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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by alex01 on December 30, 2002, at 5:34:09
Almost 18 long months ago i took a small amount of dexamphetamine after I was miss diagnosed as ADD. In fact I'm bipolar II have been for many years. Anyway after my one try of dex i had a big over-stimulation / panic attack which has more or less lasted since then. I has changed a bit, it used to come on for a couple of hours and then stop, and then it became less severe but more constant. It is not always panic but a very overstimulated feeling and very uncomfortable.What I am investigating with little success is the possibility of a kindling sort of reaction where the dex did something once and sort of moulded my brain to keep doing it. Is this possible? I had an eeg and it had a small abnormality which led the neurologist to shrug his shoulders. But even if its not a seizure, from what i know it could still have a kindling / sensitization angle to it.
ANY advice gratefully received including and pointers to where i could track down advice on this sort of problem which has proved to be a bit out of the ordinary for the doctors I've been to see.
By the way the two meds which provide some relief have been beta blockers and lithium. Would anti-convulsants be advisable?
Posted by gheld on December 30, 2002, at 8:45:04
In reply to anti-convulsants for panic?, posted by alex01 on December 30, 2002, at 5:34:09
Klonopin is frequently used, in large doses, as an anti-convulsant and many of us have used it in lower doses as an anti-panic agent. It has worked very well for me for several years, and with no dosage increase.
Posted by Ritch on December 30, 2002, at 9:51:15
In reply to anti-convulsants for panic?, posted by alex01 on December 30, 2002, at 5:34:09
>
> Almost 18 long months ago i took a small amount of dexamphetamine after I was miss diagnosed as ADD. In fact I'm bipolar II have been for many years. Anyway after my one try of dex i had a big over-stimulation / panic attack which has more or less lasted since then. I has changed a bit, it used to come on for a couple of hours and then stop, and then it became less severe but more constant. It is not always panic but a very overstimulated feeling and very uncomfortable.
>
> What I am investigating with little success is the possibility of a kindling sort of reaction where the dex did something once and sort of moulded my brain to keep doing it. Is this possible? I had an eeg and it had a small abnormality which led the neurologist to shrug his shoulders. But even if its not a seizure, from what i know it could still have a kindling / sensitization angle to it.
>
> ANY advice gratefully received including and pointers to where i could track down advice on this sort of problem which has proved to be a bit out of the ordinary for the doctors I've been to see.
>
> By the way the two meds which provide some relief have been beta blockers and lithium. Would anti-convulsants be advisable?Klonopin or Neurontin. Maybe Gabatril?
Posted by viridis on December 30, 2002, at 13:34:56
In reply to Re: anti-convulsants for panic? » alex01, posted by Ritch on December 30, 2002, at 9:51:15
Klonopin (clonazepam) is the first one that comes to mind -- it's extremely effective for panic disorder in many, like me. If you want to try something besides a benzodiazepine first, some people have had success in anxiety reduction with Neurontin (gapapentin). It's very mild and has few or no side effects in most people. I take both; the Klonopin caused a little drowsiness and disorienation for the first week or two, but now has no side effects at all. Neurontin gave me a gentle, pleasant "buzz" the first couple of times I took it, but I've never felt anything since.
For me, I'm quite sure that Klonopin has the main anti-anxiety, anti-panic effect, and my psychiatrist agrees, but prefers that I stay with Neurontin as well for its subtle mood-stabilizing effects. I also take Xanax (alprazolam) once in a while for really stressful occasions; it seems to take effect quickly and really shuts down overwhelming feelings of anxiety. I avoid taking it often, partly because it does have a reputation for inducing dependence if taken regularly (and with the Klonopin, I just don't need to use it much). I'm pretty sure that I'm dependent on Klonopin, but it's had such a positive effect on my life that I don't mind.
Some people do experience depression from Klonopin (although it acts as an antidepressant for me, by reducing the anxiety that leads to depression). Xanax appears much less likely to be depressogenic.
This is definitely something to discuss with your doctor, and I'd strongly recommend that you see a psychiatrist with experience in anxiety disorders if you aren't doing so already.
By the way, be careful if antidepressants such as SSRIs (Prozac, Zoloft, Celexa, Paxil, etc.) are suggested -- although they do seem to help with anxiety disorders in some people, they can also trigger severe anxiety in some (like me). If you do go the antidepressant route, I'd suggest you start off cautiously with very low doses. Some doctors don't appreciate the effects these drugs can have on people with serious anxiety problems.
Good luck -- there are lots of options, although I'm guessing that Klonopin may turn out to be the best.
Posted by worrier on December 30, 2002, at 23:14:28
In reply to Re: anti-convulsants for panic? » Ritch, posted by viridis on December 30, 2002, at 13:34:56
> Klonopin (clonazepam) is the first one that comes to mind -- it's extremely effective for panic disorder in many, like me. If you want to try something besides a benzodiazepine first, some people have had success in anxiety reduction with Neurontin (gapapentin). It's very mild and has few or no side effects in most people. I take both; the Klonopin caused a little drowsiness and disorienation for the first week or two, but now has no side effects at all. Neurontin gave me a gentle, pleasant "buzz" the first couple of times I took it, but I've never felt anything since.
>
> For me, I'm quite sure that Klonopin has the main anti-anxiety, anti-panic effect, and my psychiatrist agrees, but prefers that I stay with Neurontin as well for its subtle mood-stabilizing effects. I also take Xanax (alprazolam) once in a while for really stressful occasions; it seems to take effect quickly and really shuts down overwhelming feelings of anxiety. I avoid taking it often, partly because it does have a reputation for inducing dependence if taken regularly (and with the Klonopin, I just don't need to use it much). I'm pretty sure that I'm dependent on Klonopin, but it's had such a positive effect on my life that I don't mind.
>
> Some people do experience depression from Klonopin (although it acts as an antidepressant for me, by reducing the anxiety that leads to depression). Xanax appears much less likely to be depressogenic.
>
> This is definitely something to discuss with your doctor, and I'd strongly recommend that you see a psychiatrist with experience in anxiety disorders if you aren't doing so already.
>
> By the way, be careful if antidepressants such as SSRIs (Prozac, Zoloft, Celexa, Paxil, etc.) are suggested -- although they do seem to help with anxiety disorders in some people, they can also trigger severe anxiety in some (like me). If you do go the antidepressant route, I'd suggest you start off cautiously with very low doses. Some doctors don't appreciate the effects these drugs can have on people with serious anxiety problems.
>
> Good luck -- there are lots of options, although I'm guessing that Klonopin may turn out to be the best.> Two things on this topic...paxil did to me what the dex seems to have done to you. My psychiatrist thinks it overloaded my brain with way to much serotonin and essentially rewired my brain in a not particularly helpful way,so I echo the above comments about caution with antidepressants. My doc also thinks the whole panic/anxiety thing bears a strong resemblence/relationship whatever to seizure disorders and so the anticonvulsant thing makes sense and does help. I'm currently on xanax, but we're considering klonopin or even phenobarbitol if the rollercoaster experience of the xanax gets too worrisome (it's very short acting so you can really tell when it starts and stops working. But as mentioned it does seem to actually help a bit with depression. Good Luck.
Posted by viridis on December 31, 2002, at 0:19:21
In reply to Re: anti-convulsants for panic? » viridis, posted by worrier on December 30, 2002, at 23:14:28
Hi Worrier,
If Xanax helps but you don't like the ups and downs, I'd definitely recommend that you try Klonopin. For me at least, it's very smooth, and a small dose lasts all day. I can't believe the difference it's made. There is the concern about depression, but for me it reduced my depression greatly (because most of my depression stems from worry and anxiety). People also noticed how much sharper and more enthusiastic I was soon after I started taking it, and it definitely allows me to think more clearly.
I do best when I take K in the morning -- some doctors will suggest you take it before bed, but I found that the effects wore off by about noon the next day and I had to take Xanax to compensate. When I switched to dosing in the day, my need for Xanax almost disappeared. As I mentioned before, K did have some mild side effects in the beginning (e.g., be extra careful when driving), but these completely disappeared in a couple of weeks.
I've been on the same dose (1 mg/day) for a year and a half, and have had no need so far to increase it; my psychiatrist has offered to if necessary, but I'm quite happy with this dose. I'd certainly give K a try before moving to barbiturates. Also, as I mentioned in my other post, I augment the K with a small dose (0.25 - 0.5 mg) of Xanax occasionally, and this works very well for "breakthrough" anxiety.
All the best,
Viridis
Posted by worrier on January 1, 2003, at 15:02:27
In reply to Re: anti-convulsants for panic? » worrier, posted by viridis on December 31, 2002, at 0:19:21
Thanks for the feedback. I think I'll discuss the klonopin with my doc soon. I'm not that worried about the depression thing,as I too feel the depression is due to the anxiety (or the frustration about the anxiety). I would like a more even feeling...I think the xanax waxing and waning thing makes you feel like it's all the drug and you aren't really playing a role in controling the problem at all.(if that makes any sense).
Posted by JackD on January 2, 2003, at 1:31:35
In reply to anti-convulsants for panic?, posted by alex01 on December 30, 2002, at 5:34:09
Klonopin, as suggested, is definitely up there when it comes to effective anti-panic medications. I take it myself. I have also found Lamictal to be a HUGE help for panic. Personally, so far, I think mood stabilizing meds work best (at least for me) for panic; it almost makes sense since panic could involve overactivity in the brain, and mood stabilizers work to stop this. Good luck.
Posted by Kam on January 2, 2003, at 9:40:16
In reply to Re: anti-convulsants for panic?, posted by JackD on January 2, 2003, at 1:31:35
I have severe panic, and I have tried many SSRI's, between side effects and the lack of them working for me, I've become a little frustrated. My doc just started me on Lexapro, I told him that the xanax has helped me the most. Although I worry about addiction. I didn't know about Klonopin til viewing this site, if the Lexapro doesn't work I am discussing with my doc as well. GOOD LUCK !
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