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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by grapebubblegum on August 1, 2001, at 15:31:06
I am confused. I have heard people say things like (and granted, this is an extreme example) "They didn't have the shoes in my size and I just started to have panic attacks." Then there are more serious examples like, "I was so worried that my son would not arrive home OK that I went into a panic attack." I don't know what goes on inside anyone else's head but I have experienced extreme worry about someone and even a general mood upset but it didn't seem the same as a panic attack. I'm not trying to split hairs verbally; I don't like to argue semantics and I know for a fact that it must be very hard for someone who has never undergone a panic attack to know what it is and thus they may be likely to label something else as a panic attack, but are there any other panic attack sufferers out there who know what a panic attack is? I am starting to wonder if my panic attacks are something else that I have not yet defined because they entail symptoms much worse than being worried or upset or "panicky." I know that makes no sense, but when people say they are panicking over their tax extension, I am pretty sure they mean something else. To me, anxiety and panic are different although of course I won't rule out the idea that one lays the groundwork for another or is really a more potent version of the other; it just doesn't seem quite that way to me, though.
That said, I'm sure there are different degrees of panic attacks, but in light of the standard advice like "they may seem scary but they are not harmful and they are self-limiting..." I am starting to wonder if I am dealing with something else. My doctor said it is true that people with severe panic attacks may be seen pacing, uncommunicative, or curled up in a ball on the hospital floor shaking their head and repeating "no," until injected meds drag them with great difficulty into unconciousness, but I am wondering if there is such a thing as crossing a line from "panic attacks" into a different condition altogether.
Posted by MM on August 1, 2001, at 17:14:39
In reply to Can anyone help with a definition?, posted by grapebubblegum on August 1, 2001, at 15:31:06
It's possible that what you experience isn't a panic attack and is crossing over into another condition. I can't say. I found this link with a general discription of panic and agoraphobia (both of which I have been diagnosed). http://www.adaa.org/aboutanxietydisorders/panicdisorder/
Just a thought, but do you know anything about bipolar? Anxiety/panic seems to be somewhat comorbid with BP (I also have this diagnoses).
For me it's like my fight or flight response is on a hair trigger, and anxiety is ALWAYS there in the background. I can tell you that the degree of severity went from high to higher when my life got more stressful, but since I took SSRI's it seems that it has crossed a line and got worse. That doesn't happen to everyone. I guess it can happen to people who have underlying bipolar (and I hear SSRI's can't be tolerated by people who have TLE).
Panic attacks are DEFINITELY NOT the same as being worried that you'll be late for work etc. It's INTENSE fear, like you're about to be eaten by a shark. Your heart is about to leap out of your chest (or is throat the expression?), and your mind is going ten billion miles per hour. It comes from when we had to hunt lions (or whatever)and had to be VERY aware of our safety and surroundings, and we needed the adrenaline for strength. Sorry for rambling. Hope this made some sense and helped.
Posted by Zo on August 1, 2001, at 18:25:03
In reply to Re: Can anyone help with a definition? » grapebubblegum, posted by MM on August 1, 2001, at 17:14:39
> (and I hear SSRI's can't be tolerated by people who have TLE).
You do? I have TLE. . . and every SSRI was a complete bombout. Do tell!
Zo
Posted by grapebubblegum on August 1, 2001, at 19:20:26
In reply to Re: Can anyone help with a definition? » MM, posted by Zo on August 1, 2001, at 18:25:03
No TLE for me.
I have not had episodes as bad as I described in a while, and those episodes were always co-morbid with other major stresses such as being sick. I have tolerated SSRIs well; in fact they have reduced my threshold for PAs. And yes, there is a history of bipolar in my family; I am sandwiched between two people of that diagnosis, my father and my son. I always quit SSRIs for other reasons, though.
As much as benzos can help to prevent attacks (they don't derail them as well as prevent them for me) they do leave me depressed. I didn't think that was true but I didn't understand depression symptoms: extreme irritability, extreme oversensitivity... at least that's how it goes for me. My doctor is thinking of geodon instead. Now I'm not in PA phase but in quasi-pre-PA phase whereby all food looks revolting and I don't want to do anything to overextend myself for fear of triggering PAs.
Posted by medlib on August 1, 2001, at 20:29:51
In reply to Can anyone help with a definition?, posted by grapebubblegum on August 1, 2001, at 15:31:06
Hi gbg--
Those of us who have a mental illness know that those who *don't* regularly misunderstand the considerable differences between the emotional episodes they experience and the illnesses we have to cope with. Situational depressions, anxieties or panics are associated with and sustained by events *external* to the individual. Sometimes, they are intense and/or prolonged, but they are always *reactive* in nature. Most are mild-to-moderate in severity and self-limiting. Treatment, if required, usually is brief.
Though they can be triggered initially by an external event, clinical major depression, GAD (Generalized Anxiety Disorder) or Panic Disorder are *internal* illnesses, biochemical imbalances which may have genetic, endocrine, or cumulative stress components. They usually are moderate-to-severe in intensity and chronic or cyclical in length. Treatment may be extended and/or complex; the therapeutic goal may be correction or amelioration of the condition, rather than cure (as is the case in other chronic illnesses, such as diabetes or arthritis).
For me, the difference between anxiety and panic is time-related; roughly, anxiety is worry/fear of what may or will happen, while panic is a reaction to what *is* happening. I think of a situational panic episode as an experience of frenzied bewilderment, usually in response to a sudden unexpected event perceived as uncontrollable.
A panic *attack* is a sudden intense activation of the sympathetic nervous system ("fight or flight response) which is perceived as life-threatening. It's frequently accompanied by a "false suffocation syndrome"--the sensation that one's airway is swelling shut causing choking or feeling of oxygen starvation.
Recently, I had a series of panic attacks every 12 hours for 10 days when I discontinued Geodon. Each lasted 45min-1 hour and was terrifying. (The one other time I felt like that, my throat *was* swelling shut--from anaphylactic shock caused by a new antibiotic!)Perhaps, what you are experiencing is Panic Disorder. About.com has a good site with a detailed description, "identifying-type" questionnaire, etc. (The paid advertisements at the bottom are off-putting, but easily ignored.)
http://panicdisorder.about.com/cs/pdbasics/index.htmThe best-known site on the net dealing with anxiety and panic is tAPIR (the Anxiety and Panic Internet Resource) at:
http://www.algy.com/anxietyAre you taking any medications for your symptoms? My pdoc prescribed Valium (when I finally got hold of him), which helped a little with the drug-related muscle tremors, but did nothing whatever to ease or shorten the panic attack itself. I know that quick-acting benzos are often rxed, but, surely, a long-standing disorder requires something more. Has anything worked for you?
Hope these sites help you find some answers. Well wishes---medlib
Posted by MM on August 2, 2001, at 1:29:12
In reply to Re: Can anyone help with a definition? » grapebubblegum, posted by medlib on August 1, 2001, at 20:29:51
I don't know if this has been proven or anything, it's real people's experience so I hope this doesn't mean I'm mis-informing anyone. I did a search (I have msn search btw) for temporal lobe epilepsy, and came across a message board where some people who have TLE had posted. Here's the link:
http://www.depersonalization.co.uk/oldboard/messages/messages/147.htmI don't know if I have TLE (I'm thinking I do), but I can say SSRI's increased depersonalization for me too.
Posted by grapebubblegum on August 2, 2001, at 8:55:24
In reply to Re: Can anyone help with a definition?-Zo, posted by MM on August 2, 2001, at 1:29:12
Thanks medlib and everyone. 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. 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. 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. Typically, though, for me, a PA is never over until I sleep. And of course benzos make sleep a little more easily attainable.
To answer the meds question: I typically go on SSRIs until I think I can live without them. I taper off them with no problem and live fine for a few months or more. Then, (and I cannot take out the element of life stress) a major life stressor, and I mean MAJOR, comes along and throws me back to where I started so that I am back on the SSRI wagon. 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?
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
Posted by grapebubblegum on August 2, 2001, at 16:22:19
In reply to Re: Can anyone help with a comparison? » grapebubblegum, posted by Elizabeth on August 2, 2001, at 15:11:43
Thanks, Elizabeth. I've taken xanax and I've been given Ativan by injection at a hospital, and they do work, but sometimes a PA can get so bad that it is not a smooth, swift ride down.
Anyway, you asked about the cognitive aspect. I guess it is similar to what you might feel if someone were driving a nail through your toe and you saw no end in sight: for me it's not a suicidal feeling as much as a feeling that my being alive is some sort of mistake or a feeling that just possibly it might have been better had I not been born. This is a passing sentiment and a half-formed thought at that; so I consider it to be a reaction to unrelenting (psychic) extreme discomfort.
As for the twisted thoughts, it's kind of that unreality feeling coupled with, "Ah, I feel better; maybe going into a store to grab some groceries might help distract me," alternated with, "maybe this store is making me feel worse," and "I'll just read the concert t-shirt of the man in front of me in line," and then, "the shirt is making me feel worse." In other words, seemingly irrational thoughts and emotional content linked to supposedly irrelevant data in the environment. That's what I meant.
Well, my son took zyprexa and he ate CONSTANTLY until the doctor switched him to geodon and now he is eating normally again.
Posted by Gracie2 on August 2, 2001, at 23:38:03
In reply to Re: Can anyone help with a comparison?, posted by grapebubblegum on August 2, 2001, at 16:22:19
First, worrying is a terrible habit that can escalate to the point of ruining your health. After my brother was killed in an accident, I refused to let my son out of my sight because I knew that if I did, I would never see him again. If he disappeared for a second, I became frantic.
Needless to say, this was harmful to both of us, but I would not refer to these episodes as panic attacks. If I had to put a name to it, I would think of it as some sort of post-traumatic stress disorder.Anyway, much later in life, I started to suffer occasionally from real panic attacks. The physical symptoms are debilitating. If you can move at all, it is to pace around aimlessly or, prehaps, to find someplace to hide, such as locking yourself in your car or in a bathroom. You hyperventilate, your hands shake, sometimes you cry. Often you talk to yourself. You are not really in control or able to function in an appropriate manner. In short, you simply "lose it". This kind of attack (in my unofficial opinion) can make you a danger to yourself and others, and requires medication.
On the other hand, constantly worrying is a slow kind of death. To break this habit, I was helped a great deal by Dale Carnegie's classic book, "How To Stop Worrying and Start Living." I cannot recommend it highly enough.
Good luck to you-
Gracie
Posted by medlib on August 3, 2001, at 0:11:42
In reply to Re: Can anyone help with a comparison?, posted by grapebubblegum on August 2, 2001, at 16:22:19
Hi again--
You asked about Geodon. I would still be taking it had I not developed extrapyramidal symptoms (jaw locking, muscle tremors). My experience with G. was so atypical, both on it and coming off of it, that my pdoc wanted to send it in to the manufacturer; but I couldn't be bothered (too devastated by the death of hope). It's the only med I've taken that took me anywhere near "normal."
Although I've felt that my G. experience was too weird to be of any use to others, Geodon *did* very effectively stop the panic attacks that withdrawing from the drug triggered. Just the smallest amount (maybe 1/4 of a 20 mg. capsule) was enough to eliminate all panic sxs in 20 min.--and without that protracted hangover of exhaustion and weakness afterward. (Of course, as panic disappeared, EPS *reappeared*.)
So..., although the company lit makes no reference to panic sxs, G. just might turn out to be a good choice for you. If you decide to try it, your pdoc will have samples (since it's new). It's a good idea to start low and take it with food (up to 60% more bioavailable). I found it activating and anorexic (delightful!); and it seemed to be completely gone in 12 hours, so 2x/day dosing is necessary to maintain levels.
Good luck and well wishes---medlib
Posted by Elizabeth on August 3, 2001, at 0:15:19
In reply to Re: Can anyone help with a comparison?, posted by grapebubblegum on August 2, 2001, at 16:22:19
> Thanks, Elizabeth. I've taken xanax and I've been given Ativan by injection at a hospital, and they do work, but sometimes a PA can get so bad that it is not a smooth, swift ride down.
I'd guess that IM Ativan would work significantly faster than taking a pill. But anyway, the trick with taking pills is to take them as soon as you start noticing panic symptoms.
> Anyway, you asked about the cognitive aspect. I guess it is similar to what you might feel if someone were driving a nail through your toe and you saw no end in sight: for me it's not a suicidal feeling as much as a feeling that my being alive is some sort of mistake or a feeling that just possibly it might have been better had I not been born.
I understand.
> This is a passing sentiment and a half-formed thought at that; so I consider it to be a reaction to unrelenting (psychic) extreme discomfort.
I have depression-associated panic attacks. The feelings I have aren't so different from what you describe. I also feel very guilty, as if the panic is some sort of punishment.
> In other words, seemingly irrational thoughts and emotional content linked to supposedly irrelevant data in the environment.
That's an interesting one. I'm not sure what to make of it.
> Well, my son took zyprexa and he ate CONSTANTLY until the doctor switched him to geodon and now he is eating normally again.
That's cool. Most antipsychotics cause a lot of appetite stimulation, so if Geodon doesn't, it's a nice step forward.
-elizabeth
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