Posted by Rick on August 24, 2001, at 1:32:59
In reply to Re: Xanax and panic, Elisabeth, more., posted by Thrud on August 23, 2001, at 20:54:24
You shouldn't be too quick to dump the Xanax without giving yourself time to adjust to the side effects, and perhaps even finding that you can lower the dosage without losing benefit.
While it varies greatly by individual, many find that Klonopin works a lot better as an ongoing treatment for panic than Xanax, and at lower equivalized doses with less fatigue. That's certainly true for loads of people who post here. It is longer acting and thus doesn't need to be taken as often. If you check Medline you'll see other benefits as well. If the Xanax doesn't work out, you should *definitely* give Klonopin a try. (It's the mainstay of my social phobia treatment. It actually *increases* my libido at a moderate dose, but I'm not sure that's typical.)
Getting back to short-acting benzos, some people respond better to Ativan than they do to Xanax.
Benzos are the gold standard for panic -- even if many docs remain benzophobic -- but there are other alternatives besides SSRI's.
The reversible (no food restrictions) MAOI moclobemide has shown success in many panic disorder studies (with and without comorbid depression). It has about the lowest incidence of sexual dysfunction of all the AD's.
Serzone, while having a somewhat lower success rate for panic than the SSRI's, works very well for many people. It has a very low incidence of drug-induced sexual dysfuntion (I take it with the Klonopin with no problems in that regard), but at the highest doses it can have a sexually inhibiting effect in some. Many people find it quite sedating, although some don't. You just never know...
I've heard a few reports of Remeron efficacy in panic. It has a lower incidence of sexual dysfuntion than SSRI's, but not as low as Serzone. It tends to be even more sedating than Serzone, and has a reputation for inducing weight gain.
On the OTC front, some panic specialists find that Taurine supplementation is all that is needed for some patients. (Taurine is an amino acid, one of the ingredients in Red Bull -- not that I'm suggesting you use Red Bull!)
Finally, several Israeli studies found that mega-doses of Inositol (a B vitamin) work as well as SSRI's in panic (and OCD), without side effects. See Medline.
Good luck, and please read the following article on panic, which was posted here a couple months ago by another individual. It's fabulous information (much of it applicable to *any* anxiety disorder), even though I do disagree with the author on a couple of points. It points out how benzos are generally most efective longterm in PD, yet high-powered pharmaceutical company marketing, and benzophobia in the medical community cause PD sufferers to end up with (usually) inferior and side-effect-laden SSRI treatment instead.
http://bearpaw8.tripod.com/pd.html
Rick
> > > (Conversely, when I am unmedicated my libido is fantastic).
> >
> > Do you have atypical depression as well as PD, by any chance?
>
> I am absolutely intrigued that you made this link. When I am at my most anxious/depressed is when I have my *highest* libido, which flies in the face of the classic depression=no libido scenario.
> Therefore, I ask you the Holy Grail question that no pdoc has successfully answered for me: is there a drug or group of drugs which will help the atypical depression/pd group WITHOUT killing the sex drive?
> Thanking you in advance for divine insight.
>
> Thrud
>
poster:Rick
thread:76063
URL: http://www.dr-bob.org/babble/20010822/msgs/76199.html