Dear Dr. Roach:I just discontinued using metoprolol succinate extended release (ER) at a dosage of 6.25 mg. My heart rate is normally in the 70-80s, and my blood pressure is normal. My doctor prescribed metoprolol for palpitations, but it seems totally unnecessary. My issue is that I am experiencing tachycardia of over 100 beats every single night as well as dry mouth.

Could this be anxiety? And do you think an antidepressant like Zoloft or Paxil would help? I had a Holter monitor, which showed nothing wrong with my heart. The palpitations were sporadic only when I was anxious.

I stopped metoprolol because it exacerbated my anxiety and caused me depression as well as panic attacks. My doctor prescribed me 1 mg of Ativan to take at bedtime, but I am very scared of getting addicted to it. So, I thought maybe an antidepressant would help instead. My doctor prescribed 25 mg of Zoloft, but I want another opinion. — S.S.

Answer: Generalized anxiety disorder is a common problem and may be associated with panic attacks (sometimes depression as well). The most common (and highly effective) medication treatment for generalized anxiety disorder, with or without panic attacks, is an SSRI-type drug like sertraline (Zoloft). Therapy is another option, and the two together are more effective than either separately.

Metoprolol is an effective treatment for the fast heart rate that some people get when they have anxiety, and metoprolol by itself is helpful for many people who have anxiety. (The high heart rate can make people feel even more anxious.) However, it sounds like metoprolol did not work for you. There is a small increased risk of depression among people who take beta blockers like metoprolol.

In my opinion, lorazepam (Ativan) is not a good long-term choice for an anxiety disorder, but it can still be helpful in some people while they’re waiting for another treatment to start working (such as therapy or a medicine like Zoloft). It takes six to eight weeks to reach maximum effectiveness.

Addiction is not an issue when both the patient and prescriber agree that it will be only used as a short-term treatment. For Zoloft, 25 mg is a low dose, and some people need higher doses (sometimes much higher) to control their symptoms.