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Re: Best thing for panic attacks/extreme anxiety Rakken

Posted by Elizabeth on October 31, 2001, at 9:31:25

In reply to Re: Best thing for panic attacks/extreme anxiety, posted by Rakken on October 29, 2001, at 18:31:36

> Sorry I wasn't very clear. I have been on Adderall for one month so far, and I was on Dexedrine for a month before hand. Other stimulants have not been effective for me. I have tried Provigil, Ritalin, and a few anti-depressants.

It's interesting that the other stimulants didn't work but Adderall does. How much Adderall are you taking, and if you remember, what were the doses of the other stimulants (especially Ritalin and Dexedrine)? Also did Dexedrine work (something you said further down suggested that it had) and if so, why did you switch?

> I was diagnosed with major depression a little over 2 years ago. I tried Prozac, Remeron, Paxil and Risperdal (for anxiety with the depression). I may have been on some other anti-depressants, but I can't recall right now. My pdoc told me that people who didn't respond to SSRI's usually responded to the tricyclics. So she prescribed anafranil and depakote. She had me get an EEG before I started the anafranil. It was slightly irregular so she didn't want me to take it.

Tricyclics lower the seizure threshold, and clomipramine (Anafranil) is one of the worse ones in that respect. Nortriptyline would be a better choice, I think; it has fewer side effects in general.

> The EEG wasn't too weird. Some EEG expert said that some people just have different heart rythms or something.

EEGs measure brain waves, not heart rhythms! (But it is true that a lot of people have EEGs that are slightly "off" but don't have seizures or anything. I assume you've never had any seizures?)

> The anti-depressants changed my personality a lot and more or less put me in a daze.

In what sense did they change your personality?

You mentioned a couple of SSRIs and Remeron. Did you ever try Effexor, Wellbutrin, Serzone, Desyrel (trazodone), Nardil, or Parnate?

> I have a lot of difficulty concentrating and staying awake. I also had a problem with motivation (not linked to pot which a few doctors have tried to claim, it was more connected to the depression). I wasn't very alert or intouch with the world before I went on Dexedrine/Adderall.

Stimulants, or activating antidepressants (such as Wellbutrin or MAOIs), seem like they would probably work for that sort of depression, and antipsychotics like Risperdal seem like a bad choice, IMO. Antipsychotic drugs are often sedating and can dull your concentration, motivation, and alertness.

> I am 18 years old now and feel that I have matured a lot.

The reason I asked is that doctors do often understand that some people experiment with drugs as teenagers but don't go on to become addicts. If you've stopped doing drugs altogether then doctors shouldn't be too concerned. I also think that being older makes a difference -- in general it's assumed that you're more responsible.

> The lorazepam incident happened exactly a year ago on October 31st. I had taken 3 a few days before and felt practically nothing. I got them from a kid at school. They were very powdery (white, little round pills). I didn't believe that they were real or that they would even work. So I took about 11 plus all the remaining powder and broken pieces. I didn't intend to overdose. I didn't even think they'd work. Unfortuanately for me, they did all too well. I woke up the next morning not remembering a single thing from the previous night. I went to the hospital and explained to a doctor what had happened. It was very stupid of me and I can't belive it was only a year ago. To me it seems like it was five.

Ahh, so it was an accident related to experimenting with recreational drug use. I think that doctors will be okay with that as long as you make it clear that you've learned your lesson. (What posessed you to want to try Ativan, anyway?)

> I think that I have ADD (without the hyperactivity) with an anxiety/panic disorder.

Yeah, it sort of sounds more like ADD than depression. Can you say anything about your depression symptoms, if any? Perhaps the doctor who diagnosed you with depression was misled because you seemed tired, or perhaps the depression was secondary to the anxiety and ADD.

> The Adderall may make the anxiety more intense, but it is the only thing I have responded to well. It has made my life much better even with the increase in anxiety. I take 10 mg of Dextrostat in the afternoon so that I can stay awake until I want to fall asleep (10 PM or so).
> That way I can control my sleep schedule. I take clonidine which makes it a little easier to fall asleep.

Interesting combination. Does the clonidine do anything else for you?

I took Cylert (a long-acting stimulant -- it lasts all day but is milder than Ritalin or amphetamine) for a little while in college and it helped me feel alert in the day and, like the stimulants do for you, it improved my sleep, made it more regular and less fragmented.

> I have been looking around a lot for info on anxiety/panic disorders. I have high baseline and high anticipatory anxiety in between attacks. They can be brought on when any sort of attention is brought near me (not to me directly), or if I think that people are looking/talking about me. I am extremely self conscious. I also get them when I am alone worrying about things or thinking about future events. I have had them when I am with friends at work or when driving to school. I also have them sometimes when walking to a class or anticipating the end of a class. They are spontaneous it seems, but are very easily brought on when attention is brought near me.

My pdoc says that a lot of people have a mix of generalized anxiety (worrying, ruminating about the past and/or the future), social anxiety (fear of being the focus of attention, performance anxiety, extreme self-consciousness), and panic disorder (spontaneous panic attacks). I also think that situationally-predisposed panic attacks can lead to spontaneous panic attacks. I have many of the same problems that you have, BTW.

> I think that benzos are the best choice for my anxiety, but I don't think that my pdoc will consider them.

Don't be so sure. I think if you present things the right way, s/he might be willing to try benzos. Be sure that your doctor knows about the panic attacks. Emphasizing the anxiety rather than the depression might help if you feel that a benzo is right for you. Don't ask for a specific benzo. If you start taking it and don't "feel" anything, you shouldn't assume that it isn't doing anything -- take it for a little while (a few days, at least) and see if your anxiety seems to be getting better.

Also, if your pdoc wants you to try another antidepressant that you haven't tried, don't object too much. Be patient. If you insist that you need benzos, it could make you sound like a "drug seeker." (Funny expression -- aren't people who go in asking for antidepressants or antihistamines or whatever also "drug seeking?")

I think that since you've tried two SSRIs already and had problems with them, you shouldn't be expected to try another SSRI (the SSRIs besides Paxil and Prozac are Zoloft, Luvox, and Celexa). But there are other antidepressants that work differently and you may find that they help you. Don't rule antidepressants out completely.

> I don't want something that have lots of side effects or changes my personality/perceptions.

You can't predict what side effects a particular drug or class of drugs will have for you. The only things I'd say you should probably stay away from are antipsychotics (like Risperdal), SSRIs, and the other antidepressants that you've tried already (like Remeron).

> I can recall my pdoc saying something about lorazepam when I visited her after the incident. She said something like, "I never prescribe those for longer than 11 or so days. They're muscle relaxants. Very dangerous."

Benzodiazepines are not "very dangerous," although ODing on them isn't exactly a good idea! And they are perfectly good treatments for social phobia, panic disorder, and generalized anxiety -- a lot of people find them much more tolerable than antidepressants, which often make anxiety *worse* at first (SSRIs in particular).

> I think she is very close minded and stubborn in some ways.

From what you say, it sounds like she is. Maybe you should consider trying to find a different doctor. (But as I said before, don't give them the impression that you are looking for someone to prescribe benzos for you. Benzos really are quite safe, well-tolerated, and minimally addictive, but a lot of doctors still have unreasonable prejudices against them.) Do you have a GP, a regular doctor? If so, you might talk to him/her about the problems you've been having with your psychiatrist and ask for a referral.

Hope this helps. Take care.





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