![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jms600 on September 22, 2009, at 6:36:34
Is there anything else I can take for treatment resistant panic disorder? I suffer from severe and uncontrollable panic attacks. I've been through a lot of medications...
Benzos = developed tolerance to them so my doctor won't presrcribe a higher dose.
SSRIs, venlafaxine and mirtazapine = tried them all, didn't control it.
Buspirone (45mg) = didn't control it.
Lithium (600mg) = didn't control it.
Haloperidol/Stelazine (4mg) = didn't control it.
Amitriptyline (200mg) = didn't control it.
Zyprexa (15mg) and Seroquel (300mg) = Zyprexa really helped so I foolishly thought I was better and stopped taking it. When the anxiety came back and I started taking the Zyprexa again it just didn't work the second time.
Lyrica (300mg) = currently taking, doesn't appear to be helping very much.
Phenelzine = my doctor won't prescribe it.
Is there anything else I can try? I don't know how much longer I can go on feeling like this.
Posted by SLS on September 22, 2009, at 7:48:11
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
> Phenelzine = my doctor won't prescribe it.
Go for a second opinion or find another doctor.
- Scott
Posted by Phillipa on September 22, 2009, at 10:39:57
In reply to Re: What else for treatment resistant panic disorder?? » jms600, posted by SLS on September 22, 2009, at 7:48:11
Beta blockers? Phillipa
Posted by linkadge on September 22, 2009, at 11:08:31
In reply to Re: What else for treatment resistant panic disorder?? » SLS, posted by Phillipa on September 22, 2009, at 10:39:57
Why not add some inositol? It can be combined with pretty much any psychiatric med.
Linkadge
Posted by linkadge on September 22, 2009, at 11:19:33
In reply to Re: What else for treatment resistant panic disorder??, posted by linkadge on September 22, 2009, at 11:08:31
I would also agree with SLS. Panic can somtimes be a symptom of another psychiatric illness. I know some people with ADHD (especially inattentive) can have bad panic attacks that areactually improved by stimulants. Apparently the constant gapping out causes the patient to panic after they realize that they may be missing something critical.
Linkadge
Posted by linkadge on September 22, 2009, at 11:20:18
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
Tryptophan may be worth a try it can probably be combined with lyrica.
Linkadge
Posted by doxogenic boy on September 22, 2009, at 12:40:56
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
> Is there anything else I can take for treatment resistant panic disorder? I suffer from severe and uncontrollable panic attacks. I've been through a lot of medications...
>
> Benzos = developed tolerance to them so my doctor won't presrcribe a higher dose.
>
> SSRIs, venlafaxine and mirtazapine = tried them all, didn't control it.
>
> Buspirone (45mg) = didn't control it.
>
> Lithium (600mg) = didn't control it.
---Did you try lithium together with SSRIs, venlafaxine or mirtazapine?
> Haloperidol/Stelazine (4mg) = didn't control it.
>
> Amitriptyline (200mg) = didn't control it.
>
> Zyprexa (15mg) and Seroquel (300mg) = Zyprexa really helped so I foolishly thought I was better and stopped taking it. When the anxiety came back and I started taking the Zyprexa again it just didn't work the second time.
>
> Lyrica (300mg) = currently taking, doesn't appear to be helping very much.---
The simplest idea I can come up with is Lyrica and Seroquel in higher doses, and then may add low-dose lithium and the antidepressant you had least side effects from. (This is just my guess, but actually, the first time I came to treatment, I had a panic attack. That was the beginning of my psychiatric history).
http://www.ncbi.nlm.nih.gov/pubmed/17502773http://www.ncbi.nlm.nih.gov/pubmed/14990767
doxogenic
Posted by jms600 on September 22, 2009, at 12:45:08
In reply to Re: What else for treatment resistant panic disorder?? » jms600, posted by doxogenic boy on September 22, 2009, at 12:40:56
> > Is there anything else I can take for treatment resistant panic disorder? I suffer from severe and uncontrollable panic attacks. I've been through a lot of medications...
> >
> > Benzos = developed tolerance to them so my doctor won't presrcribe a higher dose.
> >
> > SSRIs, venlafaxine and mirtazapine = tried them all, didn't control it.
> >
> > Buspirone (45mg) = didn't control it.
> >
> > Lithium (600mg) = didn't control it.
> ---
>
> Did you try lithium together with SSRIs, venlafaxine or mirtazapine?
>
>
>
> > Haloperidol/Stelazine (4mg) = didn't control it.
> >
> > Amitriptyline (200mg) = didn't control it.
> >
> > Zyprexa (15mg) and Seroquel (300mg) = Zyprexa really helped so I foolishly thought I was better and stopped taking it. When the anxiety came back and I started taking the Zyprexa again it just didn't work the second time.
> >
> > Lyrica (300mg) = currently taking, doesn't appear to be helping very much.
>
> ---
>
> The simplest idea I can come up with is Lyrica and Seroquel in higher doses, and then may add low-dose lithium and the antidepressant you had least side effects from. (This is just my guess, but actually, the first time I came to treatment, I had a panic attack. That was the beginning of my psychiatric history).
>
>
> http://www.ncbi.nlm.nih.gov/pubmed/17502773
>
> http://www.ncbi.nlm.nih.gov/pubmed/14990767
>
>
> doxogenic
Yes - I'm currently on 600mg lithium and 75mg venlafaxine. The reason for the low dose of venlafaxine is due to national guidance i've read here in Britain that any dose above 75mg can exacerbate anxiety.
Posted by doxogenic boy on September 22, 2009, at 13:09:22
In reply to Re: What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 12:45:08
> > Did you try lithium together with SSRIs, venlafaxine or mirtazapine?[...]
> Yes - I'm currently on 600mg lithium and 75mg venlafaxine. The reason for the low dose of venlafaxine is due to national guidance i've read here in Britain that any dose above 75mg can exacerbate anxiety.
---Maybe it can, but I have anxiety and depression, and I have tried 450 mg venlafaxine. If you add Seroquel in a higher dose first, it may work against anxiety side effects from high-dose venlafaxine.
My psychiatrist has said that Seroquel makes patients endure higher doses of escitalopram (or citalopram).
doxogenic
Posted by desolationrower on September 22, 2009, at 16:40:50
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
while looking for a MAOI prescribing doctor, try
clonidine
an NRI, probably added to an sri (75mg of venlafaxine counts). i'd suggest nortryptaline; the 5ht2a block probably would help w/panic, probably moresoe with 5ht level raised w/a sri. (amytr.' metabolite is nortr. what was your experience with that drug, did you stop b/c thats the highest rec. dose, or did you have plasma level checked, or side effects?)
practicing meditation is also really good for panic.
-d/r
Posted by jms600 on September 22, 2009, at 17:23:47
In reply to Re: What else for treatment resistant panic disord, posted by desolationrower on September 22, 2009, at 16:40:50
> while looking for a MAOI prescribing doctor, try
>
> clonidine
>
> an NRI, probably added to an sri (75mg of venlafaxine counts). i'd suggest nortryptaline; the 5ht2a block probably would help w/panic, probably moresoe with 5ht level raised w/a sri. (amytr.' metabolite is nortr. what was your experience with that drug, did you stop b/c thats the highest rec. dose, or did you have plasma level checked, or side effects?)
>
> practicing meditation is also really good for panic.
>
> -d/r
>
>
>
I stopped the amitriptyline as it just didn't seem to help my anxiety and panic. Just wasn't really helping.
Posted by Jeroen on September 23, 2009, at 15:45:11
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
Solian maybe?
Posted by mogger on September 26, 2009, at 0:39:20
In reply to What else for treatment resistant panic disorder??, posted by jms600 on September 22, 2009, at 6:36:34
Please try 18 grams of inositol a day, it is good for panic attacks.
Joseph
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.