Mark Gould Beta Blocker Discussion

[bisontuba]

Nobody should ever, ever, ever, mess with beta blockers UNLESS under a Doctor's supervision...period.
Mark

[Uncle Markie]

First I've heard of this - beta blockers are for HBP generally. I've been managing HBP for 20 years now - always under a doctor's supervision. A person would have to be an idiot to do otherwise.

[tubajon]

His opinion is a little rigid. Lots of music has been created and performed while substances were being used. Beta blockers work more on rate control than BP. Didn't Berlioz smoke a lot of opium? On and on with that. There are just so many complexities that encompass people, it's a little strange to judge orchestral playing as "pharmaceutical".

[Donn]

It sounds like a rambling, spontaneous discussion after a couple beers. Ask him again tomorrow.

[bort]

Nobody should ever, ever, ever, mess with beta blockers UNLESS under a Doctor's supervision...period.
Mark

Don't mess with BluBlockers either.

[mceuph]

I recently started on several meds for high blood pressure. I have noticed that it drops my resting and active heart rates significantly. It's almost impossible to get my heart rate above 90, even when exercising. They don't make me any less nervous as far as I can tell. I hadn't thought about how this could affect performances yet, but a more relaxed heart rate during a performance couldn't hurt j guess.

[PaulMaybery]

This has been posted here before with at best a lot of anecdotal information. The using of it is very personal and really no one else's business hence I do not believe it is a 'moral issue.' It is not a performance enhancing hormone or drug in that it does not give any additional physical strength or heightened awareness, as with the case of certain athletes who do use performance enhancing substances.

To add to the anecdotes: I happen to be on 100 mg daily in an extended release dosage. I have had a heart attack with noticeable damage and reduced pumping and need something to protect the heart from overworking, and also to avoid a rapid increase or irregularity in the pulse rate/rhythm that could possibly dislodge a clot. I also take an additional cocktail of pharms for the purpose of regulating my BP and dealing with the coagulation issue of the blood. Granted there are benefits with Beta Blockers with regards to the way the nervous system kicks in when the body is under stress. We might say there is less "fight or flight." This is not to say the patient exhibits any loss of sensitivity or emotion. I have noticed absolutely nothing of this nature. It is not a psychotropic drug. I have experienced absolutely no negative side effects and to be quite frank, I rather enjoy the modicum of stability it affords.

In my opinion if a performer experiences a negative nervous symptom while trying to perform and a Beta Blocker would help them level the playing field, then I would be in favor of them being prescribed the drug. Why should they suffer when quality of life could be so much better? I agree, prescription and dosage should be under the care of a physician. Self medication can be dangerous. For those who have never experienced the use of a Beta Blocker first hand, there is no reason to believe that it makes you a better musician. It only allows you to be able to articulate your talent without physical impedance.

Paul (who should get all worked up over this issue, but is cool as a cucumber) Maybery

BTW as an edit. The heart rate can be significantly increased while on Beta Blockers. I had my stress test a few months back, and with sufficient incline on the tread mill coupled with speed, I had my pulse up and over 160 in less than a minute. The nitroglycerin was also handy should it have been needed.

So: I do not agree with Mark's assessment of Beta Blocker use. What's more, I feel his opinion smacks of a bit of arrogance and a lack of empathy for his colleagues who may suffer from conditions with which he may fortunately not struggle. Certainly, there may be some abuse of Beta Blockers, but we are not talking about abuse, but rather regular and presumably prescribed use.

[royjohn]

You can have endless arguments over this...autonomic responses are capable of being modified by training, but the problem is convincing people of that when the idea that they are "possessed" ( and I use that word consciously) of some ailment which requires medication. It is certainly easier to take meds than it is to undertake to modify one's own behavior via training. If such a course works for you and the side effects are not a problem (and probably you will convince yourself they are not when you are uncomfortable with anxiety creeping and crawling about yourself), then go for it and take meds, if you like.

I had a conversation at Church last week with a very healthy and handsome looking young man of about 17 who said he had an "anxiety disorder" and took meds for it. I proposed he try heavy exercise for it and he said he had, which I think is not the case.

I had a professor back in the 70's who taught his graduate students to run up their blood pressure to avoid the draft. When salesmen came to sell him new biofeedback equipment, he could run his pressure up and down to oppose the claims of the salesmen regarding the accuracy of their equipment. He believed in himself.

Of course it's a matter of belief and practice, lots of it. I don't like sitting in the doctor's waiting room and once when I sat waiting for doc for 45 minutes I had a bp of about 138/90 on exam and the doc immediately reached for a prescription pad. I ran out of there and changed doctors immediately. On the other hand, give me five minutes in the right frame of mind on a bench in the Walmart (could have done it in the doc's waiting room if I'd felt like it) and I can lower my pressure below the present 120/80 guidelines. Despite being 85 lbs overweight and out of shape. Yes, it's a matter of believing, but you will not convince those who WANT to believe otherwise that it is.

I'm speaking from 30+ years as a psychotherapist/hypnotist [now retired]...

[royjohn]

Bloke,
You're always very clever, but be specific, are you saying that anxiety is the same thing as diarrhea? If you're nervous, you "just can't help it."??

[toobagrowl]

I am naturally a "high strung" person when it comes to performances and auditions and such. And high blood pressure does run in my family I have all-the-sudden gotten "nervous" at some auditions and performances - adrenaline pumping like crazy through my veins, fast heart rate, sweaty palms. I usually just "got thru it" during those times, but it wasn't fun. It still happens from time to time, and I just play through it and focus my energy on the music, and it usually turns out well. But on a few occasions, I felt it hindered my very-prepared playing. The orange juice & banana beforehand takes a little bit of the adrenaline-pumping "edge" off, but not much. But I have wondered how certain auditions & performances would have gone if I had taken beta-blockers

[royjohn]

Bloke wrote:
<<I'm just saying that not EVERYthing (including "not all emotional problems") that ails one can be solved by relaxation techniques.>>

with which I would have to agree. But we're not talking about a few deep breaths here. First, one has to believe that it is possible to influence an "anxiety disorder." Then it takes a period of training in relaxation along with some consideration of what kind of thinking and what life situations might be fomenting the "anxiety disorder." Learning a different way of thinking might be in order. Laying off stimulants might be part of it. Exercise and nutrition might be, also. After all of that, it might be possible to do without meds. Or you might have to change jobs or find that a nasty spouse was a part of the problem...

Seeing as how a major religion (Zen) bases its approach to enlightenment on relaxation and meditation practiced rigorously, I don't see how improving or curing an anxiety disorder is beyond the disciplined practice of "relaxation techniques," if you want to call sophisticated meditation by such a name.

There just isn't a free lunch in this life, but people keep searching for it. If that is your preference, go for it. If you believe, as I do, that most of our problems are in the mirror in the morning, you will have some different ideas about what to do. That doesn't mean I wouldn't take the latest chemotherapy if the need arose, just that I'd consider very carefully what other options there were beforehand.

I thought I had a "low note disorder" but I decided to go back to practicing tuba before deciding to ask my MD for appropriate meds...

[royjohn]

I will now retire and let others more accustomed to doing so have the last word. Bet they will...

[bisontuba]

*

[Donn]

Hi-
Regarding what Paul said of my statement:

'So: I do not agree with Mark's assessment of Beta Blocker use.

"Mark" = "Mark Gould", I'm pretty sure.

[ghmerrill]

Just a bit of residual professional curiosity here ...

I know (from the epidemiological literature) that the off label use of beta blockers has been increasing in recent years -- and prescribing a beta blocker for anxiety is an off label use. So who's writing the scripts in these cases? Cardiologists? Primary care docs? Psychologists or psychiatrists? PAs or NPs in clinics?

I'm pretty sure that in my case things would get a little testy if I asked my cardiologist for a beta blocker script to treat anxiety. And in fact, if I ever sought a pharmaceutical solution to anxiety, beta blockers probably wouldn't make it onto my candidate list for a variety of reasons. But it does appear that the off label use for anxiety treatment has increased. So who's doing the prescribing in these cases?

And how does it work? Do you go to some doc in the hope of getting treatment for anxiety and the doc says "Well, let's try a beta blocker first."? Or do you go to some doc and say "I'd like to try a beta blocker for my performance anxiety," and the doc say "Okay, here's your script."?

Just curious about the practical aspects of this medical treatment.

(Full disclosure: I've been on a low dose ACE inhibitor for some years for hypertension. I know, and my cardiologist knows, that I really wouldn't need it if I would drop 10-15 lbs and exercise regularly -- but she doesn't want to wait for that and see me stroke out, and she keeps muttering things about fighting genetics. It's largely laziness on my part, and I do plan to address that. She has said "A beta blocker would be the next step, and you don't want to go there if you don't have to." My eldest child (age 40) is on a beta blocker, among a number of other things, despite being 6'4" and about 170 lbs on a good day. But he's had open heart surgery four times and has about a 20% ejection fraction. Alas, there are some conditions you can't psych your way out of.)

[Donn]

"Medical" cannabis (or "medical" NiQuil) though (prescribed by "self" for "pain") is always legit.

Well ... in that connection, it might be interesting to note that the defendant in a local murder case apparently plans to use dextromethorphan (Nyquil etc.) intoxication as a defense. In connection with his "genetic makeup" which supposedly makes him less able to tolerate the stuff, and some other drugs - Xanax and an antihistamine, maybe more. Dextromethorphan is also used at dosages like 20x higher than normal as a hallucinogen. Reviewing the list of side effects at dosages like that, I think we would agree it isn't "legit", really looks scary.

But your point stands, since it's easy to avoid accidentally getting a 20X overdose, and if we assume the local murder case is in the "Twinkie defense" category of desperate legal stunts, we find no problem with normal use of dextromethorphan without medical supervision. And of course likewise with cannabis, where despite widespread use without medical supervision I believe there are no known cases of a fatal overdose.

[PaulMaybery]

Hi Mark Jones!!!
In my earlier comment, I was referring to the OP Mark Gould's comments. Not your's my friend. I totally agree with you. Sorry for the confusion.
Paul

[ghmerrill]

And of course likewise with cannabis, where despite widespread use without medical supervision I believe there are no known cases of a fatal overdose.

Aside from problems such as driving under the influence (which aren't peculiar to marijuana), the big danger tends to lie in the area of drug-drug interactions -- which are often difficult to predict because of individual variation in responses. If you're already taking things like a cardiac or BP med, a diabetic med, and/or a blood thinner, you need to be REALLY careful about what you add to that mix, whether it's under a physician's supervision or not, and whether it's legal or not.

Significant adverse events -- even for very common OTC medications -- are also often age-related, and you should beware of this as you get older. It's really not all that difficult to ruin your kidneys (at any age) by just taking too much acetaminophen regularly over a long period of time. And the age-related risk curves for NSAIDs (like ibuprofen and naproxen) have been thoroughly and repeatedly documented. And some of these effects can sneak up on you with few bad indications until you have a major event.

Marijuana seems relatively innocuous in terms of major events and major drug interactions (so far as I can tell from research reports), but that's always something to keep in mind. Even more so with drugs like beta blockers. And a lot of the responsibility is now on the patient. Over the past five or so years, I've become quite alarmed at what (based on my own personal experience) I see as continued lowering of standards in primary care -- including outright errors, obvious oversights, genuine incompetence, and simply failures to be aware of the patient's medical history and details of his/her current condition. The specialists I go to, I thoroughly trust. But I haven't had a primary care doc I trust for about ten years as primary care has shifted over to a kind of assembly line and cookbook approach. So whatever you do, learn as much as you can on your own about what your treatment is and what to watch out for.

[bisontuba]

Hi Mark Jones!!!
In my earlier comment, I was referring to the OP Mark Gould's comments. Not your's my friend. I totally agree with you. Sorry for the confusion.
Paul

Hi Paul---
Sorry 'bout that...too many Marks!
Mark

[Rick Denney]

I think some of you guys are missing the point. It's not that Propanalol is a treatment for anxiety. It's a treatment for conditions that anxiety exacerbates.

Whether that condition is essential tremor, or high blood pressure, is a different issue. Most people suffer from some degree of essential tremor--and brain fog during anxious situations is, as far as I can tell, caused by the same condition. It's an overdose of adrenalin. As for me, at about Bloke's age, I suffer from essential tremor to the point where I have at times been unable to play--my body moved so much that I could not keep my lips on the mouthpiece. We're talking waaaay beyond an unintended vibrato. There have been times when I have used my left fist as a brace between my head and the bell of the instrument to control tremor.

That is not bad psychology--nothing in my current performance life approaches the stress of performance I have mastered in the past, or that I deal with routinely in my professional life.

(The use of Propanalol for essential tremor is on-label, actually--and my regular doctor prescribes it without hesitation. I didn't ask for it--I simply described the problem and he wrote the script. I take 10 mg at a time, and only when the performance situation seems like it will demand it--maybe six or eight times a year.)

If a person suffers from hypertension, a beta blocker prevents adrenalin from causing it to be worse under stress. Same with tremor--it simply reduces the effects of adrenalin. It does not make me any less nervous, and I still have to master my anxiety if there is any. I still have to master the music to control that.

Those who disparage it have never sat on stage unable to play at all, when the music in front of them is something they can play 100 times out of 100 in the practice room.

All the things that psychs talk about vis a vis relaxation are great. But if there is a physical ailment, why wouldn't a person seek a medical solution? Isn't that what medicine is for? (I did NOT say "drugs".)

But it is not a performance-enhancing drug. It won't make a poor musician into a good one, and the best musician (who performs at his best) never lost an audition because a lesser musician (performing at his best) took a beta blocker.

Rick "thinking videos like this are like watching naturally skinny people explain why fat people are fat" Denney