Managing Medication Side Effects: Tremors and Heart Rate Concerns

The side effects of psychotropic medications include body tremors (shaking hands) and discomfort from anti-side effect medications such as heart rhythm pills or Kankun?

Hello, Doctor: I am currently taking psychiatric medications (lithium, SSRIs, and other mood stabilizers).
The side effects of lithium have caused hand tremors, which are exacerbated by the interaction between Lexapro and lithium, leading to increased tremors and body shaking.
Therefore, my doctor prescribed a beta-blocker (Kankon) to counteract these side effects.
I was diagnosed with mitral valve regurgitation and asthma in childhood, and upon learning about my asthma, my psychiatrist switched my medication from the beta-blocker (Kankon) to another one.
In the past, when I was not taking Kankon, my average blood pressure was in the pre-hypertensive range of 130-140/90-100, with an average heart rate of 90-100.
However, while currently taking the beta-blocker, both my blood pressure and heart rate have normalized, but my heart rate has dropped to around 60, which is a significant difference from my previous average of 90-100.
Recently, due to lithium-induced tremors, I have adjusted my anti-side-effect medication from Kankon back to the previous beta-blocker.
Lately, I have noticed that I am easily experiencing chest tightness and shortness of breath, which becomes more pronounced when lying down, accompanied by a feeling of pressure in my chest and the sensation of my heartbeat.
When the temperature is higher, the discomfort in my chest increases, and I find it difficult to breathe deeply.
My blood pressure readings are normal, but my heart rate has dropped to 60.
I am uncertain whether this sudden drop from my previous average heart rate of 90-100 to 60 could cause any physiological discomfort.
My psychiatrist has suggested that I see a cardiologist, but when I visited a cardiologist last year, they noted my mitral valve regurgitation combined with autonomic dysfunction.
I have bipolar disorder and panic disorder, but this discomfort does not resemble my previous panic attacks.
Is it possible that my anti-side-effect medication needs adjustment? Or could the beta-blocker be unsuitable for me? Or are there other potential causes? (Currently, my psychiatrist does not intend to discontinue lithium or SSRIs and advocates for the use of anti-side-effect medication to alleviate the tremors caused by drug interactions.)

Ms. Li, 20~29 year old female. Ask Date: 2023/06/25

Dr. Wu Xueming reply Cardiology

A heart rate maintained between 60 to 100 beats per minute is considered acceptable.
For other concerns, it is advisable to consult a psychiatrist.

Reply Date: 2023/06/25

More Info

Managing medication side effects, particularly in patients with complex medical histories, can be quite challenging. In your case, you are dealing with the effects of lithium and SSRIs for bipolar disorder, alongside the use of beta-blockers (such as 康肯) to manage side effects like tremors. The interplay of these medications can lead to various physiological responses, including changes in heart rate and feelings of chest tightness.

Firstly, it’s important to understand that beta-blockers are commonly prescribed to manage symptoms such as anxiety and tremors. They work by blocking the effects of adrenaline on the heart and blood vessels, which can lead to a decrease in heart rate. A heart rate of 60 beats per minute (bpm) can be considered normal for some individuals, especially those who are physically fit. However, if your baseline heart rate has typically been in the range of 90-100 bpm, a sudden drop to 60 bpm could indeed feel unusual and may lead to sensations of lightheadedness, fatigue, or even chest discomfort.

The symptoms you describe, such as chest tightness and difficulty breathing, particularly when lying down, warrant careful evaluation. While your blood pressure readings are normal, the combination of a lower heart rate and the sensation of chest pressure could indicate that your body is reacting to the changes in medication. It’s crucial to differentiate whether these symptoms are due to the beta-blocker, the underlying heart condition (mitral valve prolapse), or possibly anxiety-related issues.

Given your history of mitral valve prolapse and autonomic dysregulation, it’s plausible that the beta-blocker may not be the most suitable choice for you. While beta-blockers can help with anxiety and tremors, they can also exacerbate feelings of fatigue and chest tightness in some patients, particularly those with pre-existing heart conditions. The fact that you are experiencing increased discomfort and a sense of pressure in your chest suggests that a reevaluation of your medication regimen is necessary.

It is advisable to follow your psychiatrist's recommendation to consult a cardiologist. A thorough cardiac evaluation, including an electrocardiogram (ECG) and possibly an echocardiogram, can help determine if there are any underlying issues that need to be addressed. Additionally, discussing your symptoms with your psychiatrist is crucial, as they may need to consider adjusting your psychiatric medications or the dosage of the beta-blocker.

In the meantime, managing your anxiety through non-pharmacological methods, such as cognitive-behavioral therapy (CBT), mindfulness, or relaxation techniques, may help alleviate some of the symptoms you are experiencing. Avoiding stimulants like caffeine and ensuring adequate hydration can also be beneficial.

In summary, the combination of lithium, SSRIs, and beta-blockers can lead to complex interactions that may affect your heart rate and overall well-being. It is essential to communicate openly with both your psychiatrist and cardiologist about your symptoms and concerns. They can work together to adjust your medications appropriately, ensuring that you receive the best possible care while minimizing side effects. Your health and comfort should always be the priority, and finding the right balance in your treatment plan is key to achieving that.

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