Managing Panic Palpitations: Medication Dilemmas and Solutions

Q: Managing Panic Palpitations: Medication Dilemmas and Solutions

Hello, Xiao Yu： The medications you are taking include an antidepressant (Fuxu), a medication for lowering heart rate and blood pressure (Xinlv Ding), and an anxiolytic (Anbining). <br>The antidepressant works by regulating the autonomic nervous system, which helps reduce the fre

Panic palpitations

I take 1.5 tablets of Fuxu, 1 tablet of Xinyu, and 1 tablet of Anbining every day.
Recently, I still often feel my heart beating strongly.
Tonight, I experienced a bit of a panic attack.
What should I do? Can I take 2 tablets of Xinyu? The family medicine doctor said it's okay, but the psychiatrist said it's not.
However, the palpitations are very uncomfortable.

Xiao Yu, 40~49 year old female. Ask Date: 2021/12/29

Dr. Lin Mianzhang reply Psychiatry

Hello, Xiao Yu: The medications you are taking include an antidepressant (Fuxu), a medication for lowering heart rate and blood pressure (Xinlv Ding), and an anxiolytic (Anbining).
The antidepressant works by regulating the autonomic nervous system, which helps reduce the frequency of your panic attacks, making it a root-cause treatment with preventive effects.
On the other hand, Xinlv Ding and Anbining can respectively lower your heart rate (thus reducing palpitations) and alleviate anxiety.
These two medications are for emergency use and are symptomatic treatments; they can effectively relieve symptoms when a panic attack occurs, but they do not have preventive effects against panic attacks.
Therefore, when you experience a panic attack, you can take Anbining or Xinlv Ding again, and it is also fine to take both medications together.
Unless you have pre-existing low blood pressure issues, taking two Xinlv Ding should not pose any problems.
However, if you continue to experience frequent panic attacks despite regular medication, you should discuss with your doctor whether the dosage of Fuxu needs to be adjusted, as this medication is specifically intended to prevent panic attacks.
Wishing you a speedy recovery.

Reply Date: 2021/12/29

More Info

Managing panic palpitations can be a complex issue, especially when it involves medication management. Based on your description, it seems that you are currently taking a combination of medications, including 1.5 tablets of a calming agent (likely a benzodiazepine or similar), 1 tablet of a heart rhythm medication, and 1 tablet of another medication (possibly an antidepressant or anxiolytic). Despite this regimen, you are still experiencing significant palpitations and panic attacks.

First, it's important to understand that palpitations can be caused by various factors, including anxiety, stress, and the side effects of medications. In your case, the combination of medications you are taking may not be effectively managing your symptoms, or you may be experiencing side effects that exacerbate your feelings of anxiety and panic.

Medication Considerations
1. Heart Rhythm Medication: The heart rhythm medication you mentioned (referred to as "心律錠") is likely intended to help regulate your heart rate. It's crucial to follow your healthcare provider's advice regarding dosage. If your family doctor suggested that you can take 2 tablets, but your psychiatrist advised against it, this discrepancy should be addressed. It’s essential to consult with your prescribing physician to clarify the appropriate dosage based on your specific health needs and to ensure that it is safe for you to increase the dose.

2. Calming Agents: The calming agent you are taking (撫緒) may help with anxiety but can also cause sedation and other side effects. If you are experiencing excessive drowsiness or other adverse effects, it may be worth discussing with your doctor whether a dosage adjustment or a different medication might be more effective.

3. Panic Attacks: For managing panic attacks, cognitive-behavioral therapy (CBT) is often recommended alongside medication. CBT can help you develop coping strategies to manage anxiety and panic symptoms more effectively.

Recommendations
- Consult Your Doctor: Given the conflicting advice from your family doctor and psychiatrist, it is crucial to have a comprehensive discussion with your healthcare provider. They can assess your current symptoms, review your medication regimen, and determine whether adjustments are necessary.

- Monitor Symptoms: Keep a detailed log of your symptoms, including when the palpitations occur, their intensity, and any associated feelings of anxiety or panic. This information can be invaluable for your healthcare provider in tailoring your treatment plan.

- Lifestyle Modifications: Consider incorporating lifestyle changes that can help reduce anxiety and palpitations. Regular physical activity, a balanced diet, adequate hydration, and sufficient sleep can all contribute to better overall mental health. Additionally, practicing relaxation techniques such as deep breathing, meditation, or yoga may help alleviate symptoms.

- Emergency Plan: If you experience severe panic attacks or palpitations that feel unmanageable, it’s important to have a plan in place. Know when to seek immediate medical attention, especially if you experience chest pain, shortness of breath, or other concerning symptoms.

Conclusion
Managing panic palpitations requires a multifaceted approach that includes medication management, therapy, and lifestyle changes. It is essential to work closely with your healthcare providers to find the most effective treatment plan for your specific situation. Open communication about your symptoms, medication effects, and any concerns you have will help ensure that you receive the best possible care. Remember, you are not alone in this, and with the right support and treatment, it is possible to manage your symptoms effectively.

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