These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Panic attack/anxiety
Question: I would like to know what is the recently recommended medication to treat panic attack and anxiety.
Answer: Panic attacks are common and usually start in the late teens or early 20s. They tend to
run in families and often occur for several months followed by long spells where they are
absent. A large percentage of patients will develop depression at some time during their
lives. Several medical conditions will mimic or cause this disorder and need to be screened
prior to treatment. Also, different drugs have been known to trigger this disorder. Alcohol,
antihistamines, caffeine, cocaine, pseudoephedrine, aspirin, hallucinogens (LSD etc.) are the
ones available without a prescription – the rest are prescription drugs. Treatment centers on
use of drugs SRI antidepressants, tricyclic antidepressants, MAO antidepressants, beta
blockers and benzodiazepines (Valium, klonopin, etc.). in about that order. Combinations of
the drugs are also often effective.
Panic Disorder
Question: It has been suggested that I use SSRI drug (Paroxtine)
(Aust. Aropax). I haven’t experienced full panic for some time
but am still experiencing severe anticipatory anxiety which is
limiting my life to quite a degree. Should I go ahead with
taking this drug? What’s against it? I have read the counterindications
and potential withdrawal problems. Is this drug construed as being
addictive? What are the side effects? Should I battle on
without drug assistance?
Answer: There have been several treatment protocols for the syndrome called Panic Attacks. Use of the serotonin reuptake inhibitors(SRI) has been very effective in about 60-70% of patients with this problem. Use of SRI with drugs such as klonopin is also effective. Occasionally, use of beta-blockers is also helpful. Paroxetine(Paxil) is one of the common SRIs used in this disorder. There is no withdrawal problem and the drug can be stopped at any time without tapering, etc. The drug is not addictive, although some patients feel so good on it that they really don’t want to stop taking it. I would really try and see how you feel on the drug. The only way to see the difference is to try it. I have had amazing stories from patients who have fought this problem all their life. They really never knew what it felt like to not have the problem, so give it a go.
Panic Attacks and Seratonin
Question: What is the relationship between seratonin and panic attacks?
Answer: Panic attacks are extemely common and unfortunately tend to be very debilitating. They tend to be precipitated by situational clues-closed spaces, heights, etc and also tend to run in families. The individual often feels like they are going to die. Rapid heartbeat, shortness of breath, sweating, choking, chest pain, etc. are the common signs. Some individuals will awake at night with the above symptoms thought to be triggered by different sleep stages. About 1% of all people will experience these-women about twice as commonly as men. Treatment involves making the right diagnosis and ensuring that cardiac conditions, thyroid conditions or other medical causes are not the cause. Tri-cyclic anti-depressants have been the drug of choice until recently. Since the advent of seratonin uptake inhibitor drugs these are usually the drug first tried due to low side effects and effectiveness. Other drugs include fairly potent sedatives like
clonazepam and alprazolam and a class of anti-depressants called MAO inhibitors. Generally, one starts with the serotonin uptake inhibitors and proceeds to the other drugs if there is lack of effectiveness. Some psychologists have experimented with desensitization of the triggering situational clue. It does seem that some sort of chemical “imbalance” causes these episodes-whether it is serotonoin or not is not yet clear.
Panic Disorder
Question: I have been taking .75 milligrams of Klonopin for diagnosed
panic disorder. I have been on the medication for about 1.75 years
and I am afraid that I am addicted and will never be able to
stop. I am hesitant to reduce my dosage as I get edgy and suffer
from extreme tightness in the chest which I associate with heart
problems. I also take Propanol (30 milligrams a day) as I
suffer from PVC’s and I always think that something is seriously
wrong with my heart even though tests have shown otherwise. The
chest pain and PVC did not start until about 2 years ago and this is
when I went to the emergency room in an ambulance for the first time, thinking I was having a heart attack. I take Pepcid daily and believe
that this helps relieve some of the symptoms of chest pain. Most of
the time, however, I am still convinced that there is something wrong
with my heart. I even experience flashes of heat or hot blood from
the left side of my chest into my arm, periodically. I cannot find an answer as to why this happens from any
physician or book. I used to be such a different person. I am even
afraid to exercise now, as I feel that I may suffer a heart attack.
How do I get off of Klonopin and find either a better medicinal
solution or just get off of medication altogether. I have been given
Paxil to try but have been afraid because I have heard that these
SSRI type drugs are better suited for depression and OCD, and may
cause more anxiety in panic disorder sufferers. However, as I
understand, they can help obsessiveness and compulsiveness. I
seem to be obsessed alot about my heart and chest pains. Is it worth
trying Paxil? My first “panic attack” occured when I had
been on 20 milligrams of Prozac for 2 weeks. This was when I was not taking
Klonopin. I also feel slow and not as mentally responsive, which is something I
attribute to the Klonopin.
Answer: Panic disorder is a very common and very disabling problem. There is the exact feeling
of having a heart attack or not being able to breathe. While we don’t exactly know the
cause, it does appear to run in families and has some of the same characterists of depression.
In general, the SRI anti-depressants(paxil for example) are very helpful, although it may take
moderate to high doses to treat the problem. Twenty milligrams is a small dose of paxil. If this is
truly your problem you need to work closely with your physician increasing the dose until the
symptoms are under control, using Klonopin as necessary during an attack and using paxil to
prevent further attacks.
