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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Cairo on May 5, 2005, at 13:25:28
Anybody have this problem? I just increased my dose to 100mg and am now having crying spells, shortness of breath, agitation. While I had this at the beginning at 25mg, it got better after two weeks and raising the dose every two weeks didn't have quite the same horrible effect until a couple of days ago, 2-3 days AFTER I raised the dose to 100mg.
Why would Topamax do this? I get all sorts of paradoxical reactions to meds. Are the GABA receptors being overstimulated thereby losing sensitivity or something like that?
I'm going to taper off the Topamax, but that will take time. Until then, what can I do to calm things down??? I'm irritable, in pain, crying and there are a whole bunch of family issues going on and I need to keep it together for my kids. My pdoc can't see me until next week.
C
Posted by stresser on May 5, 2005, at 20:34:36
In reply to Re: Topamax and panic attacks, posted by Cairo on May 5, 2005, at 13:25:28
Have you called your pdoc and told him about your symptoms? I think you should do that if you haven't already. If you have, what did he say to do? Did you take your dose back to .75mg? -L
Posted by Cairo on May 5, 2005, at 21:20:06
In reply to Re: Topamax and panic attacks » Cairo, posted by stresser on May 5, 2005, at 20:34:36
Left a message and they told me to schedule an appointment for next week. The problem is the pdoc didn't prescribe the Topamax; my Rheumatologist did for pain and she told me to cut back (which I already am, but that must go slow).
I still would like to know what the mechanism might be for Topamax causing anxiety. I found a letter to the editor stating that Topamax caused panic attacks in the Journal of Clinical Psychopharmacology, but no abstract and haven't gotten a copy of it yet to see why. Would appreciate elucidation. Thank you.
Cairo
Posted by theo on May 5, 2005, at 22:23:15
In reply to Re: Topamax and panic attacks, posted by Cairo on May 5, 2005, at 13:25:28
I had the same problem, I hated Topamax. My sister takes it for migraines and lives in Boston. I had her ask her Neurologist some questions for me and he said NEVER give Topamax to someone with anxiety, and that is what my pdoc prescribed it to me! I felt scared to be around people and was in a bad state of mind.
Pdocs say they don't prescribe SSRI's to people because they cause mania and my two worst anxiety (mania) inducing meds were Topamax and Lamictal, go figure.
Posted by Cairo on May 6, 2005, at 4:55:53
In reply to Re: Topamax and panic attacks » Cairo, posted by theo on May 5, 2005, at 22:23:15
I'm feeling a little better after lowering the dose. Decided the taper little quicker as not using it for seizures, so cut it back by 50mg yesterday.
I forked out money to pay for the article that "Panic Attacks Associated With the Use of Topiramate" in the Journal of Clinical Psychopharmacology August 2001 21:4 which says the carbonic anhydrase properties which are clinically associated with paresthesias and kidney stones theoretically could lead to CO2 retention and panic attacks.
Maybe, or maybe not this simple explanation.
Cairo
Posted by ed_uk on May 6, 2005, at 6:03:26
In reply to Re: Topamax and panic attacks, posted by Cairo on May 6, 2005, at 4:55:53
Hi,
>carbonic anhydrase properties which are clinically associated with paresthesias and kidney stones theoretically could lead to CO2 retention and panic attacks...........
>shortness of breath.......
This could be a symptoms of Topamax-induced metabolic acidosis. Topamax can induce metabolic acidosis due to its action as a carbonic anhydrase inhibitor.
Ed.
Posted by Cairo on May 6, 2005, at 13:52:35
In reply to Re: Topamax and panic attacks » Cairo, posted by ed_uk on May 6, 2005, at 6:03:26
What would this induction of metabolic acidosis mean for other medications, if anything??? Is there anything I can do to help reverse this other than cut back the Topamax? I tried a couple of Tums, but didn't seem to do anything. Topamax is so long acting that maybe it wouldn't. Any suggestions? Don't know if my pdoc will know what to do other than taper, either. As I'm not taking Topamax for seizure, could I taper more quickly than usual?
Cymbalta 30mg also caused panic attacks. What gives with me? SSRIs, even at low doses, give me muscle tremors, hot flushes, etc. I read that giving SSRIs in addition to trazodone could mess up the beta adrenergic receptors further. I'm taking trazodone for sleep. This could explain the Cymbalta. I need a good (correction: great) psychopharmacologist to figure out all my idiosyncratic reactions. I just don't know where to go.
Thank you, Ed.
Cairo
> This could be a symptoms of Topamax-induced metabolic acidosis. Topamax can induce metabolic acidosis due to its action as a carbonic anhydrase inhibitor.
>
> Ed.
Posted by ed_uk on May 7, 2005, at 9:28:39
In reply to Re: Topamax and panic attacks » ed_uk, posted by Cairo on May 6, 2005, at 13:52:35
Hi,
Metabolic acidosis can be confirmed by doing blood tests for pH, paCO2 and bicarbonate concentration.
If it's absolutely necesary to continue Topamax, the metabolic acidosis could be treated with sodium bicarbonate tablets and/or potassium bicarbonate. Regular blood monitoring would be essential to determine an appropriate dose.
If it's not vital to continue Topamax, it would probably be best to taper off it.
Regards,
Ed.
Posted by Bob on May 7, 2005, at 13:40:21
In reply to Re: Topamax and panic attacks » Cairo, posted by ed_uk on May 7, 2005, at 9:28:39
I would have to recommend a taper off of Topomax as well. A few years back I had an experience with that med that ended up being very scary and uncomfortable. Everything bad that could have happened seem to occur, such as kidney stones, extreme anxiety, panic, emotional lability (crying spells), and significant hostility. These are the ones I remember off the top of my head. I was ordered to taper off as quickly as possible because of the kidney issues, and then each dose change of the med destabilized me further. Needless to say, it was a life threatening experience. I'm not saying this will happen to you, but the point is that these meds are unknowns in a lot of ways, and you have to hedge your bets and take the conservative route, if you can. Oh yeah, the med also made me confused and blurred my vision at times. One might asked why I would have been crazy enough to take it, and the answer is that in the beginning, it felt good, and was giving me subtle hypomania - I felt better than I had in a long time.
Posted by Cairo on May 8, 2005, at 8:32:58
In reply to Re: Topamax and panic attacks » ed_uk, posted by Bob on May 7, 2005, at 13:40:21
I tapered rather quickly from 50mg BID to 75mg for two days, then 50mg for two days then 25 mg for two days. Now I'm planning to increase the time between 25mg doses. Can the 25mg tablet be split? I'll ask the pdoc on Tuesday for the 15mg sprinkle caps.
I definitely notice that my symptoms improve a little as the dose wears off, and kicks up again when I take another dose. I'll need to ask him what else he can give me to reduce this. I dread taking the next dose as I know what will happen- probably now there is some anticipatory anxiety kicking in, in addition to the real side effects.
I bought some pH strips and did a urinary check. I know, not indicative of anything, but it's interesting that it was 5.2 after I had already lowered the dose to 50mg and now it's rising as I taper the dose. Do you really think having bicarb checked will help? Everyone is just telling me to taper off.
There's also a post above http://www.dr-bob.org/babble/20050504/msgs/494466.html
which says "increasing GABA indiscriminately is not necessarily anxiolytic at all; ask the many people for whom gabitril made anxiety worse." Couldn't Topamax do this?You would think that by lowering my Topamax dose, my symptoms should abate much more quicly, but they continue. Could this be not just the acidosis, which the body should correct rather quickly, but some other mechanism of neurotransmitter overcompensation/ receptor oversensitivity going on? Cymbalta at doses above 5mg (or I should say below 30mg as I started there and tapered down) also caused panic attacks, and caffeine and even chocolate can make me nervous and disturb sleep if I am in a sensitive mode.
And I still think dopamine is a factor here. Could depletion of dopamine, followed by administration of these drugs cause these idiosyncratic reactions? There is a history of Parkinsons and dementia and Fibromyalgia in my family a newer theory of Fibro involves dopamine. No doc wants to discuss this with me. They all say Wellbutrin causes anxiety or doesn't do much for their Fibro patients. But I'm the oddball who can't take SSRIs because they give me severe muscle tremor and tightness at very low doses and who looks "addisonian".
I REALLY want to try pregabalin as Neurontin helped with muscle spasm, anxiety and a tiny bit with pain, but weight gain, fogginess were a big issue. And I needed to keep upping the dose. I fear that the same might be true of pregabalin, however.
Cairo
Posted by ed_uk on May 8, 2005, at 10:45:48
In reply to Re: Topamax and panic attacks, posted by Cairo on May 8, 2005, at 8:32:58
Hi Cairo,
>Now I'm planning to increase the time between 25mg doses.
I wouldn't recommend it, Topamax has a relatively short duration of action and needs to be taken regularly. You could try taking 15mg/day for a few days if you can get the sprinkle caps. Alternatively, you could take 25mg/day for a few more days and then stop completely.
>I definitely notice that my symptoms improve a little as the dose wears off, and kicks up again when I take another dose. I'll need to ask him what else he can give me to reduce this.
Perhaps you don't need any medication for this. You'll probably feel much better when you've stopped the Topamax completely :-)
>Do you really think having bicarb checked will help?
No. It would only be necessary if you were going to be taking Topamax on a long term basis.
>They all say Wellbutrin causes anxiety or doesn't do much for their Fibro patients.
As with all psych drugs, the only accurate way of finding out what effect Wellbutrin will have on you is by trying it!
Regards,
Ed.
Posted by Cairo on May 8, 2005, at 18:29:49
In reply to Re: Topamax and panic attacks » Cairo, posted by ed_uk on May 8, 2005, at 10:45:48
Thank you, Ed.
You are a scholar and a gentleman.
Cairo
> Hi Cairo,
>
> >Now I'm planning to increase the time between 25mg doses.
>
> I wouldn't recommend it, Topamax has a relatively short duration of action and needs to be taken regularly. You could try taking 15mg/day for a few days if you can get the sprinkle caps. Alternatively, you could take 25mg/day for a few more days and then stop completely.
>
> >I definitely notice that my symptoms improve a little as the dose wears off, and kicks up again when I take another dose. I'll need to ask him what else he can give me to reduce this.
>
> Perhaps you don't need any medication for this. You'll probably feel much better when you've stopped the Topamax completely :-)
>
> >Do you really think having bicarb checked will help?
>
> No. It would only be necessary if you were going to be taking Topamax on a long term basis.
>
> >They all say Wellbutrin causes anxiety or doesn't do much for their Fibro patients.
>
> As with all psych drugs, the only accurate way of finding out what effect Wellbutrin will have on you is by trying it!
>
> Regards,
> Ed.
Posted by ed_uk on May 8, 2005, at 19:07:07
In reply to Re: Topamax and panic attacks » ed_uk, posted by Cairo on May 8, 2005, at 18:29:49
Awww, thank you :-)
Ed.
This is the end of the thread.
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