Panic Disorder

[PeteNYNJ]

I have been diagnosed with a Generalized Panic Disorder that seems to be getting worse and worse.  I started on Lexapro about 2 years ago but it seems to have stopped working so I have been switched to Effexor.  I have been on it for about 6 weeks and had the WORST panic attack of my life yesterday.  Luckily I had a Psych appointment and he was able to help. 

My attacks used to be somewhat mild, general worry and such.  They have now gotten to being pure hell - sweating, can't breath, chest pain, no appetite/vomiting, exhaustion but can't sleep, fear, paranoia.  He gave me Klonopin for the acute attacks and suggested I stayed with my family last night to avoid any stupid actions.

I am looking for advice from anyone who has had these panic disorders or currently have them.  What worked for you?  What to avoid to control them?  I am going through some major stress in my life (overwhelming debt, possible lay off at work, friends moving away, uncertainty of my future).

It has to get better - I can't live like this anymore. 

Thanks for reading

Pete

[bear60]

I hope you find a way to make the attacks less severe.  Be well.

[Gary85741]

     Panic attacks are the body's physiological response and defense to real or perceived threats (physical or psychological, broadly defined.)  It's the same mechanism triggered in our ancestors in early time when, for example, they faced a sabre-toothed tiger.

     When threatened, the body pulls blood to the muscles to metabolize them, away from extremities and capillaries (hence feeling cold or clammy.)  Pupils dilate to maximize visual information.  Respiration increases which causes hyperventilation, which, in turn, results in too much oxygen and the feeling of dizziness.  It's the classic 'fight or flight' survival mechanism.

     To counter these reactions, we need to reduce the oxygen supply.  One way to do this is to put a small paper bag over your nose and mouth, breathing normally (alters the oxygen.)  Since this can look kind of strange in public, the other method to use is called square breathing.  With no paper bag, inhale to the count of four, hold to the count of four, exhale to the count of four, hold to the count of four, and continue repeating the four steps (hence the 'square.')

     I have had what are thought to be panic attacks, about one every other year for the last ten years, and they are pronounced enough that I will lose consciousness.  The next time I sense an attack coming on, I will use square breathing.

     Sometimes knowing what is going on can make it less disconcerting.  Hope this helps.

Gary

[Miss Philicia]

I've been diagnosed with GP disorder now for 7 years.  Klonopin GREATLY assisted me at the beginning half -- as a member of the benzo class it's the most effective as it has the longest half life.  SSRI's like Effexor are crap for anxiety issues, as they treat depression issues and personally I find such concerns flip sides of the same coin.

GP disorder is NOT a simple case of a few attacks each year.  They are a stready, daily event and NOT a pleasant way to live -- in fact they're quite debilitating.  However, my advice is to be very careful that you don't allow your dose to increase substantially.  Your doctor probably started you at 0.5mg/daily and while you may have to increase it depending on the severity of your attacks, try not to go over 2.0mg  and NEVER stop your daily dose all at once.  A daily dose of a benzo class drug MUST be tapered off ALWAYS.  I would imagine that your doctor cautioned you about this.

As far as treating the root problem and not just the symptoms, you should be having one-on-one therapy sessions and using a cognitive behavioral approach to zero in on causes and how best to head them off in your head.

[PeteNYNJ]

Thanks Philly

I agree with the Klonopin suggestion.  He gave me .5 and that is fine.  I do feel anxious most days, but some days they are full on attacks like described above.

Thanks for the advice about Klonopin.  I dint take it every day, just take two when I have an attack and usually one at bed for a few days after (after an attack it takes a few days to get back to more "normal" anxiety level life he he)

I am confused with one thing you said .  My Psychiatrist told me that Effexor would help with the panic disorder.  It even says on their site it is approved for Generalized Anxiety Disorder.  Are you speaking from personal experience regarding Effexor or have you read that it doesn't work for GAD?

The counseling thing has to happen soon.  I have been avoiding it, I don't know why but I have.  I guess I am afraid of what lurks in this head of mine.

Pete

[Miss Philicia]

Personal experience, and I've tried about 5-6 drugs in that class (SSRI) including Effexor.  For me at least, all SSRI's are "speedy" so in fact they make anxiety issues worse.  Benzos are often prescribed to COUNTERACT this effect for those of us with anxiety issues.  It's always been my view that they like to label SSRI's for being more than just anti-depressants as a way to increase their use (and thus sales).  My first psychiatrist, and the one who correctly diagnosed my GP disorder, felt the same.

So I guess the question is do you think you have depression issues in addition to the panic attacks?  Further, if you have DAILY panic attacks why are you only taking klonopin on an "as needed" basis instaead of a daily basis?  Klonopin is not an "as needed" type of benzo... xanax is.  Klonopin takes longer to take effect, hence why it is prescribed for generalized disorders and the longer half life allows it to be used on a daily basis.  Having the med in your body at this low level at all times should greatly minimize any panic attack.

Many people avoid one-on-one therapy at all costs.  Try not to fall into that trap.  Taking pills is only at best a short term solution.

Not sure what kind of insurance you have, but if you need the name of an excellent therapist in Manhattan I can give you his name -- it's who I initially saw in '00 when I lived there.  He's gay, very experienced with people dealing with HIV, and a delightful gentleman.

[PeteNYNJ]

Thanks, Philly

I would appreciate his name. 


Thanks for the advice.

Pete

[shadowfluid]

1) Exercise
2) reducing caffeine intake
3) Breathing exercises everyday (even when you don't feel anxious)
4) Books by David Burns helped me
5) Distraction....if you feel an attack come on...call a friend

Therapy really helped me reduce the anxiety too.

[dufusmaximus]

I'm on 10mg of Paxil daily and when I start to get a panic attack (usually in overcrowded buses, theaters and long road trips in cars or planes) I can take ativan - BUT then I can't remember much the next day!  I don't take the ativan anymore, I do have it in case of long trips, but I just avoid crowded places.  I wish I could tell you why these things get triggered.  I also do this thing I call 'relive my entire life', usually every Sunday night - I have done this for years.  I go over and over every bad mistake/misfortune of my life up until the present.  Luckily it's gotten better with just the Paxil, but I have done trazadone (used as a sleeping aid) and ativan (but side effects are too extreme).  If I start to feel panicky, I usually just bolt off the bus, leave a theater (my friends have been warned), walk away from crowded places.  It's very embarrassing, I do not know why I have these attacks - they are illogical and are not anything I can 'think' my way out of.  UGH! Good luck to everyone.

[Nico]

Pete,
My attacks got so bad in the early '90's, I would leave a shopping cart full of food in the store and bolt, take an hour to walk five or six gates in the airport (always felt the need to hide), could not go to the movies and hell forget the mall.  I went to a shrink when I finally realized this was not going away.  I tried Paxil and some other benzo's.  I ended up on xanax and take 2.5 mg day, but usually only take 2 mg.  Yes, I am addicted to it after 13 years, but it was the only thing that worked and I at least feel comfortable being in public and don't worry about breaking out in a sweat, heart pounding, shaking - you know the drill.  I live a pretty normal life aside from being poz.

Philly has some good advice and I am sure he would not recommend the xanax route, but it was all that worked for me.

Good luck since I know it is a living hell to deal with.
Rog

[Miss Philicia]

Xanax is in the same class as klonopin, it just has a shorter half life.  I've taken xanax for more specific events such as an out patient surgery, etc. as it's usually for short term stuff.  Also great for major dental events.  But if it works for you great.

I hate the word "addiction" with these meds, and prefer "physical dependency"

IIRC benzos are metabolized in the liver, as are NNRTIs and PI HIV meds, so I think there's something doctors look out for in your blood work when you first go on a benzo.  Like anything, make sure you're psychiatrist is co-ordinating with your HIV specialist and/or that you're informing/consulting with each about it all.

[bear60]

 Peter, you are not even on HIV meds yet, so you really really need to get a handle on all this other stuff if you hope to make it through taking meds and so on down the road.
Take to heart what Philly is saying about the liver.
If you are drinking alcohol heavily, even if only on occasion, this can cause serious side effects in conjuction with anti depressants.  I know, I tried it and it wasnt pretty.
If you have to go on meds PLEASE make the necessary life style adjustments and the adjustments to your antidepressants so that your panic attacks are not serious.

[PeteNYNJ]

You are all right.  I do need to get a handle on these issues and I have been taking steps in the last month to finally get control of my life since it feels out of control lately. 

Thanks all for your concern and suggestions.  I really appreciate it.

I go to my ID doc on Friday for new numbers and will have conversation about everything going on.  He should be in the loop (I always ask my docs to send info to my ID doc) but sometimes things fall through the cracks.

I have started to feel hopeful the last two days that there is a way out of this mess of a life I created.  I just need to believe in myself and stop being such a victim of my own self destructive behaviour.

Pete

[PeteNYNJ]

Iam convinced the effexor is making me nuts.  I can't sit still, grind my teeth, think about suicide/hurting myseld a lot, sleep sucks,  worst labs since starting.  I am on it for 2 months and it has gotten worse.  - am telling my psych next week I want off.  Anyone with a panic disorder take anything that works?

[Miss Philicia]

I told you before, but I think Effexor is for depressions, NOT anxiety.  Anxiety needs a sedative, not Tina in capsule form.  I can't believe shrinks give this crap out.

Suggest Remeron (though it tends to make you gain some weight), or maybe Cymbalta.

read my post here:  http://forums.poz.com/index.php?topic=17254.msg219306#msg219306

[PeteNYNJ]

Philly - can you be my psychiatrist?  Tina in capsule form is the perfect description!!  It is like I drank a whole pot of coffee every hour.  I want to scream at these guys "depression is not my primary symptom, anxiety is!!!"

[Miss Philicia]

Did you call that guy that I told you about via PM?  He's quite good and will take care of you well.  He totally knows the difference between anxiety and depression, though they often go in hand but NOT always.

[bear60]

Pete...
What Philly said. 
You got to have the right psych doc.
Or do you just like sampling all these pills? 

[Miss Philicia]

I'm telling you hun... it's ALL about Dr. Jack!

[PeteNYNJ]

Hey Philly and Bear

Yes, I called him a few days ago and left a message.  Havent heard back yet. 


No I dont like trying these different pills...none of them are any fun

[Miss Philicia]

I just started back on Wellbutrin, just on a lark.  It doesn't contribute to erectile problems like the other SSRI's (notably Effexor) and it also helps to quit smoking so that's a win-win for me.  Plus I was slightly zipping around the house getting things done today (but NOT speeding like Tina with a broom) so I guess I'll stick it out for six weeks and see how it goes.

I only hope it does not interfere with my sleep or that will be the real killer.

Pete, you have to stick with each type of pill around 6 weeks before deciding whether or not it's worth it.  If it's not, just insist to the doctor to give you another one.  They all act different to each patient.  It's not really an exact science like with HIV.

[PeteNYNJ]

I have been on the effexor for 2 months now.  I am done..next

[Buckmark]

Iam convinced the effexor is making me nuts.  I can't sit still, grind my teeth, think about suicide/hurting myseld a lot, sleep sucks,  worst labs since starting.  I am on it for 2 months and it has gotten worse.  - am telling my psych next week I want off.  Anyone with a panic disorder take anything that works?

I don't have a panic disorder, but I did take Effexor for depression about 4 years ago.  It sucked -- I was constantly nervous and jittery, like I was on some kind of strong stimulant.  I could barely sleep.  And I couldn't get an erection if my life depended on it.    And it did nothing for my depression. 

Hopefully your psychiatrist will help you find something that works for you.

Henry

[PeteNYNJ]

Thanks, Henry

Feel the same way except it does nothing to my erection capabilities....which is good I guess if I could get laid  lol

I would probably jump out of the bed or obsess over what I look like naked.  Yeah, this is a fun drug.

Lexapro made me never want to have sex and when I did, it took forever to finish.  I guess that would be nice if I was a top

Pete

[bear60]

Pete
I'm sorry to hear that you didnt get a call back from the psychiatrists office.  Maybe they were closed for Thanksgiving vacation...or something.  I hope you keep calling till you get a response.  It occurs to me that you could ask him for a referral if he is not taking any new patients.
Good luck.

[Miss Philicia]

Is this Dr. Jack that didn't call you back?  Most odd -- but he's dreadfully busy all the time and may not even be accepting new patients.  I can't emphasize what a wonderful man he is.  His office even has a zen garden in the back that you look out on while your head is being shrunk by Jack.

Keep calling him.  If you need a reference you can use my real name -- just PM me for it.

[PeteNYNJ]

I called a bunch of therapist and they arent taking new patients.  I guess it is that time of year.   I found one who is and I go next week.  It is time I talk to someone about these issues and not just keep popping pills.

I have a cold now too...ugh

Pete

[PeteNYNJ]

I go for my first appointment tonight with my new therapist.  I really need to talk to someone.  I am walking around NYC today just annoyed at everyone. 

This poor man has no idea what he is getting himself into

[Miss Philicia]

Walking around NYC this time of December is always annoying due to the plethora of large shopping bags.

[PeteNYNJ]

hey everyone....happy holidays

I weened off the effexor and am now on celexa.  I feel so relaxed and back to "myself".  Effexor was a nightmare.

Just an update.

Pete

[BT65]

Pete, I'm sorry I didn't see this when you first started talking about it.  I hope the Cymbalta does well for you.  Myself, I'm on Effexor, but I tend to have problems with focusing, so it works well for me.   

I was on all the benzos before-even Valerese which is the higher mg of Valium (15 mgs).  I, however, have a very addictive nature, so those things can't be used with me.  Actually what works for my panic attacks is a med called Zyprexa.  I take 5 mgs every night.  It's not physically addicting, so that works for me. 

I hope your therapy is going well for you also.  I've had the same therapist since '91.  He comes to my apartment now and he, his wife and I have all gotten to be good friends.  His wife performs with the local theatre and he's taken me to see a couple plays she's been in.  They're also my granddaughter's godparents.  Unusual, I know.  Anyway, have a good New Year and hang in there!