Okay, initially I'm going to disagree with treatment using Xanax and Cymbalta. I don't care for the use of an SSNRI in the presence of anxiety disorder. This class of drugs are known as selective serotonin, norepinephrine inhibitors. The inhibition of uptake of these neurotransmitters leaves them available for metabolism far longer than normal conditions allow and the result is increased levels which cause relief of depressive symptoms. Xanax, or alprazolam, is in a class of drugs called benzodiazapines and they are relatively short-acting, but because of this have a rather potent effect range and withdrawl symptoms are experienced in some cases despite the short half-life of the drug. Adding Ativan, a similar benzodiazapine, is simply putting things over the top in my opinion.

One vital clue is your statement regarding the ironic disappearance of symptoms once reaching a portal of proximity to help in the way of healthcare, ie the emergency room. This is extremely common among patients with anxiety disorder and the sense of security perceived is often extremely potent in its ability to cause change in anxiety symptoms and abate the problem temporarily until a panic threshold occurs once again.

As I've told others who either join or visit this forum, you will not die from benign palpitations and in over 40 years of practice, I've never even heard of a patient developing a cardiac event from this type of palpitation. It would be of value for you to carefully read the postings at the heading of this site entitled HEART PALPITATIONS 101. It will help you better understand what is taking place.  

As for seeing it to diagnose it, we don't need to see an arrhythmia or other event take place to diagnose the underlying problem because symptoms are related to underlying pathology. In other words, if you're experiencing symptoms of heart disease or other serious condition, we are able to use a variety of diagnostic tests to determine what is wrong. An arrhythmia is a consequence of disease, not the cause. So never worry that nothing can be found. It's always great news.

This is a difficult syndrome for someone so young, but I want you to speak with some of the members here and you'll find that it's not dangerous at all, but rather an extreme nusiance that as you already know, can be quite unnerving and unsettling. It has caused many people to become somewhat introverted and suffer from agoraphobia because they feel too far from help should they be out and about when symptoms strike. It also tends to support a notion that overwhelming embarassment will be suffered should they become incapacitated or that someone will think they are strange.

My advice here is to try and locate a more conservative healthcare professional. I think they're trying to throw everything but the kitchen sink at your condition and frankly, it can make it worse under such conditions. I'm not a fan of either Lexapro or Cymbalta and only use it under certain circumstances in the elderly. I exclusively do not prescribe it to someone your age and much of what young persons suffer from with regard to depression and anxiety is "situation specific." This is very difficult to treat with medication because unless the environmental cause is dealt with to satisfaction, no amount of medication can make the symptoms go away and many a patient has found themselves on very high doses trying to outrun their dilemma.

VERY IMPORTANTLY, however, you cannot simply stop taking these drugs and must speak with a healthcare professional in order to safely wean from them. I would ask about seeking a single agent to use in dealing with your anxiety and then couple the pharmaceutical treatment with professional counseling to better identify and understand the underlying cause for your anxiety. The combination is extremely effective. Tranxene is one of the better benzodiazepines for anxiety, but any of these drugs regardless of their value, are strictly for short-term use. This is why it's so important for you to seek and obtain professional counseling so that you are not dependent upon medication for relief.  

You will also find great support among the members here, many of whom have shared your experiences. They're an excellent group of people and can offer you a shoulder to lean on in helping guide you through some of the rougher times.

Above all, you're going to be fine. Simply continue your medications until you speak with a physician to make adjustments and then get a referral for counseling. The effects of anxiety can be extremely frightening, but are not harmful to you in any way and regardless of palpitation events, they will never harm your heart or cause a cardiac event. Stay clear of anything that has stimulant properties, ie chocolate, coffee, tea, energy drinks, etc., and not that you're doing so, but illicit substances will readily cause anxiety exacerbations to perpetuate and even threshold. Just so you're aware.

You'll be fine. Hang in there.

Best regards and Good Health

Hi Nicolette

Welcome to the forum.

RLR has always the best advice and has always been on hand with reassurance.

I am just about to start anxiety management classes, I don't like taking any medication for my anxiety, because, at the end of the day the issues that have slowly caused you to have this anxiety disorder and along with the others you mentioned, will still be there once you've come off your medication, You do need to seek counselling and some sort of coping classes.  

For now though, try to do some relaxation take a hour out every day if possible, do not take on things you really don't want to do, many people with our disorder seem to,  so say No! adjust your thoughts, as soon as that little voice in your head starts telling you your going to die, try to ignore it, it won't happen! think of something pleasant, do some diaphramatic breathing, this is where you sit up straight, put your hands on your belly just below your and on the bottom of your ribs with your middle fingers just touching, then take a deep breath in through your nose so your middle fingers part slightly then exhale through your mouth slowly making your you empty your lungs properly do this a few times and it does help, 1 you are breathing properly not in short breaths which happens when your anxious and 2 your concentrating on that! it can make you feel a little light headed if you do it for to long so keep it short.  I found changing my diet helped too, eat 6 small meals a day instead of 3 larger ones, RLR says always drink after not during eating, this works, also drink slowly, try and sit for about 20 mins after eating if you can't then don't do anything to quickly.  For me avoiding caffine is good so no Tea, Coffee, Coke or Chocolate  :'(, I nust admit I have cut down but I have the occasional chocolate bar and I drink de-caf tea,  If you decide to drink de-caf, do not drink on a empty stomach!.
Avoid all fizzy drinks, and no spicy foods cut down on cheese if you eat alot of that.  I was also told to cut out of limit the amount of leafy veg I eat as this causes wind.  Do some exercise and I don't mean go to a gym I mean do some walking and drink enough water.

I know it sounds alot but it does help they won't completely go, but will calm them and help you deal with them better.  

This is what works for me and it's worth a try.  I was about 22 when I started noticing the missed beats and it's scary, mine also get aggrivated by my periods, but one doctor told me once that anxiety is heighten at this time so its a a big circle.  Our thoughts are our biggest problem!  Try to think more positively.

Hope you didn't mind me giving my opinion across and I hope it may have helped.

Kath x  

Thank you Kathryn! I really appreciate it.