Psychiatry & Psychology--General/Anxiety and Beta Blocker

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Question
Dear Dr. Harrop,

I am 49 and generally anxious about things but not entirely gripped by anxiety. As an introvert, I do get anxious talking to people in small and large groups. I was in the teaching profession for a number of years and found myself experiencing nervous rash around my neck due to increased anxiety. As a result, I have developed essential hypertension (145/85) which surfaces during stressful/anxious situations. I have been put on a beta blocker, Atenolol (25mg), since 2013 but my dosage has been reduced to a 1/4 due to the lethargy I experienced with a higher dosage. The lower dosage is working well for me. My bp is usually normal (115/75) when I'm not anxious.

Questions:
1. Is this condition common among your patients, i.e. development of essential hypertension due to prolonged anxiety?

2. Can this type of anxiety-induced hypertension be successfully controlled through psychological therapy rather than medication?

3. I do have difficulty falling asleep at night and have been recommended melatonin (3mg) which works well for me. Would you know if melatonin, currently marketed as a dietary supplement, can be taken long term? I have read conflicting reviews about the use of melatonin.

Thank you for your time.

Answer
1. Is this condition common among your patients, i.e. development of essential hypertension due to prolonged anxiety?

Yes


2. Can this type of anxiety-induced hypertension be successfully controlled through psychological therapy rather than medication?

Yes

3. I do have difficulty falling asleep at night and have been recommended melatonin (3mg) which works well for me. Would you know if melatonin, currently marketed as a dietary supplement, can be taken long term?

It is safe to take long-term.  The effect may wear off over 6-8 weeks, but it is safe.

Psychiatry & Psychology--General

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Daniel S. Harrop, M.D.

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Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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