprazolam & Atenolol Side Effects

Q. I have a long history of anxiety and panic attacks. I am also a performing musician, which can often cause performance anxiety. I have been prescribed Xanax (alprazolam) off and on over the years along with a myriad of antidepressants like Prozac (fluoxetine), Cymbalta (duloxetine), etc.
Several months ago my doctor added atenolol to my Xanax and Cymbalta. I have had ZERO benefit from the atenolol. In fact as far as my mental state is concerned, I think I was better without it. I have done a little research and found that atenolol can cause some unpleasant side effects, so I have decided this is definitely not the drug for me.
I think doctors get frustrated and desperate and start reaching for drugs not necessarily ideal for treating my problems. Since starting the atenolol I have lost interest in everything, I am tired all the time and I am feeling severely depressed. On top of all that I have experienced sexual difficulties and my mood is so dark that everyone in the house hates the man I have become. I don’t much care for me either. (Can you tell I am severely unhappy?)
I am beginning a decreased dosage as of today. Wish me luck as I understand this can be somewhat difficult. I will try to return to this website at a later time and share any progress as it may help some of you. In the meantime I would be interested in any suggestions and comments.
Thanks all

A. John, anxiety, panic attacks and performance anxiety can clearly interfere with the quality of your life. None of the medications you are taking will actually help you overcome these problems. The meds may help a little and may serve as a chemical crutch to assist you during an attack, but you may find that cognitive behavioral therapy (CBT) can help produce a more long-lasting and successful solution. We highly recommend the book Don’t Panic: Taking Control of Anxiety Attacks, by Reid Wilson, PhD.
Although beta blocker heart medicines such as atenolol may be prescribed for performance anxiety, some people do experience depression, fatigue and sexual problems as side effects. Gradual tapering is appropriate when it comes to stopping a beta blocker like atenolol, propranolol or metoprolol. Here are some other side effects of atenolol to be alert for:

Atenolol Side Effects:

  • Slow heart rate (pulse of 50 or below is possible)
  • Fatigue, weakness, lethargy, drowsiness
  • Cold hands and feet
  • Dizziness and/or lightheadedness
  • Low blood pressure
  • Difficulty breathing/asthma
  • Digestive upset

You should also be aware of the possible side effects of alprazolam (Xanax). This benzodiazepine can also slow you down and affect your ability to concentrate. More worrisome is getting off this drug. For many people withdrawal from a benzodiazepine like alprazolam can be a major challenge. The side effects that are attributed to alprazolam are likely to apply to most other benzos as well. By the way, sexual side effects are not uncommon with antidepressants like Cymbalta (duloxetine) or Prozac (fluoxetine).

Alprazolam (Xanax) Side Effects:

  • Drowsiness, dizziness, fatigue, lethargy
  • Clumsiness, impaired coordination (not good for a musician)
  • Memory problems
  • Cognitive impairment, difficulty concentrating
  • Dry mouth
  • Sexual difficulties
  • Low blood pressure
  • Depression
  • Difficulty stopping the drug

No one should EVER stop taking alprazolam (or any other benzodiazepine such as lorazepam, flurazepam, triazolam, clonazepam, temazepam, diazepam, etc) without medical supervision. Sadly, though, doctors don’t always have a clear understanding of how to help people stop such medications. That’s in large measure because drug companies and the FDA have not provided clear guidelines for getting off benzos. If someone stops too quickly there are a long list of potential side effects to contend with.

Symptoms of Benzodiazepine Withdrawal:

  • Anxiety, restlessness, jitteriness, agitation
  • Irritability, sensitivity to sound, light and touch
  • Impaired concentration
  • Panic
  • Insomnia
  • Faulty memory
  • Depression
  • Headache
  • Fatigue
  • Muscle Cramps
  • Muscle twitching
  • Seizures
  • Sweating
  • Diarrhea
  • Blurred vision
  • Decreased appetite

Stopping Benzodiazepines:

Many years ago, Dr. Otis L. Baughman, III, at Self Memorial Hospital in Greenwood, South Carolina, told us about a slow-tapering program for benzos. First he switches people from short-acting drugs, like alprazolam, to longer-acting drugs, such as clonazepam.
Depending upon the patient and the circumstances he may start someone on 2 mg of clonazepam , twice daily. Over the first two weeks he may gradually reduce that dose from 2 mg to 1 mg twice a day. Over the next month he gradually reduces the dose to 1.5 mg a day (0.5 mg in the morning and 1 mg at night). Depending upon the progress of the patient, he may reduce the dose of clonazepam over the subsequent month to 1 mg per day (0.5 mg twice daily). The next month will see a small reduction to 0.75 mg per day (0.25 mg in the morning and 0.5 mg at night).
Over the next month he tries to reduce the dosage by 0.25 mg slowly. Finally, he tries to get the patient to 0.25 mg every other day for two weeks and then every third day for two weeks until the drug can be ultimately eliminated. This is a very slow process, and Dr. Baughman’s approach may not be appropriate for everyone. Your doctor may want to check Dr. Baughman’s recommendations for benzodiazepine withdrawal in detail. (The article is “Anxiolytic Perspectives for Primary Care Physicians,” published in Family Practice Recertification, vol. 11, 1989, pages 117-125.) Then she will be able to design your tapering-off program should it be determined that you can eventually come off alprazolam. By the way, stopping Cymbalta (duloxetine) will also require a gentle tapering should you ever need to stop that antidepressant with your doctor’s supervision.
Clearly this will have to be a very gradual process that requires a skilled provider to help you overcome your anxiety and panic attacks. Hopefully you will be able to find a cognitive behavioral therapist who really understands the techniques that Dr. Reid Wilson outlines on his website.
Good luck and let us know how you make out.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Just started leaving this horrible drug. Having extreme fatigue. Can’t even climb stairs. Is this normal? Was on 50mg for bp for about 3 years then cut it to 25mg for about 6 days now not taking for 3 days. Struggling.

Hi Michelle, I haven’t personally had the pounding heart while on atenolol, but I’ve had it as I try to wean off. One should never, ever just “quit taking the atenolol” or any other beta blocker cold turkey. You need to be tapered off gradually to avoid (or at least minimize) any rebound effects. The atenolol leaves your system fairly quickly; however, your heart and central nervous system have to re-learn to regulate everything and it is a process that happens over several weeks (or even months).
Beta blockers block adrenaline, so when the drug is removed, your system is flooded with adrenaline which can cause anxiety, panic attacks, jitters, racing heart, insomnia, headaches, tremors, and even more serious cardiac issues if you have cardiac disease. Please get a second opinion on tapering down if you need to and do some research online. You are your own best health advocate. Wishing you the best-

Actually, tapering off of atenolol depends on the dose and if you are suffering from hypertension or heart failure. A 25 mg daily dose requires no taper as it has a half life of 6-9 hours, so basically, in 24 hours, most is out of your system. If you are on a dose of 100mg, you should consult your doctor or cardiologist or how or if you should stop this med. On a low dose, side effects are minimal and can actually improve your recovery time if an athlete, as far as heart rate. As an over 50 patient taking a 25 mg dose after exercise, it’s a wonder drug to assist with BP and heart rate. I can do without it, but the benefit is tremendous.

How weird John that you are a musician! When I complained that Atenolol gave me panic attacks my GP said “No one I know has panic attacks from that drug, musicians use it prior to performance to calm them down”!!!!!! Like another lady on the forum, with all the drugs they were fobbing off on me for HBP I just wanted to die due to the side effects. Eventually I stopped all meds, yes, got a kick in chest by a donkey (invisible) but it was worth it, because have been off them and BP ok for 9 years now.

I am 25 years old a couple of years ago I noticed that my heart rate would rise to in the 100’s just after I ate or walking a little way, I got shortness in breaths and my chest would hurt as my heart rate beat fast. I knew that this wasn’t normal, so my doctor put me on atenolol, after one dose I could tell a huge difference, my heart rate would stay in the 80’s, I thought this was a miracle!
I don’t have low or high blood pressure, just a fast heart rate. I’ve been taking atenolol for 3 years now and now I am experiencing my heart fluttering like a butterfly not much but its to the point it makes me sick, also I feel as when I lay down at night now my heart beats extremely hard, not fast but real hard to the point its hard to sleep.
I recently saw a cardiologist and he told me to quit taking the atenlol. If this heart pounding is a symptom from atentolol I will quit it but I am also scared because I don’t want to go back to where my heart is beating so fast out of my chest again. I am just curious has anyone else been through the same thing that I am dealing with taking atenolol??

Good advice, Easton. Thanks for taking the time to post.

Can CBT assist in attempts to lose weight?

My experience over the past ten years of medicating my anxiety and depression has taught me that living life fully and embracing life means you get to take all of life for what it is, and what it frequently is, is a lot of discomfort. We are fortunate, though, in that discomfort makes us strong and more capable, and builds our character ethic as well. Nature means for any human being to be efficient and highly adaptive and resilient to stress.
I fault (mostly) these doctors for their enabling practices. In fact, I feel betrayed. My doctors could have stood up when big pharma really started pushing the medicines as the final cure to these disorders. It’s fine to prescribe a medicine to alleviate debilitating symptoms, but only long enough for the patient to become enabled to pursue psychotherapy and resume normal patterns of living. To fail to explain to their patient that a certain degree of discomfort is normal and to be expected in life, I think that is really irresponsible. It is hard for me to fault the patient who shows up at the doctor’s clinic nearly frozen by a relentless feeling of terror, but I do understand that, in my case, I made an error of judgment back then, too.
The only healthy response to fear and anxiety that I can think of is courage. Courage is a very simple tactic that I think of generically as “go anyway”. Plan ahead and go do what it is you are afraid of. If, instead, you keep thinking repeatedly about your fear, you have got to ask yourself why are you doing that? In athletics, and in combat, often one is taught to imagine every detail of successfully completing their mission. Sight, sound, smells, bruises, whatever. Use this imagery technique and you won’t feel so smothered and blind. (You will still be nervous and afraid, though. But you will not die of that.)
The medicines have no advantage to offer those of us who get to outgrow an anxiety problem. Cognitive Therapy, which can be done online now, goes a long way, if you practice refutation of distorted thinking and beliefs and also practice replacing the old dysfunctional thinking with clear, objective and rational thoughts and beliefs. For me, mental conditioning seems to be key in my practice of CBT. For example, I used to be angry all of the time, until I realized that I was practicing it so much that I had gotten good at feeling bad. I learned from the Buddhists to practice kindness instead, and the difference was night and day. But my thinking and beliefs regarding people had to change to make that happen.

I’d be interested in whether anyone has experience with using Intuniv for these types of symptoms; a similar but much shorter acting drug, Precedex, is quite useful for panic attacks in the perioperative period (induction, emergence) as well as a multitude of other indications…I’ve not seen side effect problems with Intuniv that are as bad as the beta blockers, at least for some people..

I have taken atenolol for years for high blood pressure and rapid heartbeat.
I also take lisinopril and some other things and have suffered from depression and other maladies; weakness, fatigue, many of which I attribute to multiple sclerosis but possibly are at least partially caused by medications.
I’m afraid to mess with the prescribed heart medicines except with the doctor’s approval. As far as mental attitude, depression, etc. are concerned the best thing I have found for it is exercise! I go to the local wellness center three times a week and exercise 90 minutes or more each time in group classes with a certified instructor. We do what we are able. We also have available machines and a walking track as well as a pool. On Fridays I do yoqua (yoqua/pilates) moves in the therapy pool with an instructor.
I only wish I had started exercising more when I was younger. I’m now 75 years young with a bunch of ailments. All my doctors heartily approve of what I’m doing. At my last visit to the neurologist for my MS, he said, “There is nothing I can do for you that will improve on what you’re doing for yourself.” My cardiologist told me that I “look so much better” since I’ve been exercising. My daughter says I’m “so much easier to get along with.” I could go on and on.
You may not have available a center as I’ve talked about, but do something. I cannot urge people no matter the age or condition to move, exercise. Do what you can. It’s wonderful. It’s been a life saver for this former couch potato.

Many performers have found stress relief through the Alexander method or technique. There’s a good intro at wikipedia and lots more on google etc. This is not instead of CBT, but an additional time tested non chemical “intervention”. Good luck with the withdrawal–go slowly but surely!

I am glad that part of the PP’s response to you was to mention getting treatment from a psychologist trained to address these issues. Taking pills can seem convenient (takes less time and relatively inexpensive), but as you have come to find out, there is a price to pay for this convenience.
There are evidenced based skills that you can learn to effectively deal with the anxiety and improve your overall quality of life–e.g. Cognitive Behavioral Therapies and Mindfulness Based therapies (ACT; MiCBT; Mindfulness Based Stress Reduction, etc.). They are skills based (like learning to play a musical instrument or learning to play tennis) but well worth the investment and ultimately less “costly” relative to what you can get by addressing these issues pharmacologically.

I was on a low dose of Atenelol for about a year. It left me with chronic asthma/low-grade bronchitis.

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