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.

DEAR DR. ROACH: Why shouldn’t you use antibiotics for a cold? — T.Y.A.

ANSWER: There are two main reasons. The first is that antibiotics, which are effective against bacteria, are not effective against the viruses, which are the cause of colds. It is true that a person (or their doctor) cannot be 100% sure whether it’s a virus, but people are generally pretty good about knowing when they have a cold.

The second is that resistance to antibiotics has become a major issue in medicine. There are now strains of bacteria that are resistant to all antibiotics, and I have seen patients die because their bacteria were resistant to all the antibiotics we have. Using antibiotics less often and for shorter durations is a major goal to reduce the rate of antibiotic resistance. (Antibiotic use in animals that are raised for food is a major issue as well.)

Patients can help by not asking for (or demanding) antibiotics for what are almost certainly viral infections.