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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 bubblegumchewer on July 28, 2002, at 12:44:07
I have a history since age 11 of panic attacks that have been intermittent but sometimes bad enough to cause disruption of my life. Every pdoc I've seen (there have been half a dozen) gives a dx of depression although I've never felt "down" or "sad." I've spent extensive time on several SSRIs and I was pretty wired on them but felt fine; no PAs (panic attacks) for months but maybe some breakthrough PAs before I went off them and then I was fine again. I've stopped them (SSRIs) and had no ill effects from stopping, and then maybe months or years later more PAs cropped up. Extremely rare use of small doses of benzos have thwarted my PAs in a pinch and allowed me sleep and then go back to "normal" the next day.
A year ago I stupidly took a layperson's advice to take klonopin 3x per day instead of Paxil. (My doctor agreed to give it a fair trial.) After four months on a low dose I had unrelenting PAs that only got worse the more klonopin I took. Soon I was nonfunctional and almost dead from inability to eat, drink or sleep. I landed in Johns Hopkins hospital where they tried me on my old friend zoloft which only made me worse, so they tried nortriptyline and I've been on it since. They withdrew the klonopin comfortably (while the nortrip kicked in) over three weeks and I got my life back again.
So for a year it's been nortriptyline every night, a great night's sleep (or shall I say a great night's coma) every night, and a nice sex life as the nortrip causes little or no SSRI-like sex-buzz-kill. I feel like my old fiesty self; just great with no PAs.
Only problem: My bowels simply do not work anymore. I have to skip the nortrip once a week just to go to the bathroom the next day. I know it can't be healthy to build up crap in the system for a week and a half No prune juice or other remedies help. Other problem: I am pregnant, but do not concern yourself with that aspect; my doc and I will assess the safety of any medicine I consider taking. But because of the pregnancy it is advised to get off the nortriptyline because it may cause delivery problems. Plus I like to go to the bathroom more than once a week so I want to go off the nortrip.
What would anyone suggest for a replacement medication, should I need one? Of course I hope to need NO medication. But the doc wants me to be ready to take small doses of klonopin if necessary, and I balk at that idea since the klonopin merry-go-round landed me in the hospital in the worst shape I have EVER been in. He also mentioned celexa. I am nervous about start-up anxiety from SSRIs plus I am just a little leery of SSRIs even though I've taken them before, but maybe I'd try celexa if I had to. I will understand that I'll be a sexual eunuch but that is better than constant panic-attack-hell.
SO, if I really do have depression, it seems to be the anxious type or at least dominated by panic attack symptoms. I welcome any input or recommendations. Thank you so much for reading my entire psychiatric history.
Posted by Squiggles on July 28, 2002, at 19:09:21
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
You're going to hate me for this, but
i'd like to ask:did they check your thyroid?
Squiggles
Posted by oracle on July 28, 2002, at 19:49:08
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
> Only problem: My bowels simply do not work anymore. I have to skip the nortrip once a week just to go to the bathroom the next day.
Increase your fluid intake and this will go away.
A gallon a day is a good goal to shoot for.
If things are this dry you are probably dehydrated
elsewhere, also.
Posted by bubblegumchewer on July 29, 2002, at 12:42:46
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
Well, guys, I appreciate any input. Sorry I can't say "eureka!" though. They did check my thyroid a few times and it was fine.
I hate to be grossly descriptive, but the constipation is not like a problem with consistency... from what I've read, the tricyclics slow down intestinal transit sometimes to the point of paralysis, which I have to admit worries me. I've been drinking lots and I've already tried all the !@#$% stool softeners and metamucil, and it doesn't make a difference whether I take them or not because that's not exactly the problem. It's like a week and a half with NOTHING, no urge to go, although of course I can just tell that my insides are backing up and then I skip the meds and I have to go the next day A LOT. No dryness problems apparent. Sorry, that was a truly gross discussion. I think this is why the tricylics are considered to have an "unfavorable side effect profile" and are hardly used anymore.
Also, my blood pressure is chronically low and I think the nortrip makes it worse. I can't stand much more of this. I was hoping someone could suggest an alternative medication that worked well for their severe panic problems.
Posted by bubblegumchewer on July 30, 2002, at 12:20:16
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
I thought someone might say "celexa saved my life" or some other such testimony.
Posted by terra miller on July 30, 2002, at 12:43:40
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
hi. i hope i don't say a bunch of redundant info as i didn't read the replies to your post. having had three kids and being on a constipating med currently, i have some thoughts.
do NOT eat: bananas, apples, applesauce, carrots, very much bread, and rice. pregnancy is constipating enough. do NOT (if you can) take prenatal vitamins prescribed by your doc through pharmacy route... instead use the brand of prenatal vitamins by "Twinlab" i cannot emphasize this enough. the other vits are incredibly constipating and the Twinlab's are not. it might cost you twice as month (usually insurance covers the ones from the doc, and the twinlab you get at a healthfood store or probably online somewhere.)
about pa's. i do not understand the logic behind the klonopin if it did you wrong before. we're all different, and if that's how you body responds, then that's what you should listen to. one thought is that, for me, the more "long term acting" benzo i use, the worse it is for me as far as potential for rebound panic. once i figured that out, it was a breakthrough. i now use xaxax as i need it; it's quick acting and gets through my system fast and doesn't linger around longer than i need it to. i just need a benzo for when you get hit right then and there with a pa. otherwise, i don't need one. this might be your case?
i also like wellbutrin. i didn't respond to SSRI's. i am not generally depressed as my dx, more anxiety related (PTSD)
you might also try dropping the caffeine and sugar in your diet.... you have to taper like you would getting off a med. both of those cause your emotions to swing. i find i really enjoy the balance i feel having been off caffeine and sugar.
hope some of those thoughts are helpful.
also, magnesium works well too for the constipation (i learned that here.)
terra
Posted by terra miller on July 30, 2002, at 12:48:02
In reply to Re: Let's play pick-a-med, posted by bubblegumchewer on July 29, 2002, at 12:42:46
hi. i didn't notice this. wellbutrin might not be for you, then. i have normal to slightly low blood pressure. with wellbutrin, my body temperature reset two degrees. it's a very rare sideeffect, but i got it for sure and have to only take small doses at a time and no SR.
Posted by katekite on July 30, 2002, at 15:36:28
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
Since you are pregnant, if you think it's even a possibility, have you considered taking nothing as a preventative and just using Xanax when they happen? People's whole systems change a ton during pregnancy and it might turn out that your body just naturally has fewer or less severe ones.
I found a high dose of klonopin to not be good for some of my symptoms (irritability or anger). While I felt overall mellow, it was as if I couldn't think as clearly or quickly or control myself as well and so things that didn't normally get out of control, did. I'd get irritated and suddenly spiral into throwing the phone or something, which I never would have done before. Disinhibition is what that's called. Probably not similar, but I thought I'd mention it as klonopin doesn't help everything.
How does caffeine affect you? Have you had to swear off of it because it predisposes to the panic attacks?
Kate
Posted by bubblegumchewer on July 30, 2002, at 17:17:40
In reply to Let's play pick-a-med, posted by bubblegumchewer on July 28, 2002, at 12:44:07
Thanks guys, for your input. I have to feel like a weird one when I say that all the times in my life that I had crippling series of panic attacks were times when I didn't consume any caffeine and I've been happiest and most symptom-free when I drink a lot of coffee. I know that makes no sense. My only guess can be this: I heard that the world is addicted to coffee because it has a mild antidepressant effect that people naturally seek.
I don't take any prenatal vitamins currently. I eat several bowls of Wheaties (lots of vitamins) with bran cereal each day. My goal is to take nothing in the way of medication. I am going to taper down to 0 mg. of nortriptyline but I just wanted an idea of something to take if things turn bad. The doctor already sent home the little sample package of celexa which is gathering dust on the top of my fridge.
Posted by katekite on July 30, 2002, at 19:34:38
In reply to thanks, posted by bubblegumchewer on July 30, 2002, at 17:17:40
I wondered if you'd say that, which is why I asked.
You seem to have paradoxical responses to medications. ie klonopin worsens your problem while caffeine improves it. ie you are nothing like most people with panic disorder.
Sometime when you are not pregnant, you might consider trying stimulants, like Ritalin. These have the benefits of caffeine but less side effects per amount of stimulation. In addition they are safe drugs in the doses taken for these problems, and have few side effects compared to some of the new unstudied antidepressants. In contrast to the media telling us that Ritalin and Adderall and Dexedrine make all people speedy addict-lookalikes and are killing children, some 5-10% of the population actually feels calmed by taking them, without significant bad effects.
I have attention deficit disorder. While I would guess you probably don't have a full-blown case of that, you might share a feature of it that I experience only in rebound/withdrawal from stimulants when I am particularly sensitive: anxiety and things that are similar to panic attacks. When I feel the most panicked and think a stimulant would least help me, it tends to help the most. Valium or Ativan also helps in the moment, mostly because I they make me less worried about not being able to handle things.
This peculiar ADD panic is as if everything around me is going way too fast to comprehend, I sometimes wake at night to it: hear a sound and suddenly every sound is frightening and the world feels like a sci-fi movie in deep space where I'm the space ship hurtling along among foreign frightening sounds/sights etc with everything seeming threatening, even a kind word from my hubby. I can't think at all and feel unable to handle even a few words back to him. Totally overwhelmed. For me its best if I can just get somewhere quiet and dark very quickly and let time do its thing. People with ADD sometimes call this 'flooding' or being 'overstimulated' or 'being overwhelmed by input', and for some its very frightening. A few lucky types actually like it.
At the very least, when you have your baby and can safely experiment, it might be worth questioning your diagnosis, getting a new opinion on it. Caffeine is supposed to make panic attacks worse and klonopin is supposed to improve them: maybe if you have such odd reactions what someone told you were panic attacks, really are not.
Now, ADD itself probably isn't a problem for you. But if you are curious about it you can check out a lengthy quiz at www.mindfixers.com which I found helpful when I was getting diagnosed just a few months ago.
Interestingly enough, nortriptyline is occasionally used in treating ADD in people who can not take stimulants. Other antidepressants used are those with activating properties: Wellbutrin, Prozac, other tricyclics like desipramin. Antidepressants work less often in ADD than stimulants and generally work less well. For ADD, that is.
Take care. And congratulations on getting pregnant. I'm not a doctor so take my observation with a grain of salt.
Oh yeah, I think lately they've decided mild caffeine consumption is ok in pregnancy.
kate
Posted by oracle on July 30, 2002, at 23:43:49
In reply to Re: Let's play pick-a-med, posted by bubblegumchewer on July 29, 2002, at 12:42:46
. from what I've read, the tricyclics slow down intestinal transit sometimes to the point of paralysis, which I have to admit worries me.
Thats fine, but I took TCA's for 10 years, and extrat fluid worked for me.
Posted by bubblegumchewer on July 31, 2002, at 12:32:06
In reply to Re: Let's play pick-a-med, posted by oracle on July 30, 2002, at 23:43:49
I'm sure that I do have some ADD features. I'll read over your post later when I have more time (I'm doing a few things at once now). I'll go check out the site you recommended.
Klonopin did help at first, in fact small doses (.25 mg) knocked me on my ***, but after I took it round the clock it seemed to lose its effectiveness; I'm convinced I had rebound anxiety that was worse than the original. I also think the klonopin depressed me terribly.
I also decided a while back to have ONE cup of coffee per day and I do feel a lot better. Thanks for all your input. I'll mull over it again later.
This is the end of the thread.
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