Posted by Elizabeth on August 2, 2001, at 15:11:43
In reply to Re: Can anyone help with a comparison?, posted by grapebubblegum on August 2, 2001, at 8:55:24
Hi, Grape. I was going to post a response to your original question, but medlib's response said just about everything I would have said. :-) The about.com site lists some of the common signs and symptoms of a panic attack: in general, they are sympathomimetic (they feel like you might feel in a fight-or-flight situation).
> Similar to what you said about valium, my comment on benzos is that they can HELP SOME but typically don't derail a well-entrenched panic attack.
Which ones have you tried? Xanax is generally the fastest-acting when taken orally (assuming your stomach is relatively empty), and I think that Ativan can be used sublingually to make it work faster. (I guess you could also give yourself IM Versed or something, but I'm not sure your doctor would go for that.)
I usually experience an "aura" of sorts (derealisation and perceptual distortions) before panic attacks, so I can take Xanax preemptively. But some people who don't get a warning like that do take Xanax at the onset of panic symptoms are able to use it to stop the attacks so they don't have to take it all the time.
> Since PAs have to run their course, I suppose the forced muscle relaxation of benzos might speed or ease the process until the attack is over.
I first tried taking Dexedrine (while on Parnate) the day that I went to backwoods Connecticut for a memorial service for a relative, a couple years ago. I didn't think to take any Xanax with me. Fortunately, one of my relatives (who works as a counselor of some sort -- social worker? psychologist?) helped talk me down. She was really good at it, too -- I was impressed.
> In my experience, the worst PA aspect is the twisted and frightening cognitive aspect that occurs once the attack is well underway, and benzos (clonazepam is the one with which I am most familiar) seem to slow thinking enough to break up the negative downward spiral of thoughts.
I think I know what you're talking about here, but could you say a little more? I experience something like that too (if I'm reading you correctly), and sometimes I have felt suicidal during a PA.
> Typically, though, for me, a PA is never over until I sleep. And of course benzos make sleep a little more easily attainable.
I know -- that post-panic shaky feeling that doesn't go away spontaneously.
Have you ever had a nocturnal panic attack, BTW?
> To answer the meds question: I typically go on SSRIs until I think I can live without them.
When I was a teenager, I took Prozac for two years -- my pdoc at the time thought that it would be a good idea to stay on it for a while since I had probably had at least one depressive episode before getting treatment. I went off the Prozac and was fine for a while, but my depression came back within a few months, and this time Prozac didn't help. I'm not entirely convinced that it had helped in the first place (it might have been a spontaneous remission or expectation effect), but I've always wondered whether the Prozac would have kept me from becoming depressed again if I'd stayed on it.
> But the doc said recently that she was thinking that geodon might be better for me in the long run than another round of zoloft. Anyone have any experience with both of these meds (or with another SSRI vs. geodon) and can give me a comparison?
I have never taken Geodon, and it does have some potentially significant differences from the other atypical antipsychotics, but I have taken Zyprexa, Seroquel, and Risperdal as well as several older APs (Mellaril, Moban, and droperidol). I've only taken very low doses, except for Zyprexa (I have taken as much as 10 mg of that). Mostly they just made me tired and hungry (the sedation went away after a few days in the ones that I took for that long). Risperdal (I think it was 0.25 mg, taken a couple hours before bedtime) triggered a very intense relapse of my sleep disorder, and I was quite upset and agitated the next day. Amoxapine, a TCA that's also a dopamine antagonist, did this too, but to a much lesser degree (amoxapine didn't make me feel awful the next day, but it did cause some very intense dreams and abnormal movements in sleep the first night I took it). Moban and droperidol both made me feel flat/numb/sluggish. Moban was kind of scary in that way: I wasn't sedated, but I felt like I couldn't move or take any voluntary action. Mellaril (just 10 mg) made me feel very tired -- I got a good night's sleep (which was what I was looking for), but I also felt very tired and foggy for much of the next day. Zyprexa was similar. Seroquel (taken at night) seemed to make me feel worse the next day, although it wasn't as intense as Risperdal in that way.
That said, some people do find low-dose antipsychotics helpful for depression, although I'm not sure about panic disorder. Geodon seems like it might be especially useful in depression, although I don't know whether it's liable to work by itself (without an antidepressant on board, that is).
I hope this helps. If you do try Geodon, I'll be interested to hear about your experience with it.
-elizabeth
poster:Elizabeth
thread:72927
URL: http://www.dr-bob.org/babble/20010731/msgs/73132.html