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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 garnet71 on May 31, 2009, at 19:35:11
I had a 2-3 day long panic attack last weekend; my doctor refused to prescribe me an anxiolytic for relief over phone on the holiday weekend. I took lots of Kava, Valerian, and magnesium, and the anxiety stopped a couple of days later. I got so tired after that, and haven't been the same since. I have had dysthmia/depression ever since the panic attack ceased, and have been extremely tired every day. Motivation is exactly the same as it was over the past couple months, and I no longer have anxiety.
Prior to that, my mood has been upbeat, positive, consistent...since a month or so after quitting SSRIs last december. I felt no depression symptoms, but have had relapses of anxiety from time to time during this period but have been amotivational since SSRI use which I stopped last December, when it was at an all time low as a result of taking SSRI.
the panic attack I had last weekend was not like my usual bouts of anxiety over the years; it was just like the 4 day panic attack I had several years ago that led to having to go to the ER and being treated like a drug seeker and being refused relief. I had uncontrollable crying both times--this isn't how anxiety normally manifests for me. These 2 events were very similar.
I've never had such a pronounced change in mood before. How does a panic attack like that suddenly cause depression? I am extremely dissapointed and upset over this. I haven't had depression in so long, just anxiety from time to time, and I don't understand what happened here.
But now in addition to the amotivation, I have depression. I never had a depression like this, and never anything with a sudden onset. I had major depression about 8 or 9 years ago.
any opinions are appreciated. I am totally lost and confused right now.
Posted by gobbledygook on May 31, 2009, at 20:22:17
In reply to Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 19:35:11
Hi Garnet,
I'm sorry this is happening to you right now. It must be a nightmare for you.
I was wondering if I could ask you a few more questions...
1) How long were you on the SSRIs?2) Did you come off it gradually or abruptly?
3) Are there any significant life events or stressors going on right now?
4) Do you know what brought on the 4 day panic attack several years ago?
5) Do you know what brought on your major depression 8/9 years ago?
Ava-
Posted by garnet71 on May 31, 2009, at 21:49:18
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by gobbledygook on May 31, 2009, at 20:22:17
1) How long were you on the SSRIs?
Off/on for 9 years. Breaks usually 3-6 months at a time with no meds, many breaks. I might have even gone a year w/o any meds in that period. Last 3 years on/off them has been horrible-they make me severly depressed, extremely fatigued and amotivational; I can't function so have to quit taking them. Go back to PDoc for anxiety symtpoms, and they prescribed them again. After first year or two after depression/ptsd, they were prescribed for anxiety symptoms.
2) Did you come off it gradually or abruptly?
Abruptly most every time.
3) Are there any significant life events or stressors going on right now?
Yes, lots.
4) Do you know what brought on the 4 day panic attack several years ago?
I forget! I remember the experience vividly, but not much before/after.
5) Do you know what brought on your major depression 8/9 years ago?
Years of chronic stress, then an event that led to PTSD/major depression. I have tested for hypothyroidism and probably other hormonal things; getting my insurance back so will be going for more tests and hopefully treatment.
Thanks Ava!
Posted by garnet71 on May 31, 2009, at 22:06:46
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by gobbledygook on May 31, 2009, at 20:22:17
Oh yeah, duh, last time I had that 4 day panic attack years ago-I was in between/off SxRIs, anxiety came back, called GP and was prescribed Xanax, ran out one week before appt. with PDoc, withdrawing from Xanax. Again, small dose-.25. That was probably the last time I took xanax. I've taken Ativan in between, but not usually xanax. I think I will def. stay away from that drug...Don't know why I forgot that!
It was the same thing-awaiting PDoc appt. w/o sufficient relief from severe anxiety symptoms. That was the first time this ever happend to me, where my anxiety was so severe almost losing my mind while waiting for a PDoc appt. This last event was the 2nd time.
Posted by gobbledygook on May 31, 2009, at 23:03:43
In reply to Re: Panic attacks ) permanent change in mood » gobbledygook, posted by garnet71 on May 31, 2009, at 21:49:18
I think what you're going through might be due to a combination of multiple factors.
You have a long standing history of being on SSRIs and I suspect that coming off of them
created a marked instability in your mood, and might have set off anxiety/panic attacks
as well as old depressed feelings.Even though you've been off of SSRIs since December, I don't think it's uncommon to see
a delayed effect, if you have been on them for many years. This will be especially worse
if you don't decrease the dose gradually. The longer you've been on SSRIs, the more time
is needed to slowly lower the dose.On top of all of this you have other new stressors and triggers that you allude to that may
have further exacerbated your current state.I think you should see your doctor about going back on an SSRI that seemed to have worked
well for you in the past - just to stabilize you temporarily.You'll probably also need some short term anxiolytics while waiting for the SSRIs to kick in.
Hopefully, you have a good therapist who can help you deal with old and new stressors,
with the eventual goal of coming off of the meds.Also, you might want to minimize caffeine, "junk food", alcohol and any other stimulants/
depressants which may trigger or aggravate anxiety/panic attacks as well as depression.In general, you want to be good to your body right now, which means regular exercise,
plenty of sleep, and healthy food. All of this will not only make you feel stronger physically,
but also psychologically.
Hang in there - and take it one day at a time.
Ava-
Posted by Phillipa on May 31, 2009, at 23:13:08
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by gobbledygook on May 31, 2009, at 23:03:43
I don't think you can have a long one panic attack for many days think they are self limited in time. Less than hour at most at a time. Any chance could be some type of bipolar? Just think out loud. Phillipa
Posted by garnet71 on May 31, 2009, at 23:50:43
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by gobbledygook on May 31, 2009, at 23:03:43
Hey Ava=Everytime I think I might have bpIImixed, someone comes a long and makes more sense (that would be you) lol.
I'm not sure if i could tolerate the RIs again. The only ones I probably could tolerate, possibly, are Prozac or Pristiq. I absolutely cannot stand the side effects though. But never continued a short trial of prozac. Effexor worked good with Wellbutrin, but WB didn't work last time-same effect as the SSRIs, strange enough.
I've read on various sites that once you are on Effexor, you pretty much are on it for life. Can't explain right now...but that could have a lot to do with it. I spent the most time on Effexor.
Thank you for the advice!
Phillipa-I am 100% sure it is nothing less than panic and anxiety. Re: a panic attack for 4 days is like this - panic for 1-2 hours, tapers down to severe anxiety for hours, tapers down to mild anxiety, almost stops; back up to anxiety or full-blown panic. Repeat for 4 days.
However, I welcome all views on the subject, and appreciate the comment.
Posted by desolationrower on June 1, 2009, at 2:47:49
In reply to Re: Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 23:50:43
related to being off benzo and also the possibility of bipolar?
i think treating your thyroid problem is also a good idea too. i'm not sure if long-term kpin or something is a good idea.
-d/r
Posted by Komet on June 1, 2009, at 10:09:31
In reply to Re: Panic attacks ) permanent change in mood, posted by Phillipa on May 31, 2009, at 23:13:08
"I don't think you can have a long one panic attack for many days think they are self limited in time. Less than hour at most at a time."
This is not my experience at all. I've had panic attacks that have lasted for many hours and even days at a time. It's terrifying, especially at night.
Posted by bulldog2 on June 1, 2009, at 10:17:37
In reply to Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 19:35:11
> I had a 2-3 day long panic attack last weekend; my doctor refused to prescribe me an anxiolytic for relief over phone on the holiday weekend. I took lots of Kava, Valerian, and magnesium, and the anxiety stopped a couple of days later. I got so tired after that, and haven't been the same since. I have had dysthmia/depression ever since the panic attack ceased, and have been extremely tired every day. Motivation is exactly the same as it was over the past couple months, and I no longer have anxiety.
>
> Prior to that, my mood has been upbeat, positive, consistent...since a month or so after quitting SSRIs last december. I felt no depression symptoms, but have had relapses of anxiety from time to time during this period but have been amotivational since SSRI use which I stopped last December, when it was at an all time low as a result of taking SSRI.
>
> the panic attack I had last weekend was not like my usual bouts of anxiety over the years; it was just like the 4 day panic attack I had several years ago that led to having to go to the ER and being treated like a drug seeker and being refused relief. I had uncontrollable crying both times--this isn't how anxiety normally manifests for me. These 2 events were very similar.
>
> I've never had such a pronounced change in mood before. How does a panic attack like that suddenly cause depression? I am extremely dissapointed and upset over this. I haven't had depression in so long, just anxiety from time to time, and I don't understand what happened here.
>
> But now in addition to the amotivation, I have depression. I never had a depression like this, and never anything with a sudden onset. I had major depression about 8 or 9 years ago.
>
> any opinions are appreciated. I am totally lost and confused right now.
>I've always felt that anxiety can cause depression as it really depletes neurotransmitters. A 2-3 day panic attack certainly could cause major depletion. Klonpin is excellent for panic attacks. Nardil can address depression and anxiety attacks.
Posted by garnet71 on June 1, 2009, at 13:31:36
In reply to Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 19:35:11
You know, i'm feeing a bit better today. I slept 5 hours last night. Better to wait this out and see before jumping to conclusions. (Always thinking ahead - and/or - anxiety thoughts.)
I had about 2 nights sleep for a whole week; it could be that I am just drained. I never thought about the neurotransmitter issue--That's interesting...when I have some more time-I want to look into that further.
The thyroid issue is something I'm definitely addressing since I have insurance now. Just today though, I found out I have been driving w/o car insurance for almost a month. I haven't even opened my mail to know it had been canceled, but I suspected soon...Waiting for insurance guy to call me back this moment...and just now I found out I was cut from my veteran's education benefits-I total surprise. I was due a check the first week of June. Another unexpected obstacle since I was supposed to have benefits for 4 more months.
Gotta get caught up on life. I've made some progress over the past couple of months, but still have stuff piled up. A lot of this depends upon upcoming PDoc appt, and what they decide to prescribe me. I am not sure how much input I'll have this time, like with other PDoc over the past several months. Scary that a doctor has so much power over my future.
Actually, it's not an irrational fear. If I hadn't sought my own pharmaceutical remedy, I would have failed college. While I had 6 months to do my thesis, I was only able to work on it mostly the last month before it was due at the end of April, after my PDOC agreed to prescribed me stimulants, then the specific one I asked for about 2 months ago helped me get it done mostly in the last week before the deadline. For the 1st half of the project, they gave me a 'barely pass' because I missed the deadline, although they could have failed me. Overall my work was not that bad, but still a great disappointment; certainly not up to par with what I'm capable of. But I am content.
If that psychiatrist did not agree with my need for those types of drugs at that moment, I would have failed since I became almost completely amotivational from SSRIs and worsening ADD symtpoms; instead, I graduated with honors. I got my diploma in the mail just Saturday. Yea!
Three more semesters of graduate school, however, will be mostly determined by my mental health and the PDoc who can help me. Last weekend really set me back for the start of the semester, which was completely preventable by the way, but I'm not stressing about classes too much - yet.
I'm going to search for a therapist soon too. One day at a time....
I think this place has been my main source of support. It's the only place where I know people will understand. I have friends who have no idea what I've been going through, despite trying to explain mental health issues. They wonder why I cancel social engagements but don't really understand that I want to spend more time with them, but it's just not possible right now until I get my life back together. Thanks, as always, for all the advice..and to anyone who has listened to all my rants recenctly--I am lucky to have your help and support..
Bright and sunny days ahead! : )
Posted by Larry Hoover on June 1, 2009, at 18:45:09
In reply to Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 19:35:11
My intuitive reaction is that your mood response is due to fatigue. Not fatigue in the plain exertional sense, or lack of sleep sense. Panic attacks involve significant sympathetic nervous system activation, and if that event is prolonged, as you describe, then that activation would place a lot of stress on your mind. And that stress is biochemical stress, in the end.
I think that N-acetyl cysteine (NAC) might be worth keeping around. It's a precursor to glutathione, and biochemical oxidative stress is quite strongly associated with glutathione depletion.
NAC is good for you, in any case. Excellent for your liver and brain. I've never noted the slightest psychotropic effect, or side effect of any kind from taking it, but over time, my brain began to work much better than it had been. My stressor was pain, but also sympathetically mediated. I don't know that it matters what the stressor is, so much.
Just my gut speaking to yours.
Lar
Posted by SLS on June 1, 2009, at 19:11:01
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by Larry Hoover on June 1, 2009, at 18:45:09
Hi Larry.
> I think that N-acetyl cysteine (NAC) might be worth keeping around. It's a precursor to glutathione, and biochemical oxidative stress is quite strongly associated with glutathione depletion.
> NAC is good for you, in any case. Excellent for your liver and brain. I've never noted the slightest psychotropic effect, or side effect of any kind from taking it, but over time, my brain began to work much better than it had been. My stressor was pain, but also sympathetically mediated. I don't know that it matters what the stressor is, so much.I have two bottles of NAC just waiting for me. I would like to wait until I stabilize on the generic lamotrigine first as not to confound the interpretation of my resultant state. I plan to take this substance indefinitely, though. I am hoping that it encourages the recovery of brain tissue and at the very least prevents the loss of any more. NAC does appear to be an ideal supplement to prevent some of the toxic effects of stress.
How much are you taking?
I am still undecided as to what would be an ideal dosage.
- Scott
Posted by garnet71 on June 1, 2009, at 19:45:20
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by Larry Hoover on June 1, 2009, at 18:45:09
Hi Larry!
Do you take extra Vitamin C with it?
http://www.advance-health.com/nacetylcysteine.html
N-Acetyl Cysteine Cautions
When taking N-acetyl cysteine it is recommended that two to three times as much vitamin C be taken at the same time. Failure to do so may result in more harm than good from taking this product because of the prolonged presence of the oxidized form of L-Cysteine. The vitamin C also helps keep the glutathione that is produced from the Cysteine in its reduced form so that it can continue acting as an antioxidant.N-Acetyl Cysteine Dosage
Typical dosage recommendations are in the range of 250-1500mg of NAC daily for the majority of therapeutic benefits.I can't wait to go to my favorite health store--it's going to be like Christmas. I want my brain to work better too :) BTW, is that ok to take w/Taurine?
The thing with supplements-I can never tell if they have a positive effect or not, especially when trying out new drug remedies. I haven't been taking very many lately, aside with the recent anxiety, except for magnesium and vitamin B. I started taking fish oil again before I had this anxiety. It's probably a coincidence, but I never know for sure.
~Thanks Lar~
Posted by johnj1 on June 1, 2009, at 19:47:40
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by Larry Hoover on June 1, 2009, at 18:45:09
Hello Larry I hope you are doing well. I have tired NAC for ocd and found it really helped but the only problem I had was headaches. They just wouldn't go away. Have you heard of this? Thanks
johnj
Posted by Phillipa on June 1, 2009, at 20:11:18
In reply to Re: Panic attacks ) permanent change in mood, posted by Komet on June 1, 2009, at 10:09:31
Long term anxiety but seriously thought they were self limiting?? Phillipa
Posted by Larry Hoover on June 1, 2009, at 20:37:30
In reply to Re: Panic attacks ) permanent change in mood » Larry Hoover, posted by SLS on June 1, 2009, at 19:11:01
> I have two bottles of NAC just waiting for me. I would like to wait until I stabilize on the generic lamotrigine first as not to confound the interpretation of my resultant state. I plan to take this substance indefinitely, though. I am hoping that it encourages the recovery of brain tissue and at the very least prevents the loss of any more. NAC does appear to be an ideal supplement to prevent some of the toxic effects of stress.
>
> How much are you taking?
>
> I am still undecided as to what would be an ideal dosage.
>
>
> - ScottI've been taking 1200 mg/day, for maybe three months. I'm about to take a holiday from it.
Lar
Posted by Larry Hoover on June 1, 2009, at 20:42:56
In reply to Re: Panic attacks ) permanent change in mood » Larry Hoover, posted by garnet71 on June 1, 2009, at 19:45:20
> Hi Larry!
>
> Do you take extra Vitamin C with it?Actually, I do. And in line with that recommendation. I've been taking 1200 mg NAC, and 2500 mg Vitamin C.
>
> I can't wait to go to my favorite health store--it's going to be like Christmas. I want my brain to work better too :) BTW, is that ok to take w/Taurine?I don't see any reason why you couldn't take both. Interesting, perhaps, but both substances you mention are sulphur-bearing amino acids.
> The thing with supplements-I can never tell if they have a positive effect or not, especially when trying out new drug remedies. I haven't been taking very many lately, aside with the recent anxiety, except for magnesium and vitamin B. I started taking fish oil again before I had this anxiety. It's probably a coincidence, but I never know for sure.
>
> ~Thanks Lar~You're welcome. Just an idea for you to try.
Lar
Posted by Larry Hoover on June 1, 2009, at 20:50:44
In reply to Re: Panic attacks ) permanent change in mood » Larry Hoover, posted by johnj1 on June 1, 2009, at 19:47:40
> Hello Larry I hope you are doing well. I have tired NAC for ocd and found it really helped but the only problem I had was headaches. They just wouldn't go away. Have you heard of this? Thanks
>
> johnjI've hear it mentioned, john. Sorry it's been your experience. Have you tried to find a lower dose that doesn't give you that problem?
I probably shouldn't have implied that there are no side effects reported. Some people have transient digestive upset. Occasional reports of headache. And there's an interaction with nitroglycerine, and with inhaled insulin.
Lar
Posted by SLS on June 2, 2009, at 5:36:03
In reply to Re: Panic attacks ) permanent change in mood » SLS, posted by Larry Hoover on June 1, 2009, at 20:37:30
Larry,
Thanks for your timely response.
> I've been taking 1200 mg/day, for maybe three months. I'm about to take a holiday from it.
Do want to ascertain just what role NAC currently plays in your treatment regime, or is there some other reason why you choose to discontinue it temporarily?
- Scott
Posted by Larry Hoover on June 2, 2009, at 10:31:32
In reply to Re: Panic attacks ) permanent change in mood » Larry Hoover, posted by SLS on June 2, 2009, at 5:36:03
> Larry,
>
> Thanks for your timely response.You're welcome, Scott.
>
> > I've been taking 1200 mg/day, for maybe three months. I'm about to take a holiday from it.
>
> Do want to ascertain just what role NAC currently plays in your treatment regime, or is there some other reason why you choose to discontinue it temporarily?
>
>
> - ScottI don't stay on any supp for extended periods. Yes, I'd like to get a sense of my response, using a challenge/dechallenge/rechallenge paradigm. But I also don't want my body to adapt completely to the increased intake level. I think that a better response (averaged over the long-term) can arise from a pulsatile intake. I let my intuition guide me on lengths of the periods of intake and the breaks in between.
Lar
Posted by drylightning on June 5, 2009, at 21:26:01
In reply to Panic attacks ) permanent change in mood, posted by garnet71 on May 31, 2009, at 19:35:11
> I had a 2-3 day long panic attack last weekend; my doctor refused to prescribe me an anxiolytic for relief over phone on the holiday weekend. I took lots of Kava, Valerian, and magnesium, and the anxiety stopped a couple of days later. I got so tired after that, and haven't been the same since. I have had dysthmia/depression ever since the panic attack ceased, and have been extremely tired every day. Motivation is exactly the same as it was over the past couple months, and I no longer have anxiety.
>
> Prior to that, my mood has been upbeat, positive, consistent...since a month or so after quitting SSRIs last december. I felt no depression symptoms, but have had relapses of anxiety from time to time during this period but have been amotivational since SSRI use which I stopped last December, when it was at an all time low as a result of taking SSRI.
>
> the panic attack I had last weekend was not like my usual bouts of anxiety over the years; it was just like the 4 day panic attack I had several years ago that led to having to go to the ER and being treated like a drug seeker and being refused relief. I had uncontrollable crying both times--this isn't how anxiety normally manifests for me. These 2 events were very similar.
>
> I've never had such a pronounced change in mood before. How does a panic attack like that suddenly cause depression? I am extremely dissapointed and upset over this. I haven't had depression in so long, just anxiety from time to time, and I don't understand what happened here.
>
> But now in addition to the amotivation, I have depression. I never had a depression like this, and never anything with a sudden onset. I had major depression about 8 or 9 years ago.
>
> any opinions are appreciated. I am totally lost and confused right now.
>When I was first diagnosed with panic disorder in 1995, I swear I had a three month panic attack. I had no idea what was wrong with me during those months, and was in a constant state of high anxiety. I suppose it was not one big panic attack, but the anticipatory anxiety was SO high that it felt like one.
Posted by rskontos on June 11, 2009, at 1:34:12
In reply to Re: Panic attacks ) permanent change in mood » garnet71, posted by drylightning on June 5, 2009, at 21:26:01
Garnet,
I have had panic attacks off and on since sometime in 06. I probably had them prior just did not recognize them.
May 23, I had one so severe at work that I did not recognize it because I was so far gone in such a short time that I just could not breathe and they got so nervous at work that they called 911 and I wound up in the ER. That one lasted for several hours despite what the ER did. Not much really, they tried to treat me for the severe diarrahea I had. I will admit it was severe, in the ER they had to keep letting me go to the bathroom while trying to put in an IV and xrays etc. Never did one of the doctors or EMT or Paramedics think it might be a panic attack. My bp shot up.
I was released about 4 hours later, the oxygen seemed to help and the IV.
I had another one the next day, the next day after that. I did finally call my p-doc who called me right back and said that was a severe panic attack. He scheduled an emergency meeting.
We discussed several options. He think my going off topamax was a mistake as it might have helped keep my mood more in check.
I have been averaging two to three panic attacks since. I do take xanax and it fine for me and my panic attacks.
I do have a great p-doc who would prescribe anything.
I am tapering off wellbutrin as I think and he said it was a possiblity that it contributed to my high bp which has stablized now.
I think it can affect a permanent mood change. I am somewhat more fearly of just being out and that happening again.
But they are happening at home too.
So all I can do is relate to your experience. My family just doesn't get it either.
rsk
This is the end of the thread.
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