advice/experience with anxiolytics please

[Juliet]

Can anyone comment on the efficacy or otherwise of beta blockers to manage anxiety during an appointment and any potential drawbacks?

I've never needed to resort to medication before - and always been reluctant to do so because of trust and control issues - but my last treatment left me with PTSD. Now that I have to go back my trauma symptoms are recurring and I'm not sure I'll be able to manage without something.

I have asked about benzodiazepines, but not sure I want to go that route, especially after reading about the unpredicatability, plus it looks as if it won't actually be an option, because I don't have anyone I could ask to accompany me.

I realise that beta blockers won't deal with the cognitive side of anxiety, but I'm hoping they might help with the side-effects of a full-on fight-or-flight response. For reasons of personal history that I'm not going to share I'm hypersensitive to stress and in the weeks before an appointment the physical effects of this just get worse and worse, add a massive surge of adrenaline to all the cortisol washing around in my system and I'm a physical wreck.

My bad experience last time also meant I had to resort to self-medicating with alcohol. I'm a very light drinker and it's something I never expected to do, but I was in such acute distress that I don't think I'd have got through the 12 hours following that particular nightmare appointment without. So I'm also wondering if, even if I can't take benzodiazepine before the appt, I could take some afterwards. I don't think I could make it through another experience like last time without a hefty pharmaceutical crutch. I live on my own, there isn't anyone I can turn to for support and I don't have a pet I can cuddle. I've NEVER been as distressed as I was that night. I can't even write about it, even on here.

I'm trying to find a new dentist. I should have realised that I'd need to do this, I suppose, but I find that difficult too and I so kept telling myself that all my doubts about the whole process were just me over-reacting. The pandemic made me even more hesitant.

What upsets me is that I used to be OKish. Nervous, but nothing out of the ordinary. I hate being such a basket case and how much it disrupts my life.

 

[Enarete]

Hi Juliet,

sorry to read that your last experience has been so traumatic. I was wondering whether you are in need of a particular treatment or an exam? And whether your ideas about beta blocker come from a dentist or are more a result of your own brain storming?

I believe getting a new dentist in your situation is pretty essential as your old dentist that caused you the trauma would be your trigger Nr.1. otherwise.

I have an experience with beta-blocker in low dose - prescribed by my GP for a stressful event where I needed to keep my sanity while doing therapy, meditation and all over-the counter stuff already. I tried it out in low stress situations and high stress situations, none of them had to do with dental appointment. I found them ok, but not life-changing and don’t use them anymore. The cognitive component of anxiety is not to be underestimated. I felt anxious even with them but it just helped me to be able to stay present. Wouldn‘t rely on them for high stress situations and with a full blown PTSD-triggering situation I guess they would be useless or I would need a dose that would put me at risk. Also not sure whether this kind of medication counts as anxiolitics and is used for dealing with severe anxiety. With that being said, there are things like nitrous or “simple“ desensitization that may be more useful for your situation (and were more useful in mine). A good dentist is the basis of it. Btw. if your anxiety is based on one single experience, then getting it sorted will be a bit easier than if it was a life-long repeated trauma. Did you get any treatment-ideas from the professional who diagnosed you with the PTSD?

All the best wishes

 

[Juliet]

NO is a non-starter for me - fear of suffocation. My first bad experience of dentistry was extractions under some sort of GA administered via a mask as a child. Wasn't told anything, strange room, strange people, really frightened. In fact that's probably when my generalised phobia about lack of control in healthcare settings started. It seems astonishing, but I think this way of doing things was probably quite normal back then, hopefully things have changed since.

I am desperately hoping that I can go somewhere else, but waiting times are so long at the moment. The appt I would like to be able to back out of was booked months ago. I'm feeling silly for not realising I'd find it hard/impossible to go back and doing something about an alternative sooner. I really wasn't prepared for all my PTSD symptoms to come flooding back, although it now seems obvious. It's as if I've been dumped right back where I was 2 years ago (close to rock bottom in many ways) and everything I've done to regain some sort of life has been wiped out.

 

[Enarete]

I'm feeling silly for not realising I'd find it hard/impossible to go back and doing something about an alternative sooner. I really wasn't prepared for all my PTSD symptoms to come flooding back, although it now seems obvious.

Nothing silly about that. It‘s pretty common to be ok all the time until the appointment comes closer.

 

[Juliet]

GP has prescribed propanolol to take before appts and diazepam for afterwards. She seemed quite optimistic the propanolol would help with the physical symptoms, so we'll see. I had to pass on the zopiclone for the night before because I can't afford it, but the pharmacy will hold the prescription for 28 days, so if I find I have a run of sleepless nights that leaves me utterly exhausted in advance I can go back and get it (glad I asked about this).

I've also started looking for a new practice. Just making the decision that I won't go back to the place that has treated me so badly is a relief, so thanks for highlighting that as a trigger.

 

[Juliet]

So I managed to get an early appt elsewhere - won't be a long-term solution, because they are too far away, but I had the consultation this morning. I was half-demented with stress until Sat afternoon, none of my usual stress-relief methods (exercise, mainly) helping much. But after a walk I sat down and started to write down what I wanted to tell the dentist - the adjustments I'd need and the history of how I'd landed up contemplating using benzodiazepine just to get through the door.

I'm really grateful to Enarete for highlighting the previous dentist as a trigger, because I think it was useful for me slowly to untangle all my thoughts and emotions and work out why I feel the way I do. Might well not work for others, but that's the kind of person I am. Didn't stop the anxiety, but having worked out what I thought was driving my responses helped to stop the escalation of the freaking out.

This morning I started taking the propanolol. Can't say it was a miracle cure, but I think it helped. Although I was still nervous and my heart rate was higher than it should have been I wasn't shaking, my breathing stayed semi-OK and the cliff-edge felt a bit further away. That made it easier to stay focused when I was preparing and driving to the appt. I took some when I arrived, and although I had to wait 10 mins (which would normally have sent my heart rate through the roof and completely taken out my capacity to taken information to the point where I'd need to concentrate really hard just to follow the nurse to the room), I stayed calm-ish. My heart got a bit fluttery, but I didn't feel as if my body was trapping me in the usual really unhelpful panicky state and my voice didn't shake when I had to go in (I waited in my car - I really didn't need the stress of sitting in a mask in a waiting room freaking out).

Long story short, I managed to stay much, much calmer and more focused during the consultation. I'm not going to kid myself - I think it would have been very different if the news had been worse - but just to be able to get through the beginning stages of the examination without the debilitating stress I normally experience was an improvement.

Post-appointment I did get the usual post-adrenaline slump, but again, not bad enough to wipe me out completely.

No point getting carried away - sample of one with no control (don't know how I'd have been without the propanolol) - and things could be very different next time. Could be a placebo effect. I think that the way it was helpful was attenuating the escalation of physical symptoms, which helped me to stay mentally calmer and more rational. And made me a much easier patient to deal with.

I should say that the other thing I did, which I suspect also helped a lot, was give the dentist written notes with what I wanted her to know of my history and what the adjustments I'd need to be able to cope. I felt a bit daft doing this, but last time I went through a consultation, although I'd planned what I wanted to say, I wasn't calm enough and listening to it all - and to my own voice shaking - was embarassing. She read my screed, clarified a couple of things briefly, but then just got straight on with the examination. Much better from my point of view.