One helpful thing I might be able to add is that some people who have a dysautonomic disorder are wrongly diagnosed as having an anxiety disorder. I thought of that just now because of the mentioning of beta blockers and patients with panic who present with palpitations. Some people have palpitations because they are tachycardic. In my personal experience, anxiety does not affect my pulse or blood pressure to any appreciable extent, but flaring of POTS symptoms does greatly. I can have a panic attack and a pulse of 60 or be calm and a pulse of 170 if I were off my beta blocker.
Some people have previously mentioned Inderal since it crosses the brain blood barrier. My question has always been: What does it do once it crosses?
I take bisoprolol and it's been the best for me by far. Inderal caused my chest to feel like it was collapsing. Metoprolol interacted severely with Paxil and way over-potentiated my effective metoprolol dose.
But I take it for my POTS symptoms, which were incorrectly ascribed to anxiety previously. I don't know what it would do for someone who has anxiety and not dysautonomia. But I do think much more attention should be paid to the possibility of a person having dysautonomia who presents with symptoms that look like anxiety.
I had a worsening of my dysautonomia before it was diagnosed. My pulse was in the 150-170ss and my psychiatrist was sure it was a panic attack. I called him, and he told me that there was no such thing as a maximum dose of Ativan and to keep taking more until I reached a therapeutic level. That was the most Ativan I've ever taken in a day, and my pulse never relented. I went to my PCP, and he also didn't diagnose dysautonomia, but instead treated the symptoms rather than the presumed cause and gave me what he described as a "homeopathic" dose of Inderal. I don't know how much it was, but it was small. It instantly knocked the tachycardia out. It was such amazing relief. Because while the cause was not anxiety, it is horribly uncomfortable to be that tachycardic for days at a time. It was very serious. He told me at the time that this was my one free trip to get admitted to the hospital for my heart (he knows I'm the worried type who would feel relieved to be admitted), but my dad talked me out of it and into just trying the Inderal. I only later found out when he measured my pulse how high it was--he didn't even want to tell me for fear of freaking me out.
Anyhow, many trips to cardiologists and many tests ruling things out, and I eventually was diagnosed with POTS and general dysautonomia. I have the hyper-adrenergic type so I don't pass out.
I am still not sure what the etiology is. Part of me thinks it could be tolerance withdrawal to benzodiazepines as POTS is a fairly common diagnosis on benzo recovery forums.
