Posted by Thrud on August 30, 2001, at 20:06:39
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Jackster on August 30, 2001, at 4:30:33
> Sorry this is off the topic of your thread -no problem..
but there was something about the description of your panic attacks that I wanted to ask you about. I've had agoraphobia with PA's for about 15 years - Paxil worked great for about 3 years and then pooped out, but that's another story. My father has been having medical problems for the last few months. He's been experiencing tightness in his chest, a kind of 'halo' effect in his vision and headaches. Anyway he's been to the Emergency Dept a couple of times and had a lots of tests - CAT scans, treadmill, blood tests - all normal. The doctor(s) finally diagnosed panic attacks - which my father won't accept - and which I find strange because the symptons are so different from mine. I have the classic hyperventilation, fear of dying, going crazy, racing heart etc. What you described sounds kind of like what my father had - would you mind giving me a more detailed description of your symptoms? The doc prescribed Paxil, but my Dad took it for one day and decided it was making him worse. I'm just wondering if someone else has the same kind of symptoms as him that he might accept the diagnosis.
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> If you don't want to talk about it, that's cool too.
>
> Thanks
> JackieFirst of all realize that I am *not* a doctor: all I have done is read up a lot on my (our) very painful affliction. Second, I am not sure I can give a more detailed description of my attacks: what I wrote pretty much covers it! Oh, except I have never had irritable bowel syndrome or gastric reflux which is supposed to be synonymous with PD. Nor have I ever had an attack while sleeping, which is also supposed to accompany PD.
I'll cut to the chase. First, there seems to be a growing recognition of sub-groups of PD: some have symptoms which overlap strongly with epilepsy, some with heart conditions. And I have read various scraps of information that some PD is actually epilepsy which occurs at deep structures in the brain: places where EEG will not pick up such disturbances (EEG only picks up 'surface' cortical epilepsy). Has your father had an EEG? If not, he should have. The docs may want him to be strapped to a portable machine for 24 hours or more to 'intercept' an attack. Visual disturbances related to epilepsy should be able to be picked up by EEG. What type of specialist(s) has he been seeing? The first place to go is a neurologist, not a psychiatrist. An endocrinologist should also be seen: adrenal tumors and thyroid problems can lead to panic attacks (I presume the CT scan ruled out pituitary tumors?). For safety reasons all physical causes should be ruled out first. By the sounds of it his heart has been checked, correct? (mitrial valve prolapse is sometimes misdiagnosed as panic disorder) I would not ask him to 'accept' his diagnosis until all possible physical causes have been ruled out.
Let's presume there are no physical causes for his symptoms and he has PD. How old is he? Often older people react more poorly to medications in general. As you would probably know, SSRIs are painful at the best of times (they were for me anyway) and it is probably harder for older people to tolerate. It is also a feature of SSRIs that you tend to get worse before you get better and that a few weeks of hell may have to be endured before improvements occur. Was he warned about this? Often now docs will prescribe a benzo of some sort for a couple of weeks to help them get over that initial 'hump'. I am surprised that he felt so bad after just one night though...maybe he hated the sedative feeling? More likely he hated his new stigmatizing 'label' which taking Paxil represented. There is no way the effectiveness of Paxil can be evaluated in one day.
Furthermore, over my >10 years of PD I generally responded quite poorly to all AD medication: they could not prevent breakthrough attacks. This is true of many PD sufferers. Whatever little subgroup of PD I fall into, I discovered by accident that I responded better to benzos than any other class of drug. The combo of the AED Lamictal and benzo also works quite well for me. Lamictal has not been trialled for PD however (I was just getting desperate). If your father only has attacks infrequently and can 'feel' them coming before they actually hit, I would ask the doctor if he should just carry around some benzos espescially Xanax) and use them to stop an oncoming attack when needed. This will be *much* less painful for him than taking Paxil continuously. Nor will be become addicted to them if his need is *infrequent*.
Benzos are not totally benign though. If you take them every now and again "as needed" you will feel tired and maybe groggy not too long after taking them, so you must find a place to rest for a couple of hours. A definite bummer if you are driving when it hits. Also, older people are more prone to the sedation. If he suffers frequently, he may be able to take benzos on a long term basis, like me. It takes a few weeks for the sedation and grogginess to go away, but they will. Once your body is used to them, in my experience they are much more tolerable than ADs. But that is also a part of the tolerance-addiction aspect of benzos: you cannot simply stop them, only taper down slowly. If you say "I do" to benzos, expect a long marriage!
An important consideration is depression. If your father also suffers from depression then he will *probably* need an AD, but it is surprising how the depression of many PD sufferers lifts once they are free from the constant pain of their anxiety. This is true of me.
I hope I have helped you some. Remember that I am not a doctor! Just a fellow suffer.
Thrud
poster:Thrud
thread:76063
URL: http://www.dr-bob.org/babble/20010828/msgs/77015.html