Psycho-Babble Medication Thread 74094

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Depakote = panic attacks??

Posted by MM on August 8, 2001, at 2:46:11

As I've mentioned quite a bit,I just started Depakote ER (500mg) and paxil (10mg). My old panic attacks are returning. Before I took any medication (SSRI's are what I was given) I had panic attacks fairly often. They were the body kind. The pounding, racing heart, intense fear, shakes, weak in the knees etc. After I took the SSRI's, I guess THAT kind of panic attack went away, but I didn't notice. Now that they've returned since I started the depakote/paxil, I realise they were gone for a while, or were different. I'm thinking possibly the depakote is making me depressed so that's why I'm getting the PA's again. I still had PA's after/during SSRI's, but they were more of a mind panic attack if that makes sense. I got overwrought with worry about my life, and my mental health. I'm still feeling that way, but now I'm getting panic attacks like I had when I was diagnosed with agoraphobia, before I took SSRI's.
I can't see my pdoc til early september (I think I'll be begging for neurontin), and don't want to call him because I've only been on this combo for about 5 days, and he'll be on vacation for a couple weeks in late august.
Sorry for rambling. I feel like my posts are getting on people's nerves here, so if I'm bothering anyone, just tell me, but does anyone have any idea why I'm getting panic attacks on depakote? Has anyone else had this happen? Will it go away after a while? Is my dose in the average range? I read Depakote's good for panic, but it's obviously not working for me. I feel pretty bad on this stuff.

 

Re: Depakote = panic attacks?? » MM

Posted by Mitch on August 8, 2001, at 8:31:54

In reply to Depakote = panic attacks??, posted by MM on August 8, 2001, at 2:46:11

> As I've mentioned quite a bit,I just started Depakote ER (500mg) and paxil (10mg). My old panic attacks are returning. Before I took any medication (SSRI's are what I was given) I had panic attacks fairly often. They were the body kind. The pounding, racing heart, intense fear, shakes, weak in the knees etc. After I took the SSRI's, I guess THAT kind of panic attack went away, but I didn't notice. Now that they've returned since I started the depakote/paxil, I realise they were gone for a while, or were different. I'm thinking possibly the depakote is making me depressed so that's why I'm getting the PA's again. I still had PA's after/during SSRI's, but they were more of a mind panic attack if that makes sense. I got overwrought with worry about my life, and my mental health. I'm still feeling that way, but now I'm getting panic attacks like I had when I was diagnosed with agoraphobia, before I took SSRI's.
> I can't see my pdoc til early september (I think I'll be begging for neurontin), and don't want to call him because I've only been on this combo for about 5 days, and he'll be on vacation for a couple weeks in late august.
> Sorry for rambling. I feel like my posts are getting on people's nerves here, so if I'm bothering anyone, just tell me, but does anyone have any idea why I'm getting panic attacks on depakote? Has anyone else had this happen? Will it go away after a while? Is my dose in the average range? I read Depakote's good for panic, but it's obviously not working for me. I feel pretty bad on this stuff.

MM,

I don't think it is the Depakote that is responsible *directly*. However it may be worsening your depression like you said making you more susceptible to them. I would suggest Neurontin instead of Depakote as well (esp. for mixed anxiety/depression). You said you diagnosed with agoraphobia? Have you tried a TCA?
Some folks get melancholic on SSRi's, and the depakote proabably wouldn't help that any.

Mitch

 

Re: Depakote = panic attacks?? » MM

Posted by Cam W. on August 8, 2001, at 8:51:37

In reply to Depakote = panic attacks??, posted by MM on August 8, 2001, at 2:46:11

MM - It's probably the Paxil that is causing the panic attacks and anxiety. These are start-up side effects of SSRIs. It may seem weird to give someone something that worsens their condition, but this only lasts a week or two, and the antipanic/antianxiety action of the Paxil will begin to kick in (2-4 weeks) .

The reason for the increase in panic attacks/anxiety as a start-up side effect of SSRIs is that they are thought to the initially increase serotonin on the serotonergic nerve cell body and at the connections between serotonergic cell bodies (somatodendritic 5-HT1A receptor stimulation). As your body gets use to the increase in serotonin (as levels of receptors alter &/or levels of other neurotransmitters change in concentration), the action on the somatodendritic 5-HT1A receptors lessens and the flow of electricity between serotonergic nerve cells is improved (via serotonin release at the terminal end of the serotonergic axon, which stimulates 5-HT2 receptors on the next cell to fire and propagates - carrys on - the electrical signal). Thus, with the increase in serotonergic neuronal conduction (in certain parts of the brain - raphe nuclei to the amygdala?), the panic and anxiety are lessened. It takes 2 to 4 weeks (longer for full effect) to begin to notice the antipanic action of the Paxil.

Well, that was more than I was going to say. I hope it makes some sense to you.

Also, the Depakote isn't working at full strength yet; this usually takes 1 to 2 weeks to happen.

Hang in there, things should begin to settle fairly soon. - Cam

 

Re: Depakote = panic attacks?? » MM

Posted by SalArmy4me on August 8, 2001, at 10:04:42

In reply to Depakote = panic attacks??, posted by MM on August 8, 2001, at 2:46:11

Usually Depakote is really good for panic disorder. Maybe you need a higher dosage:

Year Book of Psychiatry and Applied Mental Health
Volume 1999(8) Annual 1999 pp 353-354
Efficacy of Divalproex Sodium in Patients With Panic Disorder and Mood Instability Who Have Not Responded to Conventional Therapy:

Introduction.-Individuals with panic disorder often experience depressive symptoms as well, and their response to treatment is poorer than that of patients with panic disorder alone. An 8-week trial was conducted to determine the efficacy of divalproex sodium in the treatment of patients with panic disorder refractory to conventional therapy and co-morbid mood instability.

Methods.-Patients in the open trial, flexible dose study received divalproex sodium at 250 mg twice daily, increased by 250 mg increments to reach serum levels of 300 to 600 [micro sign]mol/L. Assessments were conducted at baseline, at 4 weeks, and at 8 weeks by self- and rater-administered questionnaires.

Results.-Ten patients, 6 women and 4 men, completed the study. The mean age of the group was 43.9 years, and the mean duration of panic disorder was 19.3 years. All patients had previously been treated by a psychiatrist and had taken several antidepressants and benzodiazepines in the past. All had panic disorder and symptoms of mood instability; 7 had agoraphobia. Divalproex sodium brought about significant improvement in depressive and anxiety symptoms and mood instability. The average number of panic attacks decreased from 4.3 full attacks and 4 limited attacks weekly to 1.5 full attacks and 1.0 limited attack at the end of the 8-week study, a statistically significant and clinically important change. By week 8, 80% of patients reported being much or very much improved.

Conclusion.-Divalproex sodium proved useful in the treatment of patients with panic disorder and concomitant mood instability. All patients had failed to respond to the standard treatment of antidepressants and cognitive behavioral therapy.

This interesting case series from Canadian researchers is 1 of several suggesting that valproic acid may be useful for panic disorder. Although this, in itself, is not much in the way of news, the growing evidence that there is an interface between bipolar disorder and panic disorder is of clinical significance. This is where an anticonvulsant mood stabilizer may play an important therapeutic role. Many panic patients talk about mood swings (and it is easy to dismiss this as something related to their disorder) when, in fact, they may be describing bipolar disorder type II symptoms. As the authors noted, a double-blind study is indicated to test this possibility further. Interestingly, there was a recent study of cocaine abusers who were treated with carbamazepine; those with "mood spectrum" symptoms in addition to the cocaine abuse did better with carbamazepine treatment overall than did those patients who did not have any evidence of a mood disorder.

 

Re: Depakote = panic attacks??.....thanks

Posted by MM on August 8, 2001, at 19:14:06

In reply to Re: Depakote = panic attacks?? » MM, posted by SalArmy4me on August 8, 2001, at 10:04:42

Thanks guys. I'm not sure if the paxil is causing this, though it's possible. I've tried paxil before and I don't *remember* PA's, but it's possible I had them for the first few weeks. I've never tried a TCA, or benzo and I wanted neurontin, but my pdoc said you can't tweak it. It has both the antidepressant and mood stablization effects, but they're not very strong, and you can't raise the antidepressant effect without changing the mood stabilization effect I guess. Maybe I can get him to add it on next time.
I'll just stick this out for a few more weeks and hope it gets better.


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