DS, 17, prescribed propranolol for panic attacks? How helpful without therapy?

[Fawful]

Hi, been very worried since he was prescribed this two days ago.

He has health anxiety and emetophobia, and has been on a waiting list for counselling since mid-August, when he really started to panic. He's in Y13, with all the associated stress and also has High Functioning Autism.

My question is, in your experience, would taking propranolol help him with his health anxiety and emetophobia if it doesn't change his thought pattern? (To be fait he told the GP he had panic attacks, he wasn't specific about the health aspect).

And also, at his age should he not be referred to a psychiatrist to overview his treatment? Although the doctor who referred him for counselling did say that at his age, et could no longer see a paediatrician, nor could he access 18+ services. I'm wondering who I should try to get to oversee his treatment, if that makes sense, since I think his autism is very relevant, as his health flare ups are probably linked to him being overwhelmed.

I'm having trouble untangling this, but I guess my main question is what can propranolol do for emetophobia and health anxiety?

If anyone knows of good online private CBT or counselling I would love to hear of that too.

Thanks so very much.

Sorry to hear your DS is having a tough time. Propranolol works on the physical effects of panic and anxiety - it blocks adrenaline so slows heart rate, reduces sweaty palms etc. I use it and it’s really good for tackling the physical symptoms, and although it doesn’t deal with the mental symptoms of panic, it does help to reduce that dreaded cycle of thought- physical reaction - worse thought - worse physical reaction.

Agree that meds are often best used in conjunction with CBT though.

Are you in England? If so he could self refer for CBT via IAPT.

Also propranolol works within an hour, it’s used for stage fright so he should see an improvement straight away.

Propranolol works on the physical symptoms of anxiety - rapid heart rate, to prevent panic attacks. The idea is if you stop focusing on your heart beat and the worry about having a panic attack/is there something physically wrong with me, then it will prevent a panic attack.
No it will not change the underlying thought processes etc, so therapy would be beneficial. Which side of 17 is he on? If he’s just 17 get a referral to camhs (yes he should ideally be seen by a psychiatrist in camhs who would decide if he actually needs meds). If he’s nearly 18 then look at local IAPT services available on the nhs.
If you decide to go private, make sure the person is registered with the appropriate professional bodies (BACP or the HCPC).
Autism is very likely relevant as you say. Some of it may be about managing his day to day routines etc to try and reduce anxiety where possible.

Thank you so much both, very helpful. Yes we are in England, and he turned 17 in the Summer so not 18 for a long time... I imagine referrals to Camhs will take a while but worth doing. I suppose he has to do it himself as his GP no longer talks to me?

Had never heard of IAPT, it looks so great, thanks. Sounds like he won't be able to access it just yet. I'll be needing it though :(

He is also underweight (5 ft 8, 51kg - his GP would not know, since he has grown, obvs!) so I worry the meds will knock him out, but I guess that's my own anxiety. Thank you so much for your advice, really appreciated

My dd 19 has been taking propranolol for a couple of months now and it's helped her a huge amount.
She had no appetite before because she had constant fear of vomiting as that's how her anxiety showed itself. She constantly felt nauseous.
Now she has her appetite back and can eat when out with friends again. And she's put on a bit of weight. She'd slipped into underweight BMI category.
She's due to start CBT soon too so we're hoping that will help improve things more.

IAPT can be helpful but it is highly skewed towards CBT which is not always very effective with ASD (though that's a huge spectrum and folk vary).
You should be able to self refer and, depending on local provision, 16 is old enough to qualify. Whether you are accepted for tx depends on a score determined by a rigid questionnaire re depression and anxiety so tell him not to 'play it down' if he speaks to an assessor. I'd say meds are always better with a talking therapy too though it's hard being over 26 and under 28 as you fall between the stools, provision wise. Good luck with it. I recently worked in the IAPT system so PM me if you wish x

From experience .. yes, it only addresses the physical aspects of anxiety, BUT, it does make an amazing difference, because it's the physical aspect of things that makes you think 'this must be wrong' or 'I shouldn't do this because it's worrying me'.

It doesn't change your underlying thought processes, but when you're feeling calmer, it allows you to think things through more rationally.

I too had emet when I was about his age, and part of the issue is that anxiety makes you feel sick - vicious spiral straight away from that point on. The prop helps to break that cycle, and even without any form of counselling you can readdress your relationship with food and eating in a really good way.

Counselling obviously enhances the effect, but your question was is it pointless without therapy, and the answer to that is absolutely not.

It genuinely does help on it's own as all the vicious cycle of heart racing, feeling sweaty, breathing fast that tells you something definitely MUST be wrong just disappears.

It's most odd to start with - I remember thinking 'but I should be feeling worse than this, where has everything gone?'

However therapy would be v helpful. There's usually counselling services available for young people age 13-19 (and up to 25 with disabilities) - apologies if this is what he is waiting for.

Thanks v much Anna, Linda and everyone, that is so good to know.

What you describe about your DD is exactly what has happened to him Snozzlemaid, he's underweight because of feeling nauseous.

Can I ask how in your experience is best to take the medication? The doctor said he 'could' take it three times a day but should he, or should it be as and when he feels anxious? The way the doctor said it I understood he should take it three times a day but when I asked the pharmacist he suggested as and when.

I feel so much better with him taking it as a result of this thread so thanks v much again to all that replied x

And thank you for your wise words and the offer 52andblue, I will check out what the NAS has to offer too.

Personally I would say as your doctor prescribed it. That was how I had it prescribed and I can't see how it would have worked if I only had it as and when.

If I'd only taken it when I had an episode, I'd have had to think 'I need to take a tablet', wait for it to work - all the time you have the adrenaline coursing around and reinforcing the idea that something catastrophic is going to happen. By the time the tablet worked, I might have legged it down the street.

The idea is that you block the crazy amounts of adrenaline all the time. So when you have the panicky thoughts, you don't have a panicky experience in your body to go with them - the bodily feelings reinforce the thoughts, which reinforce the feels and everything gets worse and you KNOW something terribly wrong is going on.

If he has health anxiety, blocking the racing heart beat, rapid breathing will do him a lot of good.

Makes perfect sense, thank you very much!

@Fawful

Thanks v much Anna, Linda and everyone, that is so good to know.

What you describe about your DD is exactly what has happened to him Snozzlemaid, he's underweight because of feeling nauseous.

Can I ask how in your experience is best to take the medication? The doctor said he 'could' take it three times a day but should he, or should it be as and when he feels anxious? The way the doctor said it I understood he should take it three times a day but when I asked the pharmacist he suggested as and when.

I feel so much better with him taking it as a result of this thread so thanks v much again to all that replied x

And thank you for your wise words and the offer 52andblue, I will check out what the NAS has to offer too.

My dd is prescribed it 3 times a day which is working for her. However, my ds was prescribed it when he started also taking Sertraline and he was to take it whenever he started to feel his anxiety getting out of control. He no longer takes propranolol, just the Sertraline now.

Good luck I hope it helps your ds.

I get the dreadful anxious shits and it calms my stomach so may well help him with gaining weight too.

Works a treat for me. Being relieved of that awful fight-or-flight feeling has made a massive difference to me.

I can recommend a great therapist who does CBT online, really helped one of mine through a very similar situation. I can DM you if you like?

Thank you very much everyone! Was feeling so awful him taking it this time last week.

He's been taking it since Sunday evening, has regained his appetite, not panicked at the thought of this new week, and had 0 side effect. Amazing.

The only small problem was that he had trouble deciding at what time to take the three pills. He started taking one after cycling to school (10am), then two together at 6pm. He just refused to consider spacing out the last two. Until two nights ago when he did have a panic attack. There might be some PDA part of him that quite liked the idea that he was misusing them a bit but that is another story, and one to look into in therapy (have not looked into it just yet).

@Krook, that would be great if you would still be willing, thank you v much!

Thanks again all for sharing your experiences.

I just took them when I needed them. I first started when I was going to the gym and would get racing heart. Then obviously lock down started and I used them - but only when my heart was racing so fast I couldn’t concentrate on anything else.

They only treat physical signs of anxiety - the racing heart?

How is his anxiety now?

Well, his panic seems to have mostly gone. He's still tracking how norovirus is spreading across the country so he is still watching out but it's no longer affecting his appetite. He had a couple of evenings when he was agitated and couldn't eat but the rest of the week he has noticed a real difference. He had a stressful week as well, having to take an exam, but although he didn't sleep well the night before and felt tired during the exam, it didn't translate in a whole week of panic as it might have done.
So it's been v positive.

Glad to hear you're seeing an improvement. I hope things continue to get better.
It's so so tough being a parent watching them suffer with anxiety.
Both my ds and dd suffer.
Ds has been on Sertraline for about 3 years now and that keeps him going and keeps his anxiety in check. He did have CBT at the start but I'm not sure it was long enough to have any real effect.
Dd has only just recently needed meds and takes Propranolol. She's just started university and the way of the world at the moment has meant it's been a really difficult start. She has needed the meds to get her through it and has just had an assessment with a counsellor to start CBT when they can fit her in.
I hope your ds finds what works best for him.