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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by PanickingJake on July 27, 2004, at 22:00:30
Alright, here's my situation. I would so appreciate it if anybody reading this somewhat "fits the bill" as far as my symptoms go, would tell me what kind of therapies you've done (feel free to be techical).
Anyway,
I have an interesting hellish twist on Panic disorder and really bad "General Anxiety Disorder." So what I'm saying is that I am in a constant panic state 24-7, as opposed to having panic attacks every few days and such. Its like the panic attack that never stops.Main symptoms: Sever shakiness, severe brethlessness, rapid heart beat; your basic panic attack stuff, besides the mind racing, to a degree. And throw a little bit of depression in there (more brought on by my anxiety).
I've done tons of CBT and yoga and meditation and have my mind under control. Meaning, thoughts don't bring too much added anxiety to my life.
I HAVE TO EXCERCISE EVERYDAY to even attempt to get through the day. It builds up, and I bike, and it builds up and I bike.
I have a very "chemical" problem. The CBT helps, but not much. When I'm better, that stuff will really come in handy though. I'm on currently:
Klonopin(1m 4x/day) for my four best times of the day, Remeron (30 at night), Effexor XR (225) in the morn.), *Buspar(120), Seroquel for sleep and Gabatril (6 and only 6mg).
*with the change of Remeron and Effexor, I usually use buspar to add the littlest amount of seretonin as possible to help transitions.
Anyone fit the bill?
Posted by Glydin on July 27, 2004, at 22:43:50
In reply to Severe Panic and Anxiety disorder anyone like me?, posted by PanickingJake on July 27, 2004, at 22:00:30
Jake, sorry for your extreme situation. If you are taking the meds you're taking and are still experiencing all the symptoms you describe - methinks a rethink on your treatment plan is in order. I had garden variety "anxiety disorder" (trying to separate GAD vs. SAD was moot, as I had it all) to include panic and agoraphobia. Klonopin saved me after other failed drug trials, most of which increased my anxiety states tenfold. CBT was useful info but didn't work well in the real world for me. Klonopin taming my spun up, overworked "flight or fight" response was the only thing that worked.
Is the constant anxiety/panic h*ll your only disorder or do you have other diagnoses?
Posted by PanickingJake on July 28, 2004, at 0:01:59
In reply to Re: Severe Panic and Anxiety disorder anyone like me?, posted by Glydin on July 27, 2004, at 22:43:50
Thanks for writing!!!
Only one other diagnosis of an unknown neuropathy (pain in feat). I've been told repeatedly that they don't have anything to do with one another from both sides, though medications do spread the distance. For example, Effexor and Remeron help the pain a little I think. Neurontin, which I was using for pain, brought on my anxiety the first time when I was in college.
Anyway,
Its just a straight up constant adrenaline rush (fite or flight) that builds up over each minute. If I wasn't able to exercise I'd also probably be in a hospital because I am able to exercise some of the panic build up out of me. If I wasn't on the meds I am on now I would surely be in a hospital, so I'm actually a lot "less worse" than I was. The norepinephrine route seems to be the direction I'm going and is showing a little promise. I've pretty much extinguished all "just serotonin" routes like celexa, paxil, ect..
> Jake, sorry for your extreme situation. If you are taking the meds you're taking and are still experiencing all the symptoms you describe - methinks a rethink on your treatment plan is in order. I had garden variety "anxiety disorder" (trying to separate GAD vs. SAD was moot, as I had it all) to include panic and agoraphobia. Klonopin saved me after other failed drug trials, most of which increased my anxiety states tenfold. CBT was useful info but didn't work well in the real world for me. Klonopin taming my spun up, overworked "flight or fight" response was the only thing that worked.
>
> Is the constant anxiety/panic h*ll your only disorder or do you have other diagnoses?
Posted by partlycloudy on July 28, 2004, at 7:58:41
In reply to Severe Panic and Anxiety disorder anyone like me?, posted by PanickingJake on July 27, 2004, at 22:00:30
Yes, Jake - I am your twin. Nice to meet you. I also have major depression, but the anxiety and panic have/had been 24/7. It wasn't until the depression receded that I was able to exercise and that helped a lot. My current cocktail, which is helping me hugely but not completely, is 150mg Effexor XR, 300mg Wellbutrin XL, Ambien 5mg as needed, Xanax .5mg as needed. CBT, yoga, meditation, yup - I'm right there. Just last night my blood was pounding in my ears and I was gasping and rolling my eyes around, and my blood pressure was normal. What a mess. My panic attacks are less severe and not an all-day event. My breakthrough treatment has been EMDR therapy. I don't know how it works completely, but for me moving through past memories has freed up a lot of the anxiety. I guess my condition is more psychological than yours, but I thought I'd offer up my experience.
Good luck
Posted by Glydin on July 28, 2004, at 8:51:12
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » Glydin, posted by PanickingJake on July 28, 2004, at 0:01:59
>The norepinephrine route seems to be the direction I'm going and is showing a little promise. I've pretty much extinguished all "just serotonin" routes like celexa, paxil, ect..
I, too found anything that messed with my serotonin just made my symptoms worse. In an effort to understand, could you elaborate on the norepi thoughts? Are you saying that decreasing the reuptake of norepi (having more available in the brain cells) will improve anxiety symptoms?
I would like to understand this. Thanks
Posted by PanickingJake on July 28, 2004, at 16:45:12
In reply to Re: Severe Panic and Anxiety disorder anyone like me?, posted by Glydin on July 28, 2004, at 8:51:12
I'll try to find you a link with a better explanation, but for now: What has happened to me, when going up on Effexor (serotonin, norepi, dopamine) is that the first 2 weeks, not much happenned. The 3rd and 4th weeks I had very noticable increase in anxiety. However, once the 5th week was there, the extra anxiety from the Effexor went away, and I could seemingly take more Buspar afterwards. What happened is that the 3rd week, Effexor was doing its job on Norepiniphrine by making more available for the receptors - more adrenaline, more anxiety. Then, because of the the "downregulation" that happens because of the extra Norepiniphrine, the 5th week was better and sixth the best. Your brain says, "Hey, there's too much of this stuff around, so I'm going to close some of the gates for reuptake of Norepiniphrine." Because of the overall effect, I will probably be upping Remeron (serotonin, Norepinephrine) in the future. Both medications also deal with serotonin, but it didn't seem to have the effect that I have if I just raise seretonin levels alone. The two bad weeks are tough to get through but worth it.
Moral of the story, if your screwin with Norepinephrine and really want to give it a shot, don't give up right away if your anxiety is worse. Everybody is different though. This is my experience and it happened every time I upped Effexor after about 150mg (I upped by 37.5 to make the two bad weeks as "bearable" as possible).
When going down off it very slowly (because I've been off it and on it again), I had the same types of problems with increased anxiety and sleepiness (which don't really work together nicely). But after the withdrawal 2 weeks, the extra anxiety was gone.
That may not all be technically correct to the word, but is how I think of it. I got a second opinion from someone in Chicago that said that what I felt, made sense with the downregulation and all. He is pushing the norep. route because just serotonin just aint workin.
Posted by Glydin on July 28, 2004, at 20:28:29
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » Glydin, posted by PanickingJake on July 28, 2004, at 16:45:12
I think I do understand the overall concept. It seems to be based on flooding to cause self-regulation. I can see where that might work and if it works for you I think that's great. I've only done one med that worked on my norepi and I did have a terrible time. Fortunately, I'm quite stable sans meds right now. I do wish you good luck in working out your problems.
Posted by PanickingJake on July 29, 2004, at 17:17:39
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » PanickingJake, posted by partlycloudy on July 28, 2004, at 7:58:41
Wow, you are my twin. Nice to meet you! Some CBT, some benzos, some ADs, and a little something for sleep. How long did it take you to end up with your current buffet o'drugs.
I appreciate you and everyone else that posted about this. I hate that anyone has to go through the same thing, but am comforted to know that I'm not alone.
Jake
Posted by PanickingJake on July 29, 2004, at 17:20:59
In reply to Re: Severe Panic and Anxiety disorder anyone like me?, posted by Glydin on July 28, 2004, at 20:28:29
Glydin,
What did you try for Norepinephrine med that didn't work and what happened if you don't mind sharing?
Posted by Glydin on July 29, 2004, at 17:52:47
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » Glydin, posted by PanickingJake on July 29, 2004, at 17:20:59
I guess I should clarify, I tweaked with my norepi and dopamine. I used Wellbutrin. Not a really good choice, but it was the last of the AD's I was willing to try. At the time, there was still a thought that this was depression based, so that was the thought on treatment. I have now learned that anxiety as a stand alone diagnosis is VERY under played and under acknowledged. The first week of WB was alright. The subsequent 7 weeks were torture. My anxiety and agoraphobia had me a housebound, trembling, heart pounding, insomnia riddened, anorexic fool. I had to take a long LOA from work and I was basically shut down completely from living any shape of a life. I was determined to try and give it time. After 2 months, I could no longer do it. I felt much better after coming off but I was not "well". I then proceeded to Klonopin only (I did not use any benzo's with AD's, looking back, that wasn't a good thing) and it was a new world for me.
Posted by PanickingJake on July 29, 2004, at 19:38:41
In reply to Re: Severe Panic and Anxiety disorder anyone like me?, posted by Glydin on July 29, 2004, at 17:52:47
Yea, two months is all I would ever give for anything, to bad it didn't pan out. I know quite a few people that weren't helped by Wellbutrin, though there are obviously others that its the wonder drug. All I know is that I don't think just one will go for me, mostly because of the high dosages I have to take.
This just happened to me last week and I thought I should share since you started Klonopin. Also remember that I have been taking 4mg Klonopin for about 2 1/2 years.
Tuesday:
Changed from Klonopin to same dose Xanax (your supposed to be able to substite a benzo for a benzo and stop any of the awful withdrawal effects)Wed: little better; the Xanax XR was better because of the long lasting part of it. I had the best sleep this year - easily. (Tues. night)
Thursday night: worst sleep in long time.
Friday: The worst I've been in two years. I was having panic attacks that had there own panic attacks.
I figured that it had to be withdrawal with the timing. Klonopin's half life is like 11 hoursish I think. I took 1mg of Klonopin and all the symptoms got better in like a few hours. Thank god!!! I wasn't gonna last that long that way. There is awful withdrawal for all the benzos. If I ever decide to try switching over, because I do think that Xanax may be a good shot for my constant panic feeling, I'm going to go off it so slowly that it will take me a 1/2 a year to get off it!
Moral of this story: Please go down slowly if you ever do stop them. For now, I'm about as "good" as I've been, so I'm going to stick with Klonopin and try to catch my breath. That sucked. I actually posted that night the first thread of this.
It reminded me of the time that I did not want to live. Not that way anyway. I didn't really want to die though either. I got into deep depression and never wanted to open my eyes or be awake. Sleeping was as close to death as I could get because I didn't have to deal with my panic. That was the most agoraphobic I've been. Bla bla bla.
Learn from my mistake (actually my pdoc's mistake). Yea, next time I see him, we're going to have to have little talk about how everything I change, I'm so sensitive to. But he won't take that into account when making decisions. Thank god I saw that guy in Chi town.
Posted by Glydin on July 29, 2004, at 22:39:13
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » Glydin, posted by PanickingJake on July 29, 2004, at 19:38:41
I did wean off Klonopin and I, like you was on it for 2 1/2 years - isn't that a coincidence? My weaning went really well. I cut 1/4 dose every 2 weeks and once I was down to .125 mgs for 2 weeks, I did an every other day thing for about a week and half. It was surprisingly easy for me. But, I do know of others who have a terrible time. We are all so very different. I've always stressed, too, what is great for me, is just a nightmare for someone else. I'm totally off any meds right now, but if my circumstances were to change, I wouldn't hesitate to restart Klonopin.
Truth be told, I was really scared of Xanax. I've known a few folks who got into some difficult issues with it and I was a little gunshy. Fortunately, the K worked out good for me and I was fortunate to find a good supportive doc willing to let me use it as monotherapy.
I do hope you work everything out. My heart is always with those suffering toxic anxiety - it's H*LL on earth.
Posted by partlycloudy on July 30, 2004, at 12:43:04
In reply to Re: Severe Panic and Anxiety disorder anyone like me? » partlycloudy, posted by PanickingJake on July 29, 2004, at 17:17:39
I started working seriously on meds and therapy last October. Got to my current effective cocktail and dosage 2 months ago. It feels strange to feel so well now after the rollercoaster ride I had. I started therapy at the same time, and added the EMDR sessions about 6 weeks ago. The improvement after I started that was rapid and marked. I don't attribute my success so far to the EMDR alone, but to the combination of all of this.
Best of luck and let me know if I can help in any way!
Posted by Pfinstegg on August 1, 2004, at 11:04:58
In reply to Your twin! » PanickingJake, posted by partlycloudy on July 30, 2004, at 12:43:04
It's wonderful to hear how the therapy, meds and EMDR have all come together to help so much! I have been following your EMDR experiences, and am fascinated that it has helped so much and so quickly. Because of your posts about it, it is something I am also considering. Thank you for sharing!
I know it's probably in the archives somewhere, but would you mind telling me once more what med combination you are taking?
(It's been crossing my mind that we might see another name change with an even more improved weather outlook)
Posted by partlycloudy on August 2, 2004, at 8:45:08
In reply to Re: Your twin! » partlycloudy, posted by Pfinstegg on August 1, 2004, at 11:04:58
Thanks for your well wishes! Having a poopy day today, but nowhere near the darkness of old. I'm on 150mg effexor xr, 300mg wellbutrin xl, 5mg Ambien, .5mg xanax....
panic attacks are the most unpredictable of my complaints. Had a rough weekend. Many migraine headaches, too - and I know that they are related to the EMDR stirring things up from my heart and head.
I see my p-doc tomorrow and have another EMDR session Wednesday. I'm working harder on this than any school project I ever had. Right now I'm entering hurricane season along with the rest of the world...
This is the end of the thread.
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