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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Nic on September 26, 2000, at 9:26:10
Hi, I am new to this board and I am trying to get some feed back.
I have been on Prozac now for about 5 years at 20mg. a day. It always seemed to make my nervousness worst.
With in the last year my PDoc has had me on Ativan 1mg. two to three times a day.
Recently he also put me on Serzone 200mg at bedtime.My anxiety still goes up and down allot. Some time it seems that I have to take more Ativan to help. And any time I've to get off Ativan, it's terrible.
Couple of Questions????? Do I have to be on Serzone and Prozac together, or just take Serzone alone.
Also. What works best for anxiety and panic attacks?????? Which are the killers for me beside my depression. I have been diagmosed as being Bi-polar.
Thanks you so much in advance!!!!!!!
It seems like a great board.
Posted by Greg on September 26, 2000, at 9:49:43
In reply to HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 26, 2000, at 9:26:10
Nic,
I also have very extreme anxiety and occasional panic attacks. I take Xanax (.5mg as needed) and it's been very helpful for me. I believe it's one of the strongest of the benzos. The downside being that it can be very addictive if not monitored closely. There are many other meds available for acute anxiety and panic, but this is the one that's worked best for me. Hope this helps.
And welcome to Babble!!!
Greg
> Hi, I am new to this board and I am trying to get some feed back.
> I have been on Prozac now for about 5 years at 20mg. a day. It always seemed to make my nervousness worst.
> With in the last year my PDoc has had me on Ativan 1mg. two to three times a day.
> Recently he also put me on Serzone 200mg at bedtime.
>
> My anxiety still goes up and down allot. Some time it seems that I have to take more Ativan to help. And any time I've to get off Ativan, it's terrible.
>
> Couple of Questions????? Do I have to be on Serzone and Prozac together, or just take Serzone alone.
>
> Also. What works best for anxiety and panic attacks?????? Which are the killers for me beside my depression. I have been diagmosed as being Bi-polar.
>
> Thanks you so much in advance!!!!!!!
>
> It seems like a great board.
Posted by catherine on September 26, 2000, at 12:20:38
In reply to HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 26, 2000, at 9:26:10
Nic,
I'm also new to the Board and Bipolar. Been diagnosed three years ago. Been on many meds., recently, Neurontin. I take Xanax for anxiety attacks seems to work great. Anything I can help you with just let me know.
Good luck! Catherine
Posted by dove on September 26, 2000, at 14:34:15
In reply to Re: HELP!!!!! Anxiety and Panic Attacks!, posted by catherine on September 26, 2000, at 12:20:38
Neurontin (Gabapentin). I'm dxed with a bunch of junk, bipolar/anxiety/panic/ADHD being the biggies. Just started the Neurontin in July and it is having an amazing effect on the mood swings, and a mild soothing effect on my anxiety. Just upped the daily dosage last week by another 300mgs in hopes of getting some anti-anxiety effects activated. My p-doc has also mentioned Klonopin and will be discussing that med in better detail three weeks from now.
dove
Posted by Nic on September 26, 2000, at 22:06:41
In reply to Re: HELP!!!!! Anxiety and Panic Attacks!, posted by dove on September 26, 2000, at 14:34:15
Should I continue to take the serzone with the Prozac, or just Serzone alone. Also for the anxiety, I've heard that Klonopin is longer lasting and was wondering is this would me more than the Ativan. Since i feel like I have to take more Ativan for it to work for me.
By the way. Thanks so much for th responses!
Nic
> Neurontin (Gabapentin). I'm dxed with a bunch of junk, bipolar/anxiety/panic/ADHD being the biggies. Just started the Neurontin in July and it is having an amazing effect on the mood swings, and a mild soothing effect on my anxiety. Just upped the daily dosage last week by another 300mgs in hopes of getting some anti-anxiety effects activated. My p-doc has also mentioned Klonopin and will be discussing that med in better detail three weeks from now.
>
> dove
Posted by Cam W. on September 27, 2000, at 6:50:18
In reply to HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 26, 2000, at 9:26:10
Nic - You may be experiencing what people on this board call "Prozac poop-out". For some reason, SSRI antidepressants sometimes stop workimg after a while. Several strategies have been tried; all with varying degrees of success in different people. Some docs lower the SSRI dose (others increase the dose), both of which sometimes helps. Others add an augmenting agent; either an antidepressant with slightly different properties; like your doc has done, or something like lithium or an atypical antipsychotic (like Zyprexa). Serzone and Prozac are often taken together, but there is a low risk of serotonin syndrome (flushing, rapid heartrate, etc.) if the blood levels of the augmenting antidepressant (Serzone) get too high (usually not a problem at 200mg daily).
Usually though, docs change to a similar antidepressant; in this case another SSRI like Paxil or Zoloft. Paxil is used fairly extensively because it has some better antianxiety activity than other SSRIs. A new SSRI may make your attacks worse for the first couple of weeks, as your bdoy adjusts to the drug, but in the long run the Paxil seems to hold the Panic in check, in many people. You need to give the Paxil at least an 8 week trial to see full effects with it (as needs to be done with any antidepressant). This is something to talk to your doc about.
Also, your increase in Ativan use should be a concern, if it continues. This may be a signal that Prozac poop-out may be occuring. It is definitely something to talk to the doc about.
Hope this helps some (& welcome to the board) - Cam
Posted by JohnL on September 29, 2000, at 4:25:25
In reply to HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 26, 2000, at 9:26:10
> Thanks you so much in advance!!!!!!!
>
> It seems like a great board.Nic,
You are right. Awesome board. Some of the most helpful folks in the world hang out here.Concerning your questions, I'm sorry to say I don't think there are any easy answers. I'll tell you why.
First of all, one of the primary side effects common to Prozac is nervousness or anxiety. That doesn't mean it always happens, but it is a common trait of Prozac.
Second, Serzone can be either anti-anxiety or pro-anxiety. It varies dramatically from one person to the next.
Furthermore, in Dr Bob's Tips as well as other literature, there is an apparent interaction between Serzone+Prozac that can result in excessive anxiety. You might try stopping the Prozac and see how things go with just Serzone. It will take 4 weeks or more for the Prozac to washout (you can stop abruptly if you want to).
When you read my posts, please try to understand that I view psychiatry from a slightly modified perspective than the general population. Most people interested in psychiatry are trained to diagnose symptoms and then treat those symptoms with medications generally accepted as being appropriate for those symptoms. I instead try to treat the cause of the symptoms. That way, instead of just numbing the symptoms or fixing them by a domino effect that takes time, correct the guilty chemistry at the heart of the problem and thus eliminate the symptoms completely.
What will work for you? Who knows. Only through trial and error can we gather clues as to what chemistry is responsible in your case. Here are some examples to consider:
A 79 year old successful enterpreneur had seen over 10 doctors for depression and anxiety. He said substances which stimulated NE (antidepressants, asthma meds) worsened his condition. After the evaluation, within 2 hours, a single Lithium daily allowed him to feel good for the first time in his life, probably for the rest of his life.
A middle aged woman complained of chronic moodiness, headache, and anxiety. She said all antidepressants worsened her and that Lithium didn't help. Electrical smoothing with Depakote made her normal within hours.
I could go on and on with tons of examples like these, but they all point to the same conclusion...anxiety is caused by a variety of chemical imbalances (at least 10), and your treatment might be limited and frustrating if restricted to just antidepressants and benzos.
During a year studying 750 anxiety with depression patients who got completely well, here is a statistical breakdown of what worked...
Serotonin antidepressants 37%
Other antidepressants 11%
Benzos 24%
Lithium 22%
Stimulants 14%
Antipsychotics 13%
Anticonvulsants (Depakote) 11%
Anticonvulsants (Tegretol) 3%
Thyroid 24% (though was sometimes a factor, was not a cure)Stimulants required a 4 to 6% of maximum antipsychotic dose 21% of the time.
Beta adrenergic blockers such as Inderal were not recorded, but were sometimes helpful especially for palpitations.
Estrogen (females) was not recorded, but was sometimes helpful.A good doctor can help sort out the clues. If you're worse or unimproved with a certain medication, chances are good the chemistry will be targeted by a different medication class. Don't rule anything out. Anything's possible. If your doctor is only considering ADs and benzos, he/she is ignoring a whole lot of other chemical imbalances that result in anxiety and depression.
John
Posted by Nic on September 29, 2000, at 11:06:47
In reply to Re: HELP!!!!! Anxiety and Panic Attacks!, posted by JohnL on September 29, 2000, at 4:25:25
> Thanks John and all of you that have responded.
What about the Klonopin that was mentioned versus the Ativan?Thanks Again,
Nic
> > Thanks you so much in advance!!!!!!!
> >
> > It seems like a great board.
>
> Nic,
> You are right. Awesome board. Some of the most helpful folks in the world hang out here.
>
> Concerning your questions, I'm sorry to say I don't think there are any easy answers. I'll tell you why.
>
> First of all, one of the primary side effects common to Prozac is nervousness or anxiety. That doesn't mean it always happens, but it is a common trait of Prozac.
>
> Second, Serzone can be either anti-anxiety or pro-anxiety. It varies dramatically from one person to the next.
>
> Furthermore, in Dr Bob's Tips as well as other literature, there is an apparent interaction between Serzone+Prozac that can result in excessive anxiety. You might try stopping the Prozac and see how things go with just Serzone. It will take 4 weeks or more for the Prozac to washout (you can stop abruptly if you want to).
>
> When you read my posts, please try to understand that I view psychiatry from a slightly modified perspective than the general population. Most people interested in psychiatry are trained to diagnose symptoms and then treat those symptoms with medications generally accepted as being appropriate for those symptoms. I instead try to treat the cause of the symptoms. That way, instead of just numbing the symptoms or fixing them by a domino effect that takes time, correct the guilty chemistry at the heart of the problem and thus eliminate the symptoms completely.
>
> What will work for you? Who knows. Only through trial and error can we gather clues as to what chemistry is responsible in your case. Here are some examples to consider:
>
> A 79 year old successful enterpreneur had seen over 10 doctors for depression and anxiety. He said substances which stimulated NE (antidepressants, asthma meds) worsened his condition. After the evaluation, within 2 hours, a single Lithium daily allowed him to feel good for the first time in his life, probably for the rest of his life.
>
> A middle aged woman complained of chronic moodiness, headache, and anxiety. She said all antidepressants worsened her and that Lithium didn't help. Electrical smoothing with Depakote made her normal within hours.
>
> I could go on and on with tons of examples like these, but they all point to the same conclusion...anxiety is caused by a variety of chemical imbalances (at least 10), and your treatment might be limited and frustrating if restricted to just antidepressants and benzos.
>
> During a year studying 750 anxiety with depression patients who got completely well, here is a statistical breakdown of what worked...
> Serotonin antidepressants 37%
> Other antidepressants 11%
> Benzos 24%
> Lithium 22%
> Stimulants 14%
> Antipsychotics 13%
> Anticonvulsants (Depakote) 11%
> Anticonvulsants (Tegretol) 3%
> Thyroid 24% (though was sometimes a factor, was not a cure)
>
> Stimulants required a 4 to 6% of maximum antipsychotic dose 21% of the time.
> Beta adrenergic blockers such as Inderal were not recorded, but were sometimes helpful especially for palpitations.
> Estrogen (females) was not recorded, but was sometimes helpful.
>
> A good doctor can help sort out the clues. If you're worse or unimproved with a certain medication, chances are good the chemistry will be targeted by a different medication class. Don't rule anything out. Anything's possible. If your doctor is only considering ADs and benzos, he/she is ignoring a whole lot of other chemical imbalances that result in anxiety and depression.
> John
Posted by tjweeks on September 29, 2000, at 14:42:07
In reply to Re: HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 29, 2000, at 11:06:47
> > Thanks John and all of you that have responded.
> What about the Klonopin that was mentioned versus the Ativan?
>
> Thanks Again,
>
> Nic
>
> It seem as though all the doctors are rushing to try all the new drugs on patients. I had severe panic attacks for most of my life. They started when I was sixteen and seemed to reach their height when I was 31. I had always been afraid of trying pycho-meds. This was back in the early 80's. My doctor finally convinced me to try Triavil (Elavil and some major tranquilizer), it worked like a charm. Since then I have been on a maintenence dose of tofranil and ativan and have done great. The point of this is, the Doctors don't have to shove all this new stuff down your throats. The older trycillic medications, that have been around for 40 years, really do work, If you are frustrated with your present meds for panic and depression, tell your Doctor you want to try these.(I tried switching to Prozac about 4 years ago on my Doctors urgings and was having panic and depression again for the first time in 12 years. Went back to my good old trycillics and everything was fine again.
>
> > > Thanks you so much in advance!!!!!!!
> > >
> > > It seems like a great board.
> >
> > Nic,
> > You are right. Awesome board. Some of the most helpful folks in the world hang out here.
> >
> > Concerning your questions, I'm sorry to say I don't think there are any easy answers. I'll tell you why.
> >
> > First of all, one of the primary side effects common to Prozac is nervousness or anxiety. That doesn't mean it always happens, but it is a common trait of Prozac.
> >
> > Second, Serzone can be either anti-anxiety or pro-anxiety. It varies dramatically from one person to the next.
> >
> > Furthermore, in Dr Bob's Tips as well as other literature, there is an apparent interaction between Serzone+Prozac that can result in excessive anxiety. You might try stopping the Prozac and see how things go with just Serzone. It will take 4 weeks or more for the Prozac to washout (you can stop abruptly if you want to).
> >
> > When you read my posts, please try to understand that I view psychiatry from a slightly modified perspective than the general population. Most people interested in psychiatry are trained to diagnose symptoms and then treat those symptoms with medications generally accepted as being appropriate for those symptoms. I instead try to treat the cause of the symptoms. That way, instead of just numbing the symptoms or fixing them by a domino effect that takes time, correct the guilty chemistry at the heart of the problem and thus eliminate the symptoms completely.
> >
> > What will work for you? Who knows. Only through trial and error can we gather clues as to what chemistry is responsible in your case. Here are some examples to consider:
> >
> > A 79 year old successful enterpreneur had seen over 10 doctors for depression and anxiety. He said substances which stimulated NE (antidepressants, asthma meds) worsened his condition. After the evaluation, within 2 hours, a single Lithium daily allowed him to feel good for the first time in his life, probably for the rest of his life.
> >
> > A middle aged woman complained of chronic moodiness, headache, and anxiety. She said all antidepressants worsened her and that Lithium didn't help. Electrical smoothing with Depakote made her normal within hours.
> >
> > I could go on and on with tons of examples like these, but they all point to the same conclusion...anxiety is caused by a variety of chemical imbalances (at least 10), and your treatment might be limited and frustrating if restricted to just antidepressants and benzos.
> >
> > During a year studying 750 anxiety with depression patients who got completely well, here is a statistical breakdown of what worked...
> > Serotonin antidepressants 37%
> > Other antidepressants 11%
> > Benzos 24%
> > Lithium 22%
> > Stimulants 14%
> > Antipsychotics 13%
> > Anticonvulsants (Depakote) 11%
> > Anticonvulsants (Tegretol) 3%
> > Thyroid 24% (though was sometimes a factor, was not a cure)
> >
> > Stimulants required a 4 to 6% of maximum antipsychotic dose 21% of the time.
> > Beta adrenergic blockers such as Inderal were not recorded, but were sometimes helpful especially for palpitations.
> > Estrogen (females) was not recorded, but was sometimes helpful.
> >
> > A good doctor can help sort out the clues. If you're worse or unimproved with a certain medication, chances are good the chemistry will be targeted by a different medication class. Don't rule anything out. Anything's possible. If your doctor is only considering ADs and benzos, he/she is ignoring a whole lot of other chemical imbalances that result in anxiety and depression.
> > John
Posted by JohnL on September 29, 2000, at 14:50:49
In reply to Re: HELP!!!!! Anxiety and Panic Attacks!, posted by Nic on September 29, 2000, at 11:06:47
> > Thanks John and all of you that have responded.
> What about the Klonopin that was mentioned versus the Ativan?
>
> Thanks Again,
Nic,Klonopin or Ativan. Might as well flip a coin. It's not at all uncommon for one to work while another doesn't. It never ceases to amaze me how each person's chemistry willingly embraces one molecule but forcefully rejects another. Trial and error, that's the only way to tell. If it's the right choice, you'll know it without a doubt. If it isn't, you can at least gather clues from whatever reactions you do have to try to help guide future medication choices.
This is the end of the thread.
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