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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jms600 on April 8, 2008, at 4:21:55
Hi everyone,
I've been on Zyprexa now for around five weeks for acute anxiety and panic. I started on 2.5mg and gradually increased to 10mg per day. I'm also taking 20mg Lexapro per day.
Unfortunately the Zyprexa isn't doing what it should be. I'm still getting terrible anxiety and crushing panic attacks.
I'm starting to worry about my condition a lot now. Zyprexa seems to help everyone on this board for anxiety, but it doesn't seem to work for me. It doesn't even make me drowsy.
Is there anything else anyone can recommend I try next..? I've been on all SSRIs in the past, as well as Seroquel, Amisulpride, Remeron and Effexor (all at different times). I want to stop on the Lexapro if possible as it seems to be helping my depression.
Can anyone please offer some advice?
Thanks.
Posted by med_empowered on April 8, 2008, at 5:55:55
In reply to Zyprexa isn't helping... what next??, posted by jms600 on April 8, 2008, at 4:21:55
have you tried klonopin? ativan? Serax? Atarax/Vistaril? Neurontin? Gabitril? The antipsychotics are actually a weird choice for anxiety, unless you have psychotic features or something...
anyway, good luck and keep us all posted.
Posted by llurpsienoodle on April 8, 2008, at 10:05:23
In reply to klonopin?, posted by med_empowered on April 8, 2008, at 5:55:55
I'm having a very atypical reaction to wellbutrin. It's helping my anxiety. who would have thought?
I suppose it's kind of like how some people smoke to be stimulated and others smoke to chill out.
or could be the dopaminergic stuff
or could be the adrenergic stuff.
I'm not going to complain.
klonopin was great for me for about 1.5 years. I've been off of it for about a week now. (6 days) and I'm not missing it. It made me feel a little too mellow. too stable.
I highly recommend the benzodiazepines.
-Ll
Posted by Phillipa on April 8, 2008, at 10:33:53
In reply to Re: klonopin?, posted by llurpsienoodle on April 8, 2008, at 10:05:23
Have you thought or tried valium? Phillipa
Posted by cactus on April 8, 2008, at 15:51:10
In reply to Re: klonopin?, posted by Phillipa on April 8, 2008, at 10:33:53
Klonopin has been fantastic for me, for both panic and Generalized Anxiety Disorder, but I think there is a major drug interaction with klonopin and zyprexa, I'm sure your pdoc would know about this but just google it to double check if you decide to try klonopin, I might be wrong.
Good luck, I understand what you're going through, both Zyprexa and seroquel did nothing for my anxiety and neither did any SSRI's/SNRI's, which I have tried quite a few of!!
Valium and klonopin worked wonders for my anxiety. I respond well to benzo's and I must be one of those freaky people who don't suffer from the klonopin depression factor.
Posted by bleauberry on April 8, 2008, at 16:04:18
In reply to Zyprexa isn't helping... what next??, posted by jms600 on April 8, 2008, at 4:21:55
The anxiety is from a different biochemistry than you have been targeting. Things that are different with high potential are:
klonopin, xanax, lithium, depakote, lamictalKlonopin or xanax have a very high potential of working within minutes, the others have potential but not as high and take a few weeks.
Other causes include hyperadrenalism (test saliva cortisol 4 times in a day), hypoadrenalism (same test), or hyperthyroid.
Posted by jms600 on April 8, 2008, at 16:42:22
In reply to Re: Zyprexa isn't helping... what next??, posted by bleauberry on April 8, 2008, at 16:04:18
Hi everyone
Thanks for the advice. Yes - I am currently taking Valium, and yes - it does help. It's just I'm frightened of taking it too often as I'm worried I'll get use to it's effects and so it will cease to become effective.
Bleauberry - I found what you had to say really interesting...
"Other causes include hyperadrenalism (test saliva cortisol 4 times in a day), hypoadrenalism (same test), or hyperthyroid."Could you elaborate a little on the "test saliva cortisol 4 times in a day" bit - what does this test involve? Should I just ask my doctor for a 'cortisol saliva test'?
I'd be grateful if you could elaborate a little - thanks Bleauberry.
Thanks to everyone else who posted too.
Posted by Phillipa on April 8, 2008, at 19:32:37
In reply to Re: Zyprexa isn't helping... what next??, posted by bleauberry on April 8, 2008, at 16:04:18
Bleauberry you found lamictal helpful for anxiety and panic? How come when my TSH is high I get the anxiety and panic and then burn out on the anxiety? Love Phillipa
Posted by bleauberry on April 8, 2008, at 21:31:46
In reply to Bleauberry - could you elaborate a little...?, posted by jms600 on April 8, 2008, at 16:42:22
Many pioneering doctors see adrenal/thyroid issues as the disease of the century, and yet these issues are almost totally unrecognized or ignored by the majority of mainstream doctors including endocrinologists.
If you type in a google search "saliva cortisol lab test", or "adrenal stress index lab test", you should get some hits that lead to sources where you can order them yourself online from reputable labs such as Doctors Data. You get a kit in the mail, follow instructions, gather saliva in 4 test tubes throughout a day, then send it back to the lab. The results will show your cortisol curve over a 24 hour period and how it compares to healthy samples. A General Practioner might be up on it, but most aren't. It is common routine everyday testing with integrative MDs, alternative MDS, and naturopaths.
It is too long to explain here, but if your cortisol is below the healthy range, or above it, or zigzagging all over the place where it shouldn't, one can expect symptoms that are hard to treat. Doctors will scratch their heads why their favorite meds aren't working. And it is actually quite easy and cheap to treat.
Thyroid testing can be done by your GP, and actually some online places allow you to order the test kit through the mail yourself and only requires a finger prink instead of blood draw.
What you want is TSH, freeT3, and freeT4. Most docs look at TSH only. That is ok when someone is fairly healthy. When there are symptoms, you have to look deeper. TSH doesn't tell us much that is useful. The other numbers paint a clearer picture.Wilson's Syndrome is an umbrella term that deals with sub-optimal yet not completely destroyed adrenal and thyroid. Type in Wilson's Syndrome, or Wilson adrenal fatigue, or Wilson thyroid, and you'll find some good reading to learn more. There is a good book to read too.
I've talked with literally hundreds of people dealing with this stuff and I deal with it myself. Well schooled. So when you do testing, let me know and I can help you figure out what results mean and also share with you what usually works for others and what doesn't. Generally speaking, if you see it advertised at adrenal fatigue websites, or health food websites, it probably doesn't work. Your GP actually has the best meds, and they are cheap and common.
But you need the lab tests first. There are some simple home tests to do that you should stumble onto during your Wilson's search or adrenal fatigue search. They involve a specific blood pressure test, laying down test and then immediate standing up test; a bright light in the eye test; and an average daily temperature test after taking your temperature 3 times a day for a week or two. These things show a pretty clear picture of whether there are problems your doctor has missed or not.
Posted by bleauberry on April 8, 2008, at 21:42:25
In reply to Re: Zyprexa isn't helping... what next?? » bleauberry, posted by Phillipa on April 8, 2008, at 19:32:37
> Bleauberry you found lamictal helpful for anxiety and panic? How come when my TSH is high I get the anxiety and panic and then burn out on the anxiety? Love Phillipa
Weak fatigued adrenal glands cannot handle it. Simple as that. They try with what little they have, but in short order they are pooped out.
Your TSH shouldn't be high. I thought they were taking care of your thyroid stuff. Geez. I sure wish you had some better quality care. You deserve it. Your suffering, as far as I have seen the last few years, is equal part illness and equal part insufficient medical skill.
If I recall, you said you have Hashimotos? If that is true, then you will go through alternating random patterns of hypothyroidism and hyperthyroidism. You will need a doc who can make adjustments quickly and knows how to go with the flow and not hesitate or procrastinate. On your part, it may be unrealistic to expect to take the same meds and same doses every day like clockwork. You may instead need to tailor your specific choices of meds, doses, and times of day you take them, to fit your symptoms that are happening right here and now. The only med I am aware of that shows evidence of stabilizing Hashimotos symptoms is Tegretol.
Posted by Phillipa on April 9, 2008, at 19:48:32
In reply to Re: Zyprexa isn't helping... what next?? » Phillipa, posted by bleauberry on April 8, 2008, at 21:42:25
Tegretol how does that work and what about trileptal would that work? And what dose. See the pdoc tomorrow that would give me something to go on. Thanks Blueaberry love Phillipa
Posted by Phillipa on April 9, 2008, at 19:59:19
In reply to Re: Zyprexa isn't helping... what next?? » Phillipa, posted by bleauberry on April 8, 2008, at 21:42:25
Goggled Wilson's syndrome and this is from American Thyroid association. Phillipa
Home > Professionals > Public Health Statements > Wilson's SyndromeATA Public Health Statement
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American Thyroid Association Statement on "Wilson's Syndrome"Updated May 24, 2005
The American Thyroid Association (ATA) has developed the following response to requests from patients and physicians for information about "Wilson's syndrome". The ATA Public Health Committee and Council have reviewed the material presented on the "Wilson's syndrome" website, considered relevant studies from the medical literature, and offer the following advice.
Summary
"Wilson's syndrome" refers to the presence of common and nonspecific symptoms, relatively low body temperature, and normal levels of thyroid hormones in blood. Dr. E. Denis Wilson, who named the syndrome after himself, contends that it represents a form of thyroid hormone deficiency responsive to treatment with a special preparation of triiodothyronine (T3).
The ATA's thorough review of the biomedical literature has found no scientific evidence supporting the existence of "Wilson's syndrome." The ATA also has specific concerns about the following issues.
First, the proposed basis for this syndrome is inconsistent with well-known and widely-accepted facts about thyroid hormone production, metabolism, and action. T3 is one of the two natural thyroid hormones. Normally, it is mainly produced in target tissues outside of the thyroid gland from metabolism of thyroxine (T4). This production of T3 from T4 occurs in a highly regulated manner. This is one reason that T3 is not currently recommended for thyroid hormone treatment in most patients with thyroid hormone deficiency. T4 therapy allows T3 to be produced, as it is naturally, by the regulated metabolism of the administered T4 medication to T3.
Second, the diagnostic criteria for "Wilson's syndrome"--nonspecific symptoms and body temperature measurement--are imprecise.
Third, there is no scientific evidence that T3 therapy is better than a placebo would be for management of nonspecific symptoms, such as those that have been described as part of "Wilson's syndrome," in individuals with and normal thyroid hormone concentrations.
Fourth, T3 therapy results in wide fluctuations in T3 concentrations in blood and body tissues. This produces symptoms and cardiovascular complications in some patients, and is potentially dangerous.
Complete Review
The "Wilson's syndrome" website lists 37 symptoms as well as "others" that can occur as part of the condition. All of these symptoms do cause suffering, distress, and functional disability in millions of people. Some of these symptoms can, in fact, be due to true hypothyroidism. In hypothyroid patients, they are typically responsive to thyroid hormone therapy. Other problems, such as asthma, are not associated with thyroid hormone deficiency. Many of these symptoms are present from time to time in virtually everyone. In addition to hypothyroidism, they may be due to a variety of illnesses or life circumstances. In other words, they are nonspecific.
The "Wilson's syndrome" website states that Dr. Wilson named this concept after himself "because it had not been previously described." In fact, for more than a century, the same set of symptoms has been given different names and attributed to a variety of causes by others, including the syndromes of neurasthenia, chronic fatigue, fibromyalgia, multiple chemical sensitivity, chronic Ebstein Barr disease, and chronic candidiasis.
The frequency of complaints attributed to "Wilson's syndrome" has been recently reviewed (Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med 1999;130:910-21) At any time, more than 20% of adults report significant fatigue and 30% have current musculoskeletal symptoms. Furthermore, the typical adult has one of the symptoms every 4 to 6 days, and more than 80% of the general population has one of these symptoms during any 2 to 4 week period.
The advocates of "Wilson's syndrome" view the cause, diagnostic evaluation, and treatment of these symptoms very narrowly. Their viewpoint does not acknowledge that when these symptoms are persistent, they may be due to a number of different subacute and chronic medical conditions, psychological or social stress, or mood disorders, including depression and anxiety. Some of these symptoms may also simply be a part of life. "Wilson's syndrome" attributes them all to a biochemical theory, which is unsupported by laboratory or clinical research. It does not consider the impact of other potential illnesses and psychosocial factors on how we feel. In doing so, attributing one or more of these symptoms to "Wilson's syndrome" may delay recognition of treatable medical illnesses and potentially addressable life stresses.
The ATA has the following specific concerns about "Wilson's syndrome" and its recommended treatment.
The diagnosis of "Wilson's syndrome" is based on an incorrect definition of normal body temperature: that it is 98.6ºF. (Mackowiak, et al. JAMA 1992;268:1578-1580) measured oral temperature in 148 healthy persons. Average temperature varied throughout the day. At 8 AM, the average temperature was 97.6ºF with more than 50% of all the measurements less than 98.6ºF, and many less than 98.0ºF. This study concluded that "thirty-seven degrees centigrade (98.6ºF) should be abandoned as a concept relevant to clinical thermometry."
The prescription of T3 for "Wilson's syndrome" is inconsistent with normal physiology and represents a potential hazard. There is no question that T3 is an active, effective thyroid hormone. However, in most vital organs, much of the T3 is produced by removal of an iodine atom from T4 delivered by the blood to sites of thyroid hormone action. The extent of T4-to-T3 conversion varies from one organ to the other, but in some organs, like the brain and pituitary, this process provides most of the T3. Treatment with T3 produces an unnaturally large amount of T3 in some organs. This may be inappropriate, especially in times of illness or nutritional deficiency. Long-term T3 treatment may cause harm. Excessive T3 treatment can affect the heart and skeleton. These effects can be serious and even life-threatening.
The sole clinical evidence supporting T3 therapy offered by the "Wilson's syndrome" website is in the form of testimonials from people who feel better after taking T3. Evidence of this kind, based on anecdotal reports of an unblinded intervention is potentially erroneous. Such reports fail to take into account two well established facts. First, many people who suffer these symptoms, even for months, get better without any treatment. Second, as many as one-third of people with nonspecific symptoms have a so-called placebo response, i.e., they get better when they are given any treatment, even an inactive capsule or sugar pill. The appropriate way to assess a new treatment is to perform a clinical trial in which patients are randomly assigned to receive either the test drug or placebo. Furthermore, the response to treatment should be assessed in a double blind manner, keeping track of what gets better, what does not change, and what gets worse, with neither the patient nor the doctor knowing which treatment the patient is taking. The ATA has been unable to find any such studies of any treatment, including T3, for "Wilson's syndrome." The Wilson syndrome website reports only success stories. Responsible medical research into a new treatment keeps track of, and reports, not only successes, but also success rates, and how often there are inconclusive responses, failures, and side effects.
The term Wilsons syndrome should not be confused with Wilsons Disease. Wilsons Disease is a well established and carefully studied rare metabolic disorder caused by excess accumulation of copper in the body.
ConclusionThe American Thyroid Association has found no scientific evidence supporting the existence of "Wilson's syndrome." The theory proposed to explain this condition is at odds with established facts about thyroid hormone. Diagnostic criteria for "Wilson's syndrome" are imprecise and could lead to misdiagnosis of many other conditions. The T3 therapy advocated for "Wilson's syndrome" has never been evaluated objectively in a properly designed scientific study. Furthermore, administration of T3 can produce abnormally high concentrations of T3 in the blood, subjecting patients to new symptoms and potentially harmful effects on the heart and bones.
The ATA supports efforts to learn more about the causes of somatic symptoms that affect many individuals, to test rigorously the idea that some as yet unidentified abnormality in thyroid hormone action might account for even a small subset of these symptoms, and to pursue properly designed clinical trials to assess the effectiveness of lifestyle, dietary, and pharmacological treatments for these common ailments. However, unsupported claims, such as those made for "Wilson's syndrome," do nothing to further these aims.
Posted by jms600 on April 10, 2008, at 15:58:59
In reply to Re: Bleauberry - could you elaborate a little...? » jms600, posted by bleauberry on April 8, 2008, at 21:31:46
Bleauberry - you're a star!
Thank you so much for the interesting and helpful advice. You beat talking to my doctor hands down!!
Thanks again,
Jamie
Posted by Zyprexa on April 11, 2008, at 2:23:52
In reply to Zyprexa isn't helping... what next??, posted by jms600 on April 8, 2008, at 4:21:55
Higher dose?
I take perphenazine with the zyprexa, because the zyprexa was not working so well and was giving diabetes.
This is the end of the thread.
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