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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by kavaman on January 31, 2006, at 15:24:38
Hi there
I have been observing this babble for some time and wanted to start contributing. And possibly getting some advice i can talk to my psych doc with.
I have had panic disorder for about 5 years. First i was put to cipramil took it for 2 months because the doctors told me i will get better i will get better. Only got about 10x worse. Then i tried buspar didnt work. Then i believe i tried nefadar, didnt help either. At this point i was taking ativan about 5 1mg pills aday , and it didnt help either. Actually tranquilizers havent much helped me ever, well ativan stops working for me within a week or so, and i have to raise the dosage EVERY DAY. I dunno why.
Anyway i got rid of ativan , when i switched to remeron. With the help from remeron the withdrawal from ativan took about 3 days of total shaking. Then my panic symptoms went away for about 2 weeks, and then my panic attacks and constant anxiety came back with a blast. I was on 30mg remeron. After about a year of not feeling well(i had some help from remeron but not enough). I lowered my dosage to a mere 7.5mg aday which i took at MORNING (yeah it made me sleep a couple hours more, but then i felt ok for the whole day). No panic at all.
With this combination i was OK and panicky free for about 3 years. Until last november the panic came back.
After this i have tried atarax, no help (tired making antihistamine, mianserin helped a few days then more panicky again. Was very tired making at first, but it disappeared totally, few antipsychotics (levozin and seroquel), either one didnt help, levozin did make me tired, but didnt do anything to the panics, which is weird as remeron does help and it also makes you tired. I almost couldnt move with levozin, it worsened my movement so much.
I CAN keep the panic away for 1-2! days a week by taking ATIVAN about 2-3 mg/day. I dont take it constantly because i dont want to become addicted to it again. Also for some reason after 2 days of it i become agitated, angry and it just plain doesnt work for me almost at all. i believe i also have athaxia, or then its just constant panic/anxiety attack after another.The remeron helps a bit when i take just small bites of many times a day. Not the whole 7.5mg/time.
I believe that the HeLP i was getting from remeron does not come from its property of raising serotonin. For me it did help because the sedating effect is so much bigger then the mood upping effect at 7.5mg. So for me anxiety/panic wise sedation seems to be the key as normal AD:s made me feel much much more panicky and awful.
Now im in the point of wanting to try something new. As sedation seems to be the key id like to try a drug that has only the sedation effects of remeron, not the mood brightening effects, but are there any like that. Also i have some other options below.
Also i was thinking about tianeptine (stablon), because it has been diagnosed to help with a many deal of anxiety disorders, and i believe it somehow eases breathing which is a big problem in panic disorder , as it also helps for asthma.
The drug choices i am currently thinking are:akineton (biperiden) , depakote, tianeptine (stablon) or low dose of triptyl or surmontin.
But what id really like to try is some drug with as sedating effect of remeron and with no, or almost none of antidepressant effects.
Hope someone can read this long post, And please tell me what do you think of the drugs i am thinking of trying. Also if someone has something to else to suggest please do. Antidepressants dont seem to be a choice for me atleast in bigger mg amounts.
-newcomer kavaman
Posted by madeline on January 31, 2006, at 19:35:58
In reply to Panic solution, posted by kavaman on January 31, 2006, at 15:24:38
Have you had a complete physical with a cardiac work-up?
After all you have tried, there might be some other explanation other than anxiety.
Believe it or not, your family doc maybe a good stop for you.
Posted by Phillipa on January 31, 2006, at 20:14:54
In reply to Re: Panic solution, posted by madeline on January 31, 2006, at 19:35:58
xanax works well for panic attacks. Fondly, Phillipa
Posted by blueberry on February 1, 2006, at 4:26:40
In reply to Panic solution, posted by kavaman on January 31, 2006, at 15:24:38
I sure feel for you. I do not suffer from panic attacks, but I have experienced them in the past when getting off of the herb St Johns Wort. They are horrible and I understand how terrifying and crippling they are.
I have a few suggestions including amino acids, magnesium, tricyclic antidepressants, cognitive behavioral therapy.
First you could try the simple very inexpensive amino acids. Tops on the list would be taurine. This is a natural amino acid that sometimes in mood disorders our bodies just do not make enough of. What it does is slow down excess activity in the brain. It also controls how various mineral ions get in and out of cells. Long story, but this is all very important. Doses can range from 500mg to 3000mg a day.
Glycine is another one. Like taurine, it is also a calming inhibiting amino acid. At health food stores you can find relaxing calming amino acid combinations that have gaba, glycine, taurine, and inositol all in one.
Magnesium works wonders sometimes for all kinds of mood disorders, especially when calming is needed. Magnesium glycinate or magnesium taurinate or both together would be good ones.
The tricyclic antidepressants might be worth trying. Do just a one week trial each of 2 or 3 of them. There are many choices, but several might be elavil, doxepin, nortiptyline.
Cognitive behavioral therapy can work. You can get it either through a professional therapist or through a self-help program from The MidWest Center (Linda Bassett, you've probably heard their ads). You can actually teach your mind to think and behave differently to both handle panic attacks with confidence and comfort and have them disappear completely.
I might also suggest trying other benzos such as xanax or klonopin, but I know you are fearful of developing rapid tolerance and going through withdrawals. That may or may not happen. They are all different.
Just some ideas. There is plenty of hope.
Posted by kavaman on February 1, 2006, at 9:28:24
In reply to Re: Panic solution, posted by madeline on January 31, 2006, at 19:35:58
I have had my lungs checked, an EKG (heart test), and then some thyroid values. All of these seem ok.Any idea if i should do any other tests, if which?
I have noticed that my anxiety level lowers towards the evening. Days and mornings are the worst. I feel like dying all the time. Perhaps this has to do with the normal bodily functions getting slower towards the night.
I get like 10-20 attacks per 24hours.. at around 8pm it starts to get better. But when i wake up next morning its back on.
-kavaman
Posted by ed_uk on February 1, 2006, at 14:06:11
In reply to Re: Panic solution, posted by kavaman on February 1, 2006, at 9:28:24
Hello
Do you live in Finland?
Ed
Posted by jflange on February 1, 2006, at 16:57:34
In reply to Re: Panic solution, posted by kavaman on February 1, 2006, at 9:28:24
kavaman-
> I have noticed that my anxiety level lowers towards the evening. Days and mornings are the worst. I feel like dying all the time. Perhaps this has to do with the normal bodily functions getting slower towards the night.
>
> I get like 10-20 attacks per 24hours.. at around 8pm it starts to get better. But when i wake up next morning its back on.This is completely normal for panic and anxiety. When your body is awake, so is the anxiety.
If ativan is not stable for you, why not try klonopin? It's longer lasting. It has helped me with panic before.
Feel better,
jflange
Posted by 4WD on February 1, 2006, at 22:37:34
In reply to Re: Panic solution, posted by kavaman on February 1, 2006, at 9:28:24
Hi Kava,
I feel for you. Truly, I understand. I went through a long spell of not exactly panic attacks but several months where I felt like I was on the verge of a panic attack constantly. I mean if normal is a 1 and a full blown panic attack is a 10, I stayed at 8 or 9 all the time. Like you, mine got better in the evening and was the worst in the morning.
I tried many different antidepressants which didn't help and many of which seemed to make things worse. Effexor seems to help most with my anxiety but there was a time where it didn't touch it.
The only thing that saved my life was Klonopin. I have been addicted to Ativan also and getting off it was horrible, as you said. I was very reluctant to take a benzo but when it reached the point where I feared for my life, I had to do it. I think Klonopin is less likely to cause tolerance than Ativan. I haven't had to increase the dosage needed to control the fear in the year and a half I've been taking it. In fact, I am taking less now than I was when I started.
I have read that tricyclic ADs are better for some people who have extreme anxiety and don't do well on SSRIs or SNRIs. I believe the SSRIs cause me to be more anxious and agitated. I've never been able to take a full dose of any of them. You might want to think about imipramine or amitriptyline (amitriptyline is supposed to be very sedating) or doxepin (Sinequan - also sedating). And I wouldn't hesitate to take a benzo in the meantime. As my pdoc keeps asking me when I keep trying to reduce my Klonopin dose "why suffer?"
Hope this helps a little. Please know that you are not alone.
Marsha
Posted by RobertDavid on February 2, 2006, at 1:08:24
In reply to Re: Panic solution » kavaman, posted by 4WD on February 1, 2006, at 22:37:34
People in here are probably getting tired of me beating the "klonopin drum" when it comes to anxiety, particularly klonopin. I've taken it 12 years without having to raise dose. I have gotten off it before, you just can't quit all at once. Your not stuck forever, if you want off you just have to go slow. Old symptoms will probably return though.
But for me getting off just reminded me why I take it. It works and workds great for my SP. Other meds work well for other people, everyone is different. Seems many people try other meds first and many don't respond well to the many anti depressants out there. They seem to just bring on more anxiety (of course that's not true for all). But I wouldn't be afraid of klonopin because of tolerance or dependance. It's a frontline med for treating anxiety with long term benefits. Just my take. My doc echos my comments. Good luck
Posted by kavaman on February 2, 2006, at 1:39:40
In reply to Re: Panic solution, posted by RobertDavid on February 2, 2006, at 1:08:24
yep i life in finland ed..... Ive been thinking of klonopin, but i really would like to try all other options before klonopin. When i take a bit larger doses of even remeron it makes me feel like my whole body is on fire, i think they make my panic/anxiety worse. Lower doses it helps a bit and i can sleep some (though i wake up in an anxiety/panic attack couple of times a night).
-kavaman
Posted by blueberry on February 2, 2006, at 5:39:51
In reply to Panic solution, posted by kavaman on January 31, 2006, at 15:24:38
I forgot to mention this.
Have you had cortisol and dhea levels checked? It could be something as simple as your adrenal glands acting weird, which would affect all kinds of things like anxiety, panic, free floating fear, and it would have kind of a pattern at different times of the day.
The tests are not expensive. If cortisol levels are too high, they can easily be lowered with Serophos. If they are too low, they can be raised with licorice root, or ginsengs, or pregnanalone, or hydrocortisone.
Since all of the psych med things you've tried have had "quirky" results, my doctor says that points in the direction of adrenal gland malfunction. And if you think about it, overamped adrenal glands would certainly cause panic attacks and that brain medications would be way off target.
Just a thought. I don't know why practitioners don't start here first...cortisol levels.
Posted by kavaman on February 2, 2006, at 16:12:36
In reply to Re: Panic solution, posted by blueberry on February 2, 2006, at 5:39:51
I have not had those tests done. However it would make some sense maybe. what is dhea ? And what kind of test is required to make that test? Is it a blood test? Are there any other tests i should consider?
The funny (or not so funny in my mind) is that in the evening/night i am feeling almost too happy. Like kind of euphoric happy drunk feeling. And im only taking 7.5mg of remeron. If i take any higher dosages of any antidepressants i feel really sick, and too happy and panicky.
Isnt it weird to say that i feel TOO happy before the panic. Thats why i was thinking of tianeptine as it seems to work different to normal ad:s . Kind of lowering the serotonin in plasma, or something like that. Also my breathing is kind of fast, or it would seem that im not breathing at all almost. And tianeptine (stablon) is also used in asthma (dont have it but i figured as it helps for asthma it must do some good for ones breathing). Its just too hard to get here in finland, i would have to fly to france to buy it .. ARGH....
In my mind it goes like this. Happy->Too Happy->Anxious->Panic ....... I tried some antipsychotics too as you can see from my post, but they didnt slow me down any.
I am really considering to do the cortisol test, as you mentioned it. Please tell me more about the dhea test.
Its just weird that the doctors in finland didnt make me do any other tests, then the thyroid gland, and ekg, lungs, when i went and complained about my anxiety. Besides those tests.
-kavaman
Posted by 4WD on February 2, 2006, at 21:36:39
In reply to Re: Panic solution, posted by blueberry on February 2, 2006, at 5:39:51
> I forgot to mention this.
>
> Have you had cortisol and dhea levels checked? It could be something as simple as your adrenal glands acting weird, which would affect all kinds of things like anxiety, panic, free floating fear, and it would have kind of a pattern at different times of the day.
>
> The tests are not expensive. If cortisol levels are too high, they can easily be lowered with Serophos. If they are too low, they can be raised with licorice root, or ginsengs, or pregnanalone, or hydrocortisone.
>
> Since all of the psych med things you've tried have had "quirky" results, my doctor says that points in the direction of adrenal gland malfunction. And if you think about it, overamped adrenal glands would certainly cause panic attacks and that brain medications would be way off target.
>
> Just a thought. I don't know why practitioners don't start here first...cortisol levels.That's a really good point. OTOH, sometimes cortisol levels can be high as a result of anxiety instead of vice versa. And again, it may be a chicken or the egg kind of question. My cortisol is way high but everything else checks out normal. And adrenal gland support vitamins prescribed by my acupunturist made me feel much worse.
Marsha
Posted by kavaman on February 3, 2006, at 9:34:38
In reply to Re: Panic solution » blueberry, posted by 4WD on February 2, 2006, at 21:36:39
My panic attacks have a lot to do with my breathing it appears. I mean it is quite hard for me to breathe even in between the panic attacks. When i use larger doses antidepressants i think my breathing becomes even more harder also it becomes faster.
Reading trough a study on tianeptine (stablon) about its use in asthma , the studies say that antidepressants and buspar bring on more asthma attacks.
However tianeptine works the other way around. Bringin less asthma attacks. So it must do something to a persons breathing.
As my panic attacks become worse and more frequent with the ad:s ive tried . Maybe just maybe tianeptine will work the other way around and my breathing improves=less panic.
However FITS like a glove. Tianeptine is not available in finland (it is in many other european countries). So i have to either fly to france to get it if i want to try. Or get an exception from the finnish medical association (this may take a month or two). Would really like to try this drug BUT..
http://www.chestjournal.org/cgi/content/full/125/1/348#B13
-kavaman
Posted by crxsi on February 5, 2006, at 11:19:18
In reply to Re: Panic solution » blueberry, posted by 4WD on February 2, 2006, at 21:36:39
Hi I have been suffering from panic and anxiety for 4 and a half years. I was treating it with ativan which eventually caused a depressive reaction as it was not helpin ght problem jus short term relief. My DR. started me on effexor 75mg and I have noticed an incredible difference.
I stil have mild anxiety but the panic attacks are gone and so is the depression. I am going to try 112.5mg next week to see if it relieves the rest of the symptoms.
Posted by 4WD on February 5, 2006, at 18:40:44
In reply to Re: Panic solution, posted by crxsi on February 5, 2006, at 11:19:18
> Hi I have been suffering from panic and anxiety for 4 and a half years. I was treating it with ativan which eventually caused a depressive reaction as it was not helpin ght problem jus short term relief. My DR. started me on effexor 75mg and I have noticed an incredible difference.
>
> I stil have mild anxiety but the panic attacks are gone and so is the depression. I am going to try 112.5mg next week to see if it relieves the rest of the symptoms.
Hi.I had the same problem with Ativan. After long term use, I became severely depressed. I am pretty sure I would have been depressed anyway, but the Ativan made it worse.
Effexor really helped me for a long time. Unfortunately it pooped out and now when I try to go back to it, it makes me more anxious, rather than less. Go figure.
Posted by JaclinHyde on February 9, 2006, at 19:55:45
In reply to Re: Panic solution, posted by crxsi on February 5, 2006, at 11:19:18
I used to suffer from panic up until I got on an MAOI. It was an amazing thing....I went to bed one night depressed and scared of everything and woke up the next morning literally unafraid anymore. It was like a veil lifted. It is the only class of drugs that I ever heard the term 'cure' attached to panic attacks. AND they almost always work. Yeah you have to watch what you eat but I would rather do without sour cream then be scared all my life.
Posted by Phillipa on February 9, 2006, at 20:18:38
In reply to Re: Panic solution, posted by JaclinHyde on February 9, 2006, at 19:55:45
Really? Does it help with severe depression that started as panic attacks and now just is MDD with too many fears and phobias to mention. Fondly, Phillipa
Posted by JaclinHyde on February 10, 2006, at 22:39:34
In reply to Re: Panic solution » JaclinHyde, posted by Phillipa on February 9, 2006, at 20:18:38
Oh absolutely! It works for 99.9% of the people who take it for symptoms just like yours. I was a hypochondriac. I mean, card carrying! So I had a high level of anxiety and a nasty depression that was totally refractory to all the other meds. My doctor finally said look, your problem is obviously NOT serotonin. The MAOI's hit serotonin AND dopamine AND norepinephrine. It seems that once prozac came out everyone who was depressed or anxious got a scrip for it. But like me not everyone benefits from the reuptake of serotonin alone.
Posted by underthecs on February 12, 2006, at 1:12:17
In reply to Re: Panic solution, posted by JaclinHyde on February 10, 2006, at 22:39:34
hi. can you tell me what MAOI you are taking?
my lexapro and topamax combo has pooped out. they worked incredibly well for a while... completely stopped the panic attacks and put a floor on the depression. now they don't even begin to help with either.i have atypical (treatment resistant) major depression, anxiety, and debilitating panic attacks. short of ECT or vagus nerve stimulation... i am running out of choices and ready to just give up.
i am scared to take an MAOI... how are the side effects and dietary restrictions? i want to be able to tell the psychiatrist what i want to try... i am tired of these expensive med trials that do not work. i have been through a lot of the SSRI's, and cannot take a benzo (abuse/addiction issues).
i am terrified that i will be "stuck" this way and no medications will help. i don't want to live this way, ya know?
Posted by RobertDavid on February 12, 2006, at 2:02:43
In reply to Re: Panic solution » JaclinHyde, posted by underthecs on February 12, 2006, at 1:12:17
It's my understanding that most people that treat anxiety with benzos don't abuse them. I would'nt rule them out, klonopin in particular. I'd consider discussing it with your doctor. I have an alcohol issue, but have taken 2mgs of klonopin for 12 years, never abused it, really helped my social anxiety. You don't get a buzz or a high from it like alcohol, but it sure helps with anxiety. That said, you may need to take something with it for the depression, otherwise Nardil seems to be great for those with anxiety and depression, especially if you haven't responded well to other meds. Just a thought.
Posted by underthecs on February 13, 2006, at 13:01:32
In reply to Re: Panic solution » underthecs, posted by RobertDavid on February 12, 2006, at 2:02:43
Thanks for the response. Actually, I have an extensive history of benzo abuse and addiction(including Klonopin)... so that's not an option. I will look into the Nardil. Thanks.
Posted by JaclinHyde on February 14, 2006, at 5:34:53
In reply to Re: Panic solution » RobertDavid, posted by underthecs on February 13, 2006, at 13:01:32
NO, NO, NO!! Not Nardil! They have changed the formula and it is just a waste of money and time (not to mention pain and suffering.) Go for Marplan.
Here are two links to the problems now being associated with the new Nardil....
http://www.stratguitar.com/nmember/nardil.php
http://www.consumeraffairs.com/rx/pfizer_nardil.html
JH
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