![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 40. Go back in thread:
Posted by Thrud on August 26, 2001, at 21:37:23
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 26, 2001, at 9:47:27
> Just getting a diagnosis and finding a treatment that worked virtually eliminated my anticipatory anxiety. You know? It was like, wow, there's a name for this and it's treatable. PAD has been much easier for me to deal with than depression (it started a lot later, too).
I was the reverse. I suffered very strong "agitated" sort of anxiety for at least 6 months before the PAs started. It was after "they" began, started spiralling up in frequency until I was having many per day that my atypical depression started. When I first crawled to a shrinks office he suspected possible epilepsy. 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. And so the 11 year struggle began..
The point I am making is that I was probably diagnosed correctly right from the start but no AD ever fully suppressed the attacks and corresponding anticipatory anxiety. The depression, on the other hand, responded quickly and very easily. I think only psychological depression remains: not regaining sexual function. Only two types of med have treated PAD adequately for me:Lamictal (only AED-mood stabilizer I've ever tried). Unfortunately gave me sexual dyfunction w/cognitive difficulties (word recall) and high levels of residual anxiety (but no attacks). Still needed some Xanax.
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).
(BTW the worst cognitive problems I ever had was with Effexor XR. I was angry and embarassed for years with that)>Klonopin (which I've been taking at 4 mg/day for about 2 weeks because desipramine doesn't work as well for PAD as Parnate did) doesn't seem to be much of an AD, either. (Xanax is supposed to be a better AD than the other benzos, anyway, except for adinazolam of course.)
Any cognitive difficulties with the 4mg/day Klonopin? If yes, were they transient?
What is adinazolam? I am going to look it up...
How do benzos exert an antidepressant effect? I thought that the GABA system was rather independent from the HT-NE-DA chain?
> > I do, but it is not really very strong or activating (not enough to counteract the AD depression). The antidepressant effect is why, at the moment, my pdoc is sticking firmly with Xanax.
>
> That makes sense to me. I'm glad he's not a benzophobe.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.
> > > I think there are differences that aren't taken care of by transsexual surgery and hormone therapy. :-) I guessed that you're a guy because it seems like sedatives tend to have that effect on men but not on women (if anything, they have the reverse effect on women).
> >
> > Hmmm. Maybe I should peddle some of my stuff as 'Viagranax' ;)
>
> I feel really dense, like there's a joke that I'm not getting. (Explain?)Dumb joke: Viagranax as in Xanax, the "Viagra" for women. (even though viagra is obviously not an aphrodisiac, that is the public perception)
> That's pretty scary -- it seems like all different sorts of ADs do that to you. 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? My google searches aren't turning up much. Maybe you know the pros and cons of these drugs?
>
> Wellbutrin was icky for me. It made my depression worse -- I was anxious and constantly ruminating, I was waking up in the middle of the night feeling miserable more often and it was harder to get back to sleep, I was on edge and easily startled, I stopped eating altogether.I fully understand. I could not sleep, full stop. The slightest sound would wake me. One thing I will say for benzos: *great* nights sleep without feeling drugged out when you wake up.
> That's why I thought Parnate would be the MAOI for you to try. Selegiline is tricky and can cause agitation.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.
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.
> 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.
> > Have you tried inositol by chance? I have come across one or two studies suggesting it is better against panic and depression than prozac. Since it is not a patentable material, I do not expect to find much more about it.
>
> I've heard good things about it. I never tried it myself.'Heard' as in published literature or anecdotally?
> > After more than 10 years of this merry-go-round I am tempted to adopt a "Darth Maul" costume, accept my bitterness and wreak revenge on an innocent world!
>
> < giggle fit >Yes, and Jar-Jar Binks will be the first to take a double-bladed light sabre to the head...
Thrud
Posted by gilbert on August 26, 2001, at 23:41:41
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 26, 2001, at 21:37:23
Thrud,
I take xanax and have tried klonopin, the klonopin made Mr. Happy very sad although I have to admit that I felt like a million bucks otherwise. The long half life on the klonopin was wonderfullllll. I take xanax and at higher doses it can have negative sexual effects mostly lethargy but those do seem to wear off. My sex drive kind of comes and goes...I am a bunny one week and a turtle the next., but the ssris obliterated my sexual capabilities completely. I take 1.5 to 2 mg per day......you may find after being on it a long time the dose may actually be effective lower. I have been able to reduce my dosage and find it works more effectively taken regularly. I also am able to get 12 to 24 hour runs out of doses without too much rebound although I here that is unusual. Elizabeth knows of the study on benzos and sex it seems that klonopin is one of the few benzos causing impotence....which it did to me. But everyone is so different alot op folks on this board have been helped by klonopin in the sex area....hope this helps.
Gil
Posted by SalArmy4me on August 27, 2001, at 0:02:28
In reply to thrud and xanax and sex, posted by gilbert on August 26, 2001, at 23:41:41
Practice Guideline for the Treatment of Patients With Panic Disorder. American Journal of Psychiatry. 155(5S) Supplement:1-34, May 1998:
c. Bupropion
Bupropion has been found to be effective in the treatment of depression. Proposed mechanisms of action include dopaminergic and noradrenergic agonist effects. Although there have been several small clinical trials using bupropion for patients with panic disorder, there is general consensus that it is not effective in alleviating either the somatic or psychological symptoms of panic attacks. It may have a role as an adjunctive treatment for patients with panic disorder who suffer sexual dysfunction as a side effect of other antidepressant medications, but it nevertheless may be potentially "overenergizing" for this specific patient group [160].
Posted by Thrud on August 27, 2001, at 2:43:17
In reply to Re: thrud and xanax and sex » gilbert, posted by SalArmy4me on August 27, 2001, at 0:02:28
> Practice Guideline for the Treatment of Patients With Panic Disorder. American Journal of Psychiatry. 155(5S) Supplement:1-34, May 1998:
>
> c. Bupropion
> Bupropion has been found to be effective in the treatment of depression. Proposed mechanisms of action include dopaminergic and noradrenergic agonist effects. Although there have been several small clinical trials using bupropion for patients with panic disorder, there is general consensus that it is not effective in alleviating either the somatic or psychological symptoms of panic attacks. It may have a role as an adjunctive treatment for patients with panic disorder who suffer sexual dysfunction as a side effect of other antidepressant medications, but it nevertheless may be potentially "overenergizing" for this specific patient group [160].Hi Sal.
Buproprion actualy *inhibited* my sexual response as well! I used it for a hellish period of monotherapy to properly test it out. Once it was certain it was not going to be of help in the sex department I kicked the packet for a field goal!
Thrud
Posted by Thrud on August 27, 2001, at 2:58:50
In reply to thrud and xanax and sex, posted by gilbert on August 26, 2001, at 23:41:41
Hi Gil!
> Thrud,
I take xanax and at higher doses it can have negative sexual effects mostly lethargy but those do seem to wear off. My sex drive kind of comes and goes...I am a bunny one week and a turtle the next., but the ssris obliterated my sexual capabilities completely. I take 1.5 to 2 mg per day......you may find after being on it a long time the dose may actually be effective lower.Were you on Xanax at the same time as an SSRI or other known "offender". If not, how long before Mr Happy became happy again? Did he return to his normal happy self or was there a residual "sadness"?
I am on 6mg per day and feel like an impotent, stupid drunk. But I am fairly relaxed (comfortably numb?)
>Elizabeth knows of the study on benzos and sex it seems that klonopin is one of the few benzos causing impotence....which it did to me.Was that the Vietnam Vet study? I think I read it. How long did you stick with the Klonopin? There was no Mr Happy improvement over that time?
>But everyone is so different alot op folks on this board have been helped by klonopin in the sex area....hope this helps.
Yes my archive searches show this to be true. I just don't understand! My pdoc wants me to stick to Xanax because of it's antidepressant effect, although he and I both understand that my depression has a direct psychological cause: medication induced impotence.
Thanks for your help Gil.
Thrud
Posted by Thrud on August 27, 2001, at 3:04:04
In reply to Re: Xanax and panic, Elisabeth, more. » Rick, posted by Rick on August 26, 2001, at 0:25:33
Hi Rick.
I just joined the alt.panic.something? group.
How the heck are you supposed to extract useful info from that rambling mess???!!!
Most of it seems to be idle chit-chat. From what I've seen, nothng like Babble-land!
Anyway, I've posted my usual pleading "please help" question and I'll see what I get.BTW, is there a search engine there so I can cut through the crap?
Thanks again Rick
Posted by Thrud on August 27, 2001, at 3:08:50
In reply to Re: thrud and xanax and sex » gilbert, posted by SalArmy4me on August 27, 2001, at 0:02:28
Congratulations on your success with Moclobemide. I hope it is everything you have been looking for.
We are all here looking for that magic pill, not to get "high" but to be *normal* again. I hope it does it for you and doesn't poop out or something.
(I was actually on it for a year or so. It was not very successful for PAD. Like the USS Enterprise I still boldy go...)
Thrud
Posted by gilbert on August 27, 2001, at 20:55:22
In reply to Re: BTW Sal...., posted by Thrud on August 27, 2001, at 3:08:50
Thrud,
I actually found the xanax to improved my sex drive while on an ssri which is probably not average. I am off ssris and find xanax does have a nice anti panic effect and helps my ruminating thoughts and gives me a little boost as well. I think at first I was too sedated to care about sex but I would guess after about a month I noticed my interest returned to almost normal.....when I say almost I mean sometimes I will still take a little longer to finish but the it still feels pretty darn good. How long have you been off ssris....it took me a long time after being on prozac to regain my orgasmic function.....could be some ssri residue adding to the xanax problem.
Now about the klonopin I did not give it a fair try because I was so sick of not being sexual by the time I got to the konopin on drugs to try I had no patience for any more sex problem.....some have waited it out and regained function.....you just gotta try and see. Also most panic patients are very sensitive to med side effects and are also very suggestible emotionally to side effects so make sure what you have is truly a physical manifestation of a chemical side effect and not a pyshcological manifestation of an unwanted side effect.
Good Luck,
Gil
Posted by Rick on August 28, 2001, at 1:03:44
In reply to Re: Rick: alt.panic, posted by Thrud on August 27, 2001, at 3:04:04
> Hi Rick.
>
> I just joined the alt.panic.something? group.
>
> How the heck are you supposed to extract useful info from that rambling mess???!!!
> Most of it seems to be idle chit-chat. From what I've seen, nothng like Babble-land!
> Anyway, I've posted my usual pleading "please help" question and I'll see what I get.
>
> BTW, is there a search engine there so I can cut through the crap?
>
> Thanks again RickDid you try searching at http://groups.google.com/ ?
This is a recently-added service of google.com that searches through several years of newsgroup posts. You don't even have to choose a specific group. Just enter several keywords in the search box, such as xanax and "sexual dysfunction" (i.e., use quotes to make it a string).
When you get your 40,000 results, it will show you the groups that use the terms the most, which will certainly include alt.anxiety-panic. If you want to narrow things down, you can then click on the link to that group to open a reverse-chronological listing of threads on the NG. Then you can re-enter the search terms, but this time click the radio button that says "search only in alt.anxiety-panic." to get a narrower list of postings that might be relevant. Etc. Always be sure to select "view entire thread." Yes, there's a lot of junk, but there may be some good stuff in there. I believe some regular Psycho-Babblers post frequently to alt.anxiety-panic, too.
I spent a few minutes nosing around like that myself and did find some people who complained of sexual dysfunction with Xanax. But frankly, the responses were usually along the lines of "Xanax never causes that, must be related to something else." The latter part of that statement is sometimes true, of course (something alluded to in gibert's last post), even if Xanax *can* cause SD for some, esp at high doses. Why don't you just try to wait it out a at least a few weeks more, and do see if maybe you could cut back a little with your doc's approval.
(I know, easier said than done!)
If that or some of the other ideas don't work, I'd still look into low-dose stimulant augmentation. If you do, there have been so many experiences in Babble-Land alone of sexual stimulation from selegiline that I really think you should consider it.
BTW, I looked for sexual dysfunction in the RXlist monograph for selegiline, too. It made me wonder if you and I were looking at the same site, given that you say you saw sexual dysfunction plastered all over the place. I only saw it once, and was listed in the laundry-list, who-knows-what-really-caused-it section that tends to include everything from hangnails to change of political affiliation. (Which is NOT to say that some people don't occasionally have very atypical reactions, as you know.) The Medscape monograph for selegiline (they try to stay very up to date) listed a "mere" 25 or so "less common" adverse effects for selegiline, and sexual dysfunction didn't make the cut. By the way, I think some of the references to "personality changes" etc. might have referred to elderly Parkinson's patients who had an unusual and maybe inappropriately-expressed increase in libido.
Hey, didja ever notice that the side-effects list for antidepressants always include depression?
If you live in a large metro, I wonder if you could find a psych who specializes in sexual disorders (even if your reaction IS all or mainly drug-induced). Not to *replace* your current guy, who sounds like a good one, but just to see if they might have any ideas for putting a grin back on Mr. Happy's face. Or maybe an endocrinologist? I believe certain hormonal/endocrine profiles could make one more susceptible. (As you can see, I'm just tossing out ideas at this point, some of which may or may not make sense.) If you're overweight or out of shape, maybe diet and exercise could help as well, either directly, or indirectly through anti-anxiety benefits that allow you to get by on less Xanax. (I'm certainly not implyng that that very-fit people aren't prone to sexual side effects, too.)
Rick
Posted by Thrud on August 28, 2001, at 6:38:42
In reply to Re: Rick: alt.panic(Caution: REAL babbling within), posted by Rick on August 28, 2001, at 1:03:44
Hi Rick
> Did you try searching at http://groups.google.com/ ?
Yes. Now I feel like a total retard since it was so obvious! (I think I'll blame it on the Xanax)
> I spent a few minutes nosing around like that myself and did find some people who complained of sexual dysfunction with Xanax. But frankly, the responses were usually along the lines of "Xanax never causes that, must be related to something else."Yes. That is exactly what I found out too. Problem is that very few used Xanax as monotherapy and those who did used it at low, PRN doses. Makes the culprit difficult to determine.
>The latter part of that statement is sometimes true, of course (something alluded to in gibert's last post), even if Xanax *can* cause SD for some, esp at high doses. Why don't you just try to wait it out a at least a few weeks more, and do see if maybe you could cut back a little with your doc's approval.
>
> (I know, easier said than done!)My pdoc said that he typically has PAD patients on initially high doses to first eliminate the panic and any other anxiety then over 18 months to 2 years the dose is slowly tapered down to very low or nothing. However, he acknowledges that my condition is chronic and very powerful, very likely requiring lifelong medication at an unknown final, "stable" dose. Will it be high enough to effect Mr Willy? Who knows.
BTW I am sticking it out until my pdoc says otherwise. The SD is very depressing, but in other respects the side effects of Xanax are simply bliss compared to ADs.
> If that or some of the other ideas don't work, I'd still look into low-dose stimulant augmentation. If you do, there have been so many experiences in Babble-Land alone of sexual stimulation from selegiline that I really think you should consider it.I see my pdoc in three weeks. Just today I mailed him a letter with some literature I pulled off the net asking him to consider selegine augmentation (at less than 10mg per day). Should be an interesting session. I also sent him information on inositol.
> BTW, I looked for sexual dysfunction in the RXlist monograph for selegiline, too. It made me wonder if you and I were looking at the same site, given that you say you saw sexual dysfunction plastered all over the place.
My apologies. I checked it again and I must have been looking at a different drug. "transient anorgasmia" and "lack of penile sensation" was reported by an unknown number of people out of a sample >900 and *only* at doses >10mg/day. Again, I will blame my oversight on Xanax (lovely scapegoat)
>
> Hey, didja ever notice that the side-effects list for antidepressants always include depression?Yes! And anxiety for anxiolytics! The way my body seems to work, if I were in a trial for aphrodisiacs they would probably have to note impotence as a potential side effect!
>
> If you live in a large metro, I wonder if you could find a psych who specializes in sexual disorders (even if your reaction IS all or mainly drug-induced). Not to *replace* your current guy, who sounds like a good one, but just to see if they might have any ideas for putting a grin back on Mr. Happy's face.In my letter I did ask him to consult his "peers" on their clinical experience with Xanax and SD.
>Or maybe an endocrinologist? I believe certain hormonal/endocrine profiles could make one more susceptible.
Possibly. The problem is that when I am not on medication I am actually *hypersexual*! (but full blown "status panicus" as well!) Nevertheless, I will bring up this point with him. My thyroid tests were normal but this is the only set of hormones I have had tested.
>(As you can see, I'm just tossing out ideas at this point, some of which may or may not make sense.)
Please continue. You have been extremely helpful.
>If you're overweight or out of shape, maybe diet and exercise could help as well, either directly, or indirectly through anti-anxiety benefits that allow you to get by on less Xanax. (I'm certainly not implyng that that very-fit people aren't prone to sexual side effects, too.)
I play rugby regularly and am pretty fit. There is no doubting that *rigorous* excercise is an excellent antidepressant/relaxant. Unfortunately, my underlying condition is way too severe to use fitness alone.
From my discussions with you and Elizabeth and Gil I think the potential combo of Xanax plus a stimulant like selegiline could be a very promising one.
Stimulant plus depressant: Sort of like Dr Dolittle's fictitious two-headed beast, the "pushme-pullyou"! I hope it doesn't rip my brain apart. It will be discussed at my next pdoc session. In the meantime, if you feel like downloading any further info, please do.Thrud
Posted by Thrud on August 28, 2001, at 6:58:32
In reply to Re: klonopin and sex vs xanax...thrud, posted by gilbert on August 27, 2001, at 20:55:22
Hi Gil.
> Thrud,
>
> I actually found the xanax to improved my sex drive while on an ssri which is probably not average.SSRIs mess around with sex so much that doesn't really surprise me.
>I am off ssris and find xanax does have a nice anti panic effect and helps my ruminating thoughts and gives me a little boost as well. I think at first I was too sedated to care about sex but I would guess after about a month I noticed my interest returned to almost normal.....when I say almost I mean sometimes I will still take a little longer to finish but the it still feels pretty darn good.
I notice the "bit longer" thing as well but that is not as bad as the ED part I get. BTW, what dose were you on then?
>How long have you been off ssris....it took me a long time after being on prozac to regain my orgasmic function.....could be some ssri residue adding to the xanax problem.
Several months. In between I was on Lamictal. Not a bad AD effect, still significant SD, anxiety through the roof. Still better than SSRIs!! Maybe residual effect. I'll ask the pdoc.
>
> Now about the klonopin I did not give it a fair try because I was so sick of not being sexual by the time I got to the konopin on drugs to try I had no patience for any more sex problem.....some have waited it out and regained function.....you just gotta try and see.I have not had sex for >10 years because no matter the drug, it always gave SD and it would never resolve...and you think *you've* lost patience? ;)
> Also most panic patients are very sensitive to med side effects and are also very suggestible emotionally to side effects so make sure what you have is truly a physical manifestation of a chemical side effect and not a pyshcological manifestation of an unwanted side effect.
This is true. I think my co-morbid depression is all psychological: I have no doubt that if I could control the anxiety without the SD it would lift immediately (my depression always responds very easily to medication, anxiety much less so). However, after nearly 11 years I can absolutely say that medication causes my SD. I become *hypersexual* if I cut out all my meds! (but then I suffer so much I want to die).
> Good Luck,
Thanks. My options are running out...
Thrud
Posted by Rick on August 28, 2001, at 21:40:59
In reply to Re: Rick: alt.panic(Caution: REAL babbling within), posted by Thrud on August 28, 2001, at 6:38:42
Thrud -
>Yes. That is exactly what I found out too. Problem is that very few used Xanax as monotherapy and those who did used it at low, PRN doses. Makes the culprit difficult to determine.That’s an excellent point and a real hot button for me. Why is everyone so ready to blame the benzo part of a combo for sexual dysfuntion, fatigue and cognitive problems? Probably because of what they hear from unenlightened docs, an because the SSRI makers have spent zillions touting the safety and low side effects of their meds, while benzos still have that damn stigma attached to them! It’s amazing how long it took for it to become widely known – and for SSRI’s to start admitting – that these drugs cause mucho sexual dysfunction.
> > If that or some of the other ideas don't work, I'd still look into low-dose stimulant augmentation. If you do, there have been so many experiences in Babble-Land alone of sexual stimulation from selegiline that I really think you should consider it.
>
> I see my pdoc in three weeks. Just today I mailed him a letter with some literature I pulled off the net asking him to consider selegine augmentation (at less than 10mg per day). Should be an interesting session. I also sent him information on inositol.I don’t want to “mental malpractice” you (a phrase Christian Scientists use) into a bad reaction, but 10mg/day of selegiline would likely be very anti-Xanaxic in terms of PD therapy. For someone with an anxiety disorder, just 5mg/day is A LOT of selegiline! Believe me, I learned the hard way when I was using it (pun not intended but appropriate). The activation stays with you a l-o-o-n-g time. Maybe you could start at 5 mg, but after a few weeks 2.5 mg/day would probably be MORE than enough! I can’t emphasize this enough.
> > BTW, I looked for sexual dysfunction in the RXlist monograph for selegiline, too. It made me wonder if you and I were looking at the same site, given that you say you saw sexual dysfunction plastered all over the place.
>
> My apologies. I checked it again and I must have been looking at a different drug. "transient anorgasmia" and "lack of penile sensation" was reported by an unknown number of people out of a sample >900 and *only* at doses >10mg/day. Again, I will blame my oversight on Xanax (lovely scapegoat)That’s OK, I forgive the Xanax. I only searched for 2 or 3 hours to find info about seligiline’s anti-sexual effects ;)
Rick
Posted by Thrud on August 29, 2001, at 7:55:08
In reply to Re: Rick: alt.panic(Caution: REAL babbling within) » Thrud, posted by Rick on August 28, 2001, at 21:40:59
Hi Rick.
>.. and because the SSRI makers have spent zillions touting the safety and low side effects of their meds, while benzos still have that damn stigma attached to them! It’s amazing how long it took for it to become widely known – and for SSRI’s to start admitting – that these drugs cause mucho sexual dysfunction.
I started out taking SSRIs as soon as they came out all those years ago, starting with Prozac of course. I had been on a tricyclic before that. (Believe it or not, it was *worse* than an SSRI!)
I simply could not relate the pain I was feeling to the comforting words of "mild" side effects which should "disappear" that the brochures and docs were saying.
Profound sexual dysfunction, insomnia, restless legs, racing thoughts, weight gain, fatigue,dizziness,headaches,impaired concentration....I had them ALL and they NEVER went away. The same applied to all the other SSRIs. (I wonder if they qualify as "cruel and unusual punishment"!) AND..most were not very effective at all against panic! I quit my first 2 pdocs because they did not believe what I was reporting to them and demanded I take my medicine like a good little boy and start getting well. (I certainly did take my medication exactly as instructed, I just didn't get well..)My third pdoc is absolutely great and we work together as a *team*. He takes my feedback seriously and acts accordingly. In turn, I obey his instructions exactly and try to make it an enjoyable session for him. I tell him exactly how I am feeling but I never whine or insinuate that my problems are in some way his fault. We often joke and chat about things more general than my particular situation and he seems genuinely happy to see me when my appointment comes round. In terms of reducing my personal suffering, we have made enormous progress in less than one year compared to the 10 preceeding years while I was without him.
It is a pity I only met this guy earlier this year; for many years I just researched the literature myself, went to a PCP and asked for another AD. They just wrote out the prescription, then "next please!". Only after running out of conventional ADs did I try a pdoc again. I was very lucky with this one. Even working with this guy, I don't expect ever to feel "well", just "better", and maybe that's good enough.
Sorry about my ramblings...maybe I have OCD as well! Or is it ADD? Maybe I'll blame the cognitive side effects of Xanax again.
> I don’t want to “mental malpractice” you (a phrase Christian Scientists use) into a bad reaction, but 10mg/day of selegiline would likely be very anti-Xanaxic in terms of PD therapy. For someone with an anxiety disorder, just 5mg/day is A LOT of selegiline! Believe me, I learned the hard way when I was using it (pun not intended but appropriate). The activation stays with you a l-o-o-n-g time. Maybe you could start at 5 mg, but after a few weeks 2.5 mg/day would probably be MORE than enough! I can’t emphasize this enough.Thanks very much for that. I don't know how much my pdoc knows about selegiline, but I will ask him to start me at 2.5 mg/day unless he suggests otherwise.
Thrud
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
Posted by Thrud on August 30, 2001, at 1:35:24
In reply to Re: Xanax and panic, experiences? » Thrud, posted by Elizabeth on August 29, 2001, at 12:08:46
Elizabeth-
> > 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.Apparently I had some atypical symptoms, like an aura just before the attack (although they were subjective feelings rather than auditory/visual etc disturbances. Diurnal variation (they always became more frequent in the evening). Plus I did not (and still do not) manifest any cognitive features during an attack, such as fear of dying going crazy, trying to 'escape' etc. In fact, during an attack I am *incapable* of thinking about anything at all; I just sort of physically and mentally freeze and experience a nightmare sensation. Stuff like that sent me for an EEG and CT scan for a brain tumor (I turned out to be allergic to the Iodine tracer: my face puffed up, tears, saliva and "mucous" poured out uncontrollably. Fun stuff!)
> > 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?Sorry, I can't remember the dose. I only rember it as the worst year of my life. Why was it surprising?
> > The depression, on the other hand, responded quickly and very easily.
>
> Responded to what, exactly?What ever it is in SSRIs that are supposed to reverse depression I guess! My depression is mostly psychological, caused by the inability to reduce my anxiety without introducing unacceptable side effects. Therefore, paradoxically, although somehow they were able to lift my mood reliably, thanks to their deficiencies and side-effects, they were equally unable to ease my depression beyond a certain point. Just better than using nothing I guess.
>
> 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.Yes, by then I had tried just about everything everything conventional and unconventional except the MAOIs. My pdoc and I did not bother with them because of their well known sexual side effects which I was (am) desperately trying to escape. (I know you like Parnate, but I'm going to try the benzo+stimulant combo or benzo monotherapy path first!) My pdoc is also considering upping the Lamictal from 200mg to 300mg. See, Lamictal has an odd effect on me in that it completely stops panic attacks but leaves me with very high general anxiety (therefore requiring Xanax[maybe klonopin would be better?]). We are not sure if Lamictal is anxiogenic or whether we need to go further to get more anxiolytic effect (if it exists). If that works I might be able to ditch the benzos and get better sexual function by using Lamictal alone. If not, there is no point in spending mega $$$ on Lamictal and we would probably go to benzo montherapy (or maybe benzo plus stimulant?)
>
> But anyway, I wonder if one of the other high-potency benzos (Klonopin, Ativan) might work for you without the side effects.There's always a chance I guess. Responses to medications are so idiosyncratic (spelling?) that it is amazing. It can't really hurt to try.
> 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?It is not that they didn't help at all. Some *virtually* didn't help at all. Others were better but could not prevent fairly regular, breakthrough attacks, particularly under stressful situations. I also mean "help" in a broader sense, like feeling I was well again.
I always gave them an adequate trial, everal months at least for all of them.> > 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.Why was it rejected in the USA?
>
> 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.Count me out then. I'll choose cheap, effective benzo impotence.
> > 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).I think the effectiveness of benzos as hypnotics may be temporary. Lamictal gives me a bit of insomnia and when I first started taking Xanax weeks ago it used to give me a great night's sleep (1 mg at bedtime would do it). Now I am getting breakthrough insomnia and not feeling as tired/sedated during the day. It is still keeping it's anxiolytic power 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.I'll keep you posted.
> [re inositol]
> > > I've heard good things about it. I never tried it myself.I'll keep you posted about that one as well.
Thrud
Posted by Jackster on August 30, 2001, at 4:30:33
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 30, 2001, at 1:35:24
>
> Apparently I had some atypical symptoms, like an aura just before the attack (although they were subjective feelings rather than auditory/visual etc disturbances. Diurnal variation (they always became more frequent in the evening). Plus I did not (and still do not) manifest any cognitive features during an attack, such as fear of dying going crazy, trying to 'escape' etc. In fact, during an attack I am *incapable* of thinking about anything at all; I just sort of physically and mentally freeze and experience a nightmare sensation. Stuff like that sent me for an EEG and CT scan for a brain tumor (I turned out to be allergic to the Iodine tracer: my face puffed up, tears, saliva and "mucous" poured out uncontrollably. Fun stuff!)
>
>
> > > 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.
> >
Hi ThrudSorry this is off the topic of your thread - 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.
If you don't want to talk about it, that's cool too.
Thanks
Jackie
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.
>
> 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
Posted by Elizabeth on August 31, 2001, at 14:51:36
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by Thrud on August 30, 2001, at 1:35:24
> Apparently I had some atypical symptoms, like an aura just before the attack (although they were subjective feelings rather than auditory/visual etc disturbances).
It's all subjective. But anyway, I have auras too, and I've never met anybody before who had panic auras.
> Diurnal variation (they always became more frequent in the evening).
I think that's consistent with atypical depression/panic disorder.
> Stuff like that sent me for an EEG and CT scan for a brain tumor (I turned out to be allergic to the Iodine tracer: my face puffed up, tears, saliva and "mucous" poured out uncontrollably. Fun stuff!)
We all know the cure can be worse than the disease, but sometimes even the lab tests can be worse than the disease! < g >
> Sorry, I can't remember the dose. I only rember it as the worst year of my life. Why was it surprising?
Because tricyclics are supposed to work at least somewhat for PAD.
> > > The depression, on the other hand, responded quickly and very easily.
> >
> > Responded to what, exactly?
>
> What ever it is in SSRIs that are supposed to reverse depression I guess!SSRIs, in other words. OK.
> Yes, by then I had tried just about everything everything conventional and unconventional except the MAOIs. My pdoc and I did not bother with them because of their well known sexual side effects which I was (am) desperately trying to escape.
Not any worse than SSRIs. But it sounds like you're getting something other than the standard SSRI sexual dysfunction, since a wide variety of meds seem to do this to you.
> My pdoc is also considering upping the Lamictal from 200mg to 300mg. See, Lamictal has an odd effect on me in that it completely stops panic attacks but leaves me with very high general anxiety (therefore requiring Xanax[maybe klonopin would be better?]).
I don't see anything wrong with adding a benzo to the Lamictal.
> We are not sure if Lamictal is anxiogenic or whether we need to go further to get more anxiolytic effect (if it exists).
Do you remember what level your general anxiety was at pre-Lamictal?
> > 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.
>
> Why was it rejected in the USA?It wasn't rejected; the drug company just decided not to try to get it approved.
> > Opioids can definitely cause sexual problems, BTW.
>
> Count me out then. I'll choose cheap, effective benzo impotence.Well, like I said, your sexual problems don't seem to be the usual sort, so don't rule anything out until you've tried it. (Have you ever taken Tylenol #3 or Vicodin or anything like that, and if so, do you remember any sexual side effects?)
> I think the effectiveness of benzos as hypnotics may be temporary.
It usually is, but they can have residual effects on sleep (e.g., making it easier to maintain sleep) after you've become tolerant to the sedation.
-elizabeth
Posted by thrud on September 1, 2001, at 0:54:24
In reply to Re: Xanax and panic, experiences?-Elizabeth » Thrud, posted by Elizabeth on August 31, 2001, at 14:51:36
>
> It's all subjective. But anyway, I have auras too, and I've never met anybody before who had panic auras.You too huh? You are also the first person I have who have auras with PA. I have them with *all* my attacks.
I know that auras are often associated with epilepsy. It wasn't too long ago when my pdoc tried me on lithium as a long shot: it actually *induced* very severe panic attacks. We were both pretty amazed. I then thought to myself "well, I definitely don't have epilepsy, lithium is supposed to smooth out and suppress overactive brain activity."
Then when I was considering ECT (which was an even longer shot) I found out they have problems performing ECT with people on lithium because it is actually a *convulsant* and can lead to dangerously long seizures during ECT. I think many ADs are also convulsants (especially the tricyclics I think) and began wondering about my generally poor response to them: epilepsy????There must be some part of my brain which goes hyperactive during a panic attack. Call that phenomenon whatever you want. All I know is that there are drugs out there that apparently restrain the offending neural material, but unfortunately, not specifically enough to prevent side effects (maybe my offending neural material is connected or connstructed very closely to that responsible for sexual activity?).
I am only interested in a correct diagnosis in so far as it can direct me towards the correct medication. Since I am already dabbling with benzos and AEDS anyway now I don't even *want* to be sent to a neuro incase he does diagnose epilepsy and I lose my drivers licence for a year! I sometimes worry that my pdoc will send me to a neuro and bang: time to ride the bus.
If benzos and other AEDs work but I keep the diagnosis of PAD, I am much happier.
> I think that's consistent with atypical depression/panic disorder.
Interesting. Where did you read this? I always felt that the *daily* predictability of my PAs were very much against the norm. I read continuously of them coming "out of the blue" or in phobic situations. I've never read about the diurnal variation-atypical depression/PAD connection. Could you direct me to some articles?
> Because tricyclics are supposed to work at least somewhat for PAD.
Apart from Lithium, it stood apart as the singularly worst medication I ever took for PAD.
> Not any worse than SSRIs. But it sounds like you're getting something other than the standard SSRI sexual dysfunction, since a wide variety of meds seem to do this to you.
I think it is time to see an endocrinologist. Apart from thyroid, I have not had any other hormonal chemical examinations. Something may be happening there.
>
> I don't see anything wrong with adding a benzo to the Lamictal.For me, it is not a bad mix.
> Do you remember what level your general anxiety was at pre-Lamictal?
No, because I was tapering off, but still under the influence of Remeron when s-l-o-w-l-y titrating up the Lamictal. As soon as strong anxiety started to kick in I was on benzos. Therefore I have no baseline to compare with.
> It wasn't rejected; the drug company just decided not to try to get it approved.
Was it a non-U.S. company? I hear the FDA throws up special "barriers" to foreign pharmaceutical companies attempting to gain approval for their products. I do not know if that is true or not.
> Well, like I said, your sexual problems don't seem to be the usual sort, so don't rule anything out until you've tried it. (Have you ever taken Tylenol #3 or Vicodin or anything like that, and if so, do you remember any sexual side effects?)No, I have not tried them. As alluded to above, I think I will see an endocrinologist first and see if anything abnormal turns up.
> It usually is, but they can have residual effects on sleep (e.g., making it easier to maintain sleep) after you've become tolerant to the sedation.That is good to know. I wonder how bad my insomnia would be without the 3mg Xanax/day? Lamictal is certainaly a rather "activating" substance.
Thrud.
Posted by Rick on September 2, 2001, at 3:32:20
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by thrud on September 1, 2001, at 0:54:24
>All I know is that there are drugs out there that apparently restrain the offending neural material, but unfortunately, not specifically enough to prevent side effects (maybe my offending neural material is connected or connstructed very closely to that responsible for sexual activity?).
I just went on another little search binge and from what I read it looks as if you may be barking up the right tree. Apparently there can be complex interplay between sex-related hormones, some kinds of epilepsy (seems to be those with psychogenic features), panic disorder, and medications used to treat seizures. As you know, the latter overlap with anxiety meds. I did Xanax and benzos in general cited in this vein in a few Medline citations, although hormonal reactions -- when present --appear to vary dramatically by individual. Many hormones are cited as posible contributors in the article and abstract that I've provided links to below.
> As alluded to above, I think I will see an endocrinologist first and see if anything abnormal turns up.
Sounds like a good idea. I read of several instances where hormone therapy and/or med changes reduced male sexual dysfunction without disrupting (or even adding to) treatment of panic or panic-like symptoms.
Hope these provide some ideas that are new to you:
http://www.gsdl.com/news/connections/vol5/conn19990630.html
Rick
Posted by thrud on September 2, 2001, at 6:27:53
In reply to Re: Xanax and panic, experiences? » thrud, posted by Rick on September 2, 2001, at 3:32:20
Hi Rick.
Those links were great. I was well aware of the role of neurotransmitters in sexual response (e.g. higher dopamine is supposed to equal more sex). I was also well aware that hormones affected sex response. What I never guessed was that they were interconnected and that neuroleptics, through this interconnection, could affect *both*.
I am afraid that my pdoc is now going to get more literature mailed to him on this topic. I will *demand* an examination by an endocrinologist. If I get normal sexual functioning by taking a hormone replacement pill or whatever I will be the happiest guy in the world!
Again, many thanks Rick. I'll keep you posted on my progress.
BTW, what if you have too much of a certain hormone: how do they "neutralize" it?Thrud
Posted by Rick on September 2, 2001, at 20:25:42
In reply to Re: Xanax and panic, experiences?-Rick, posted by thrud on September 2, 2001, at 6:27:53
> BTW, what if you have too much of a certain hormone: how do they "neutralize" it?
As you know I'm sure no expert here; I was just reporting on some of the things I read.
But I did see, for instance that hyperprolactinemia (excess prolactin) can be induced by many common drugs (including Xanax in males in a few few reported cases -- maybe not common). And that hyperprolactinemia can often be reversed through the use of dopamine agonists like bromcriptine or cabergoline, a new long-lasting dopaminergic agonist that seems better tolerated (don't know if it's available in the U.S.)
But then, could such treatment cause a reduction in Xanax benefit for panic? Maybe, maybe not. It's probably a balancing act, but apparently some hormone levels CAN be reduced via meds or supplements. And I saw quite a few reports about how such strategies have helped many patients with sexual dysfunction and other problems.
I wonder if you can find an endocrinologist who specializes in sexual function, psychological implications or both. I've never seen one, so I don't know if that suggestion makes sense or is naive. I ususally hear endocrinologists mentioned with regard to diabetes. But then diabetics apparently often have hormonally-driven and potentially treatable sexual dysfunction. It's amazing to me, the more I read, how seemingly diverse mental and physical manifestations can be interrelated. E.g., just this week Medscape reported about a very promising new drug for Alzheimer's (specifically, memory-loss) that is also useful for diabetic neuropathy and a few other diverse uses.
Rick
Posted by thrud on September 3, 2001, at 1:15:57
In reply to Xanax and panic, experiences? , posted by Thrud on August 22, 2001, at 23:52:46
Hi Elizabeth and Rick.
I have learned that both of you are certainly very knowledgable about PAD, so I have further questions (please forgive me!).
When browsing another anxiety chat/info site (TAPIR) I came across a guy who had very similar PAD symptoms to me and whose mother was shizophrenic (like mine). Someone gave a response to his questions that blew me away. I am wondering if you guys are familiar with what he is saying and have anything more to add? I searched the sites he suggested but came up empty handed (I am such a retard when it comes to finding info!)
Thanks much.
Thrud
Baloo
Veteran User posted 09-02-2001 04:08 PM
--------------------------------------------------------------------------------
Dr. S. will correct me if I state something with which he disagrees...
There is one particular variety of panic disorder that runs in families with schizophrenia. In fact, a variety of studies have found that someone with a direct relative who has schizophrenia has equal chances of developing either panic disorder or schizophrenia.The schizo/panic variant seems to be one of the best responders to a gluten-free, casein-free diet. In fact, there is research going all the way back to the 1950's or 1960's claiming that some cases of schizophrenia go into complete remission on a diet completely free of grains and their derivatives. (It's not nearly as easy as it sounds, especially in the US, where almost every processed food, from hot dogs to breafast cereal to baked beans and so forth, has gluten or some derivative of gluten added to it.) That research was pooh-poohed for a long time (like almost all research advocating any kind of dietary measures against illness), but in the last few years, some researchers have shown why it would be so. Failure to manufacture a digestive enzyme or inhibition of the enzyme's effect causes people who have such a deficiency not to break down gliadin (a component of gluten) or casein (the characteristic protein of milk) to the level of amino acids. Instead, more complex proteins get absorbed into the bloodstream. From there, some of them are absorbed into the brain. Some of these proteins are chemical relatives of opium, and some of them are highly stimulating and even toxic. It has been demonstrated by autopsy that these proteins accumulate in specific brain areas of rats that correspond to the brain areas which "misfire" in human schizophrenia and autism. The earlier research on achieving remission from schizophrenia (and autism) through diet alone has also been successfully repeated in people whose blood has the chemical markers for the syndrome in question.
People with this form of panic disorder are among the worst candidates for treatment with antidepressants. In fact, they are one of two groups in which SSRI antidepressants (a different family from imipramine) are most likely to trigger psychotic episodes. Their central nervous system is already overactivated, and all antidepressants are activating to the central nervous system.
This doesn't require faith, it simply requires a doctor who knows what he's looking for. You can detect these proteins through urinary excretion of their metabolites for up to a year from the time symptoms begin to remit.
I would think you definitely need to get with a doctor is either familiar already with treating your variant of panic disorder or will look up the relevant information.
For information on the schizo/panic variant, go to MedScape and search on "schizopanic." For a starting point on the dietary connection, search something like PubMed for "RF Cade." Or go to www.celiac.com and poke around there. That site has much relevant information on the toxicity to some people of grain proteins, even relevant for people who don't have celiac disease.
------------------
*Baloo*
Check out Medical and Psychological Models of Panic Disorder
and Panic Disorders: A Comprehensive OverviewIP: Logged
Baloo
Veteran User posted 09-02-2001 11:54 PM
--------------------------------------------------------------------------------
By the way, I myself fit this familial category, and your description of "drowning in mid-air" is an excellent description of my primary "panic" symptom.
I was also regurgitating quite a bit, even before the dysautonomic episodes began occurring, until I changed my diet.
Posted by Rick on September 3, 2001, at 4:32:47
In reply to Re: Xanax and panic, experiences?-Rick, Elizabeth , posted by thrud on September 3, 2001, at 1:15:57
Sounds very intriguing and worth exploring further. Nothing I can personally add, though.
Posted by Elizabeth on September 8, 2001, at 21:27:48
In reply to Re: Xanax and panic, experiences?-Elizabeth, posted by thrud on September 1, 2001, at 0:54:24
> > It's all subjective. But anyway, I have auras too, and I've never met anybody before who had panic auras.
>
> You too huh? You are also the first person I have who have auras with PA. I have them with *all* my attacks.Wow. We're 2 of a kind.
> I know that auras are often associated with epilepsy.
That's true, and whenever I mention them to a doctor, s/he invariably asks if I've ever had an EEG. (I have, several different times.)
> It wasn't too long ago when my pdoc tried me on lithium as a long shot: it actually *induced* very severe panic attacks.
That's a little weird -- lithium is a long shot, but I didn't think it was *that* long.
> We were both pretty amazed. I then thought to myself "well, I definitely don't have epilepsy, lithium is supposed to smooth out and suppress overactive brain activity."
As you discovered, it's proconvulsant. Seizures are one of the signs of lithium toxicity.
> I think many ADs are also convulsants (especially the tricyclics I think) and began wondering about my generally poor response to them: epilepsy????
Poor response to TCAs doesn't mean you're epileptic. Seizures on them might, though. The worst offenders in that group are clomipramine and maprotiline, I think (I might be missing one). Which one(s) did you try?
> Since I am already dabbling with benzos and AEDS anyway now I don't even *want* to be sent to a neuro incase he does diagnose epilepsy and I lose my drivers licence for a year!
This varies from state to state, but I don't think it's ever an absolute thing unless a doctor certifies that you have uncontrolled seizures that *interfere with your ability to drive*. (Panic attacks that included, say, blacking out, would also be a reason you shouldn't be driving.)
> > I think that's consistent with atypical depression/panic disorder.
>
> Interesting. Where did you read this?I forget exactly what I was responding to, but I think that I was referring to the reverse diurnal variation -- symptoms worse at night. This is pretty well established, I think. Search terms might include "reverse diurnal."
> I think it is time to see an endocrinologist. Apart from thyroid, I have not had any other hormonal chemical examinations. Something may be happening there.
That sounds like a plan.
> No, because I was tapering off, but still under the influence of Remeron when s-l-o-w-l-y titrating up the Lamictal.
Pre-Remeron (or pre-any meds), then?
> > It wasn't rejected; the drug company just decided not to try to get it approved.
>
> Was it a non-U.S. company?[Adinazolam] was discovered by Upjohn (yes, a US company). I don't know if they're the ones who market it in Europe (Germany and France at least, probably other places too).
> I hear the FDA throws up special "barriers" to foreign pharmaceutical companies attempting to gain approval for their products. I do not know if that is true or not.
I would believe it. A problem is that there's essentially a revolving door between the FDA and the drug companies -- a lot of people at FDA have ties to one or more pharmaceutical firms.
> > Well, like I said, your sexual problems don't seem to be the usual sort, so don't rule anything out until you've tried it. (Have you ever taken Tylenol #3 or Vicodin or anything like that, and if so, do you remember any sexual side effects?)
>
> No, I have not tried them.Wow. I haven't met too many adults who never had need for an opioid. (Dentists tend to prescribe them pretty liberally.)
> That is good to know. I wonder how bad my insomnia would be without the 3mg Xanax/day?
3 mg, huh? How do you divide that up?
> Lamictal is certainaly a rather "activating" substance.
I didn't notice *anything* from it.
-e
This is the end of the thread.
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