Brief Answer: Unlikely to be due to medicines. Detailed Answer: Hi Mauro, Welcome back! The tachycardia is indeed scary as it makes one immediately think that something is wrong with the heart. But tachycardia after meals is to an extent a physiological response and appears unrelated to your medicines. While the exact cause of post-prandial tachycardia is not known, it is believed that the increased blood supply to the intestines that is required to digest a heavy meal puts a load on the heart. In addition, acid reflux also adds to the problem. Usually it is triggered by some specific foods. Caffeinated soft drinks, coffee or tea are common culprits, as well as high-sugar or carbohydrate-laden foods. Some people have a noticeable response to salty foods or items containing monosodium glutamate. People with poor digestion, acid reflux and hiatal hernias are more likely to experience a racing heart after eating. I think before you make any further change to your medicines, try to remember what you had eaten on the three nights and if the meals were heavy. Try to change the food items and also make the meal lighter and see if it makes a difference. Acid production controlling medicines are also known to help. If nothing helps, there is one more thing that you can do to control the heart rate. Whenever you have tachycardia, take deep and slow breaths, taking almost twice the time to exhale than to inhale. You will notice that the heart rate comes down within a minute or two. This can reduce tachycardia in all sorts of situations, including that seen in a panic attack. I hope this brings you some relief. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Both SSRIs and TCAs cause bradycardia. Detailed Answer: Hi Mauro, It is true that fluoxetine is associated with mild bradycardia. In fact all SSRIs and tricyclic anti-depressants are known to cause mild bradycardia. If you wish, you can read more at WWW.WWWW.WW The other thing I wanted to say is please do not worry about the heart rate. Heart rate less than 100 beats per minute is normal and you need not worry about it. Fluctuations are common and not a cause for concern. I am glad that you are feeling better after starting Trivastal Retard. Regarding a decision to switch to SSRI, I feel that an SSRI would give you better control over anxiety but there still will be a risk of adverse sexual side effects. But if Trivastal can take take care of that, then it will definitely be an option to switch to an SSRI. Maybe you will know in a few more days whether Trivastal is making a difference or not. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Postural Orthostatic Tachycardia Syndrome (POTS) Detailed Answer: Hi Mauro, Please also go through some material on Postural Orthostatic Tachycardia Syndrome (POTS) which is a condition in which a change from the supine position to an upright position causes an abnormally large increase in heart rate. The Wikipedia has a good article on it. I am particularly interested that you go through it as it explains your tachycardia on standing up and secondly, it is often misdiagnosed as an anxiety disorder. Just read up on it and see if it matches your symptoms. In order to keep the query open, do not reply to this answer today. Once you reply, I shall have to answer within 24 hours as per the rules of the website. So reply after a few days when you are ready. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: As below. Detailed Answer: Hi Mauro, Yes, you are right that an increase of just 15 beats per minute is acceptable, but this is when you are on a beta blocker. Though one cannot say for sure that had you not been on nebivolol, you would have had an increase of more than 30 beats per minute. I think for the time being, you can forget about POTS and wait to see how things improve over the next few weeks. It is better not to make changes in more than one medicine at a time as you will find it difficult to identify the effects of each one. For example, Trivastal may be responsible for the sleepiness but the hike in Bystolic may also be implicated. All beta blockers cause sedation though it is less with Bystolic than with others. In my opinion, wait for at least a week or more before making any further changes. I do not expect that Requip will be less sedating, but you can try shifting the Trivastal to the night and see if it makes a difference. Switching to an SSRI may be a good idea if you have not tried one before. I hope by the end of the month, issues with other medicines would have been sorted out and then you can try any of the SSRIs. Whatever SSRI you try, give it a few weeks before deciding whether it works or not. Hope things work out for you. Best wishes. Dr Preeti Parakh MD Psychiatry

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