Posted by Elizabeth on August 29, 2001, at 12:08:46
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 26, 2001, at 21:37:23
> When I first crawled to a shrinks office he suspected possible epilepsy.
Periodically, some doctor will bring that up to me too. I think it's pretty much been ruled out (and beaten into the ground) by now.
> When the EEG came back normal he diagnosed panic and put me on some tricyclic (doxepin I think). It was almost as bad as nothing.
Hmm. That's surprising. How much were you taking, if you remember?
> The depression, on the other hand, responded quickly and very easily.
Responded to what, exactly?
> Only two types of med have treated PAD adequately for me:
>
> Lamictal (only AED-mood stabilizer I've ever tried).I don't know that Lamictal has ever been studied as a treatment for panic disorder, although it would be reasonable to try it, especially when other things haven't worked.
> Xanax (only benzo I've ever tried). At 6mg per day, STRONG sexual dysfunction (cognitive problems again, word recall + attention). Bad ataxia (stumbling like drunk).
6 mg is on the high end. But anyway, I wonder if one of the other high-potency benzos (Klonopin, Ativan) might work for you without the side effects.
It's weird that antidepressants didn't help at all. Were you able to tolerate them for long enough to find out if they would help?
> Any cognitive difficulties with the 4mg/day Klonopin? If yes, were they transient?
No side effects that I've noticed.
> What is adinazolam? I am going to look it up...
It's a triazolobenzodiazepine, like Xanax. Brand name is Deracyn. It's not marketed in the USA, but in other countries it's used as an antidepressant and anxiolytic.
> How do benzos exert an antidepressant effect?
Other than the triazolo- benzos, I don't think they do. And I don't know the mechanism in the case of the triazoloBZDs.
> I thought that the GABA system was rather independent from the HT-NE-DA chain?
All of them are related; and there's no conclusive evidence to show that depression is necessarily caused by any problem with monoamines in particular.
> So am I. He is fairly old (late 60s I am guessing)and been practicing for a long time. His clinical experience goes strongly against a lot of the 'fad' stuff like anti-benzo crusades, so he chooses experience over fads.Good for him!
> > Have you ever tried a stimulant, like Ritalin, Adderall, Dexedrine, Cylert, or Provigil?
>
> No. That is another possible avenue. I read somewhere that opiates (or is it opioids) have been used against PAD. Have you heard of this?Yes, I have -- mainly morphine, I think. I take buprenorphine (a synthetic opioid that is a partial mu agonist) myself, and while it does seem to reduce the frequency of panic attacks, it has some side effects (for me, anyway) that can trigger attacks.
Opioids can definitely cause sexual problems, BTW.
> If you look up Selegiline on rxlist.com sexual dysfunction appears *everywhere* as a side effect! I do not know why so many people claim it has prosexual properties.
Actually I'd sooner go with the reputation it has among people who've taken it, rather than what rxlist says (the monographs on rxlist are the same ones that are in the PDR).
> As for Parnate, as soon as I read the side-effect profile I got flashbacks of the bad old days of TCAs and SSRIs: I am never going down that path again.
Once again, don't be scared by the side effects that are listed for it. There's no reason to assume that any particular one will happen to you (although orthostatic hypotension and insomnia are very likely -- the benzos may offset the insomnia, though).
> > It would be interesting to see how the combination of a stimulant and Xanax would work.
>
> Yes, I will definitely discuss this with my pdoc.I'd be interested to hear what he has to say.
[re inositol]
> > I've heard good things about it. I never tried it myself.
>
> 'Heard' as in published literature or anecdotally?Both.
-elizabeth
poster:Elizabeth
thread:76063
URL: http://www.dr-bob.org/babble/20010828/msgs/76812.html