For Those with Hyperadrenergic Symptoms

[RunnerGirl]

I realize eveyone is different here and responds differently to meds. But I'm curious as to what meds are working best for those with the hyperadrenergic (excess adrenaline) forms of dysautonomia? I'm basically med-free at the moment, but my doctors have recommended two different courses of action to assist with my symptoms (which include high exercise heart rate, frequent ectopic beats, sinus arrhythmia, periods of sinus tach at rest, wide HR and BP fluctuations - ranging from high to low, and unexplained nervousness/anxiety bordering on panic when most severe.)

Compared to many on this site, I have mild symptoms, hence my ability to get away with no meds for as long as I have. However, after a very long period of "good days" where I was essentially normal, I have been waking up in the mornings with an elevated HR (not tachy but 80-90, which is quite high for me, since my normal resting HR is in the low 50s to upper 40s due to my athletic conditioning). I've been offered two different treatment options by my docs - a low dose beta blocker or an SSRI. I have Atenolol, Kerlone, and Toprol XL in my medicine chest, along with Lexapro and Prozac. I don't know which to try, andmy docs are no help! They all have differening opinions of each, and have basically left it up to me to experiment or simple continue med-free.

Does anyone with symptoms similar to mine have any suggestions regarding any of the above mentioned medications?

Many thanks,

RunnerGirl

[morgan617]

hi runner, i took clonidine for awhile and it helped. i was just so hypertensive, it didn't really help that. but i really didn't have too many side effects, just a little fatigue. it is not a beta blocker. it is recommended for things like baroreflex failure where your bp is pretty much always high. i do not tolerate ssri's or beta blockers. sorry i can't be of more help. the problem is, you're right. every one is so different in their responses, it's always a trial and error. what i have started doing tho, is asking for samples, or only getting a few from the pharmacy so i don't end up with a zillion unused meds in my cabinet. morgan

[Gena]

I have similar symptoms as you RunnerGirl, but I was just dx'd so I am still doing med-free regimen. Although one doc just prescribed a low dose calcium channel blocker which I'm going to start today. If that doesn't work then I will try an SSRI like Lexapro. I was wondering though, what tests are done to determine if you are hyperadrenergic (producing excess adrenaline)? I think that's me, but I'm not sure. My HR and BP are normally quite low (HR during day in 50s, in 40s while sleeping --with periodic espisodes of 70-80s and higher HR) (BP is often 80s over 50s).

[RunnerGirl]

Morgan: Thanks for your response and the info on Clonidine. Believe it or not, that was actually suggested to me by a professional cyclist I found on the internet who happen to have POTS. His case was a lot like mine, in that when he began training with a HR monitor, he was shocked to see how high (and how fast) his heart rate climbed. For a conditioned endurance athlete, this is just not the norm. I believe he went through the same wringer it seems we've all been through, and eventually got the diagnosis of POTS. I know he used Clonidine (like me, he was afraid of the beta blocker's impact on his exercise tolerance) and I believe his symptoms eventually resolved and he's now med-free and back in competition. Maybe I should look into this. Hope you've found an alternative med to help manage your hypertension. My BP has wild swings, but is mostly normal, so we don't need to specifically target our treatment at that at this point. The HR (and anxiety, to be honest) is the most troubling of my symptoms.

Gina: Sorry to hear you suffer from the same cluster of symptoms I have, but I'm happy you have a diagnosis. From my experience and that of many others here, that's half the battle. I hope you find success in managing your symptoms with the calcium channel blocker. Keep us posted! As to your question about what testing I had to determine I'm hyperadrenergic, I guess I should say all testing I've had (including 24-hour urine catecholomines and metanepherines, plasma free metanepherines, and numerous other tests that measure biproducts of adrenline at both the supine and upright position) show I'm actually putting out NORMAL levels of adrenaline. The key is that my symptoms are indicative of a hyperadrenergic state, and the theory is that my body is simply hyper-responsive to these normal adrenaline levels. I know some people with dysautonomia actually have abnormal adrenaline levels, but my case seems to involve the receptors of my autonomic nervous system being overstimulated by normal adrenaline levels. Again, this is the theory. And after pursuing just about ever option available to me for a more firm diagnosis (NIH, Mayo, a dozen doctors locally), I guess I'm willing to accept a 'theory' in leui of a real diagnosis!

Thank you both for responding!

[Ernie]

I Runnergirl,

I take Propranolol (BB) and Proamatine and this is the best treatment I have atteined so far.

Ernie

[morgan617]

runnergirl, i have been rejected by mayo, nih, and vanderbilt. we are going on speculation also, as my labs are all basically normal. except my epinephrine is low. weird. hope you get the help the you need and the meds are helpful to you. the clonidine did help my pulse, and i also have very limited exercise tolerance. morgan

[ramakentesh]

runnergirl - i have those same symptoms as well as trembling hands, dizziness and lightheadedness and vitreous floaters. For me i take one inderal Propranolol on my bad nights if i cant sleep or i feel anxious or panicy. This makes my dizziness worse, but atleast it calms me down.

i was so hyper originally that it took three doctors and four months to determine whether it was my thyroid doing it - but eventually it turned out that it was pots.

I also use valerian herb - which is calming without making me drowsy. (strange whgen it makes everyone else drowsy)

[pamyla]

Hi runnergirl, I have a lot of the same symptoms as you and tend to believe I am of the hyperadrenergic type too. I currently take atenolol and zoloft - both very low doses. If I had to pick one though, I'd take the beta blocker. I take a 25 mg pill and have half in the morning, half at night. Anything more and I'm too tired, but this amount is just enough to keep my heart rate down. I also have a prescription for xanax. I don't take this much at all, but occasionally I'll get that panicked feeling and it helps me out with that.

Keep us posted on how it works out for you

Pam

[MomtoGiuliana]

I took Prozac, 20 mg and a small dose beta blocker for a little over a year. I decided to try going off of them 2 months ago. So far, everything is ok, but I am having a lot of PVCs and sinus tach, especially in the AM. My doctor told me that SSRIs taken for awhile make some kind of subtle, PERMANENT, changes in the brain--wish I knew more about that--but anyway, it may be that the benefit of taking an SSRI for awhile may continue once you are off it. I believe I would not have gotten better without these drugs. I did also use Xanax, sparingly, on occasion early on to help with the panic episodes.

Good luck with your decision.

Katherine

[calypso]

Runnergirl,

I have pretty much the same symptoms as you. I have high BP swings and my BP runs a little on the high normal side all the time, plus sinus arrythmia, sinus tach (especially in the A.M.) and anxiety-like symptoms. I am taking Lexapro 10 mg. I was, up until two days ago, taking Toprol XL 25 mg, but I have cut it out to basically see how I can manage without it. So far it's not been the greatest -- my heart rate is running about 100 in the morning -- but it gets better throughout the day, and there are times when I can be standing and it's 60. So I will keep trying this for another couple weeks and go from there. I would have stayed on the metoprolol, but want to see how I manage because I am thinking of having another baby in the next year or two and would have to be med-free in that case.

I also have a bottle of Klonopin in case things get really bad. This is a benzodiazapine and can be addictive, but I have taken them as needed for many years and never have had a problem.

I hope things get better for you. I know that your good physical conditioning is working strongly in your favor. My cardiologist says this is the best cure for a sensitive nervous system.

Amy

[Guest Julia59]

I take both Propranolol---the beta blocker----and wellbutrin to make my body less sensitive to the adreanaline. 20 mg of propranolol three times a day, and 100 mg SR of wellbutrin once a day. The propranolol was not enough to kill the hyperadrengic attacks. For years the propranolol was doing fine, but when I crashed in Dec. 2000 I had break through tachycardia even when I increased the dose to 80mg a day.

They tried to put me on Ativan in the beginning of my crash period, but I was afraid of addiction so I never took much. Besides it didn't really help----it just ended up making me very weepy during my hyperadrengic episodes. About a month after Dr. Grubb diagnosed my POTS----along came the wellbutrin--------but unfortunately along came 20 pounds also.................

Julie :0)

[RunnerGirl]

Thanks to all of you who have been kind enough to respond with your personal experience in managing the dreaded adrenaline! You've each given me some important insights and I think I may now have the courage to try one or both of the medication classes that have been suggested.

I lurk a lot here but don't post very often - largely because I somehow feel wrong about it when my symptoms are so often so much more tolerable than what others here suffer through. (My symptoms were much worse in 2002 - when they seriously thought I might have pheo - so today I count myself blessed that I can function almost normally.) And yet, I am struck by just how many others here can related to the symptoms I describe - symptoms so many of my doctors were stymied by. I can't thank you all enough for being 'there' for me whenever I have chosen to 'speak' or ask questions. This is truly a very supportive group of people and I count myself lucky to be a part of the group.

I'll definitely let everyone know if I have any success (or failures, for that matter!) with any of the suggested meds!

Thanks, again!

RunnerGirl