Posted by Toby on November 9, 1998, at 14:55:38
In reply to Re: depression and GAD, posted by jj on November 4, 1998, at 12:55:20
I had an answer last week, but it seems to have gotten lost... perhaps I didn't submit correctly. Anyway, I don't think the Wellbutrin would be causing an increase in anxiety, especially if you've been on it for many years. However, it is not exceptionally good at treating panic attacks by itself. Generally, one of the SSRI's or Tofranil is used for panic attacks with good results. If you haven't been on Paxil or Zoloft before, those would be well worth a try. Some doctors are willing to prescribe a benzodiazepine in small doses while the SSRI is taking effect. If you have been on several medications in the past (maximum dose for at least 12 weeks) without benefit, then perhaps a benzodiazepine is best. I generally go for Klonopin (not so much because it is less abusable, because anybody could abuse anything if they wanted; and besides people with true anxiety tend to be afraid of medications and don't go on to abuse them) because it has a smoother course of action...slow onset, steady release into the body and long duration of action so you don't get withdrawal effects between doses which can feel just like the old panic attacks, and that long duration means you don't have to take it so many times a day to keep the attacks away. Once you find a dose that works, you generally don't need to change the dose for many years because the chemical imbalance has been corrected and generally that is a stable thing. If you haven't been on Paxil, ask the doctor about that. Because it has an annoying tendency to actually cause anxiety in anxious people if you use too high a dose at first, I generally start out with a 10 mg tablet, take half a tablet for a few days, then go up by 5 mg every 3-4 days until 40 mg per day is reached (that seems to be the magic dose for panic, although some people need less, some need a little more). That prevents the pill-induced anxiety. Once you find that it gives you no side effects, you can increase the dose by 10 mg every 3-4 days to reach 40 mg a little faster. Most people get a response pretty quickly.
poster:Toby
thread:1021
URL: http://www.dr-bob.org/babble/19981101/msgs/1112.html