![[dr. bob]](/dr-bob-sm.gif)
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 _Grant Em on July 20, 2005, at 16:20:16
I have spontaneous panic attacks, and they always seem to start w/ dissociation.
First, I'll feel that Im not as conscious as I should be. I realize that I'm not completely aware of my surroundings... I feel like I'm not able to fully comprehend everything. If some is talking to me, I realize that I'm not understanding part or all of what they are saying. If I'm just looking at something, I feel that the object is unreal.
Then, the panic begins. I think, "I'm going to faint." And hot electirc flashes pulse down my chest and my arms. I become more confused and terrified that I'm losing consciousness.Eventually, within a few minutes, I can barely comprehend anything. I can't make sense of what people are saying, it's all a mumbled mess. My arms and legs jerk, and often someone is trying to comfort me; they'll touch my shoulder and it will hurt SO BAD. I'll try to tell them to not talk, because the fact that I can't understand what they are saying is too terrifying. My body feels much too large.
Usually it lasts between 25 minutes to an hour.
When I take 5 times my normal dose of xanax, the attack will last 25 minutes. (My normal dose is .5 mg daily as needed).
My question is, are "spontaneous" panic attacks that begin with dissociation, as opposed to panic attacks caused by an outside event or stressful situation, treated differently?
Is psychotherapy more effective in the former?
Are benzodiazapenes more successful in treating "triggered" panic attacks than spontaneous panic attacks?
At this point in my illness (I had my fist panic attack less than a year ago), it seems to me that panic is an unchangable physiologic response to an internal, unconsious feeling-state in my brain- what I experience consciously as dissociation.
Xanax is eventually effective in lowering my heart-rate, paranoia, and muscle spasms, but even if taken beforehand, never extinguishes the initial panic response.
I have supportive family and friends I talk to about this; I educuate myself, I have learned from my doctor and various other sources- books, the internet, etc., that my symptoms are not uncommon; I consiously try to talk myself down from panic;
I have purposly induced feelings of dissociation to convince myself there's nothing to fear. Nothing helps.The response seems unchangeable.
I should tell you that my fist panic attack seemed to result from a mad contact high I recieved at a party. (I have never smoked marijuanna, and am apparently highly sensitive to drugs of any kind.)
After that, they just contunued *happening*. The past year has been hellish.
I am also taking 25 mg Paxil, which eases general anxiety but seems to make me apathetic and sleepy. I tried to stop taking it a few weeks ago, but had intolerable withdrawal symptoms and increased agitation and panic attacks.
I know this is a long post...it is my first post on the board. Any advice or answers to my questions will be much appreciated.
thanks.Grant
Posted by crazychickuk on July 20, 2005, at 16:34:16
In reply to Dissociative Panic Attacks...different treatment?, posted by _Grant Em on July 20, 2005, at 16:20:16
God you sound exactly like me..
mine started the same way yours did also..
i find meds agrivate my symptoms hence not being able to take anything, benzo doesnt control my symptoms either..
sorry this aint helpfull just wanted to let you know that this is what happens to me to a t! and all i do is bare with it it passes, they seem to be getting lesser but are still there, i am in thearpy doing cbt must be helping..
good luck and i hope someone can help more..
Donna xx
Posted by Declan on July 20, 2005, at 17:59:47
In reply to Dissociative Panic Attacks...different treatment?, posted by _Grant Em on July 20, 2005, at 16:20:16
Hi Grant
I don't know if the 2 different kinds of panic attack are treated differently, but my guess would be that the type that starts with dissociation would be *less* amenable to psychotherapeutic help than panic cause by an external stressor, because it is easier to identify a stressor and avoid it etc.
On the nothing to fear front, I remember something from Laing which went....'There is nothing to fear. Exactly.'
Is this the fear of becoming undone, or of falling to bits?I understand your thing is so awful, but I wonder what you think of this account of dissociation by TS Eliot, called
Hysteria
As she laughed I was aware of becoming involved in her laughter and being part of it, until her teeth were only accidental stars with a talent for squad drill. I was drawn in by short gasps, inhaled at each momentary recovery, lost finally in the dark caverns of her throat, bruised by the ripple of unseen muscles. An elderly waiter with trembling hands was hurriedly spreading a pink and white checked cloth over the rusty green iron table, saying: 'If the lady and gentleman wish to take their tea in the garden, if the lady and gentleman wish to take their tea in the garden...' I decided that if the shaking of her breasts could be stopped, some of the fragments of the afternoon might be collected, and I concentrated my attention with careful subtlety to this end.
I hope you like that.
I've spent a lot of my life feeling pretty strange.Declan
Posted by Phillipa on July 20, 2005, at 18:28:55
In reply to Re: Dissociative Panic Attacks. » _Grant Em, posted by Declan on July 20, 2005, at 17:59:47
Have you tried the xanax under your tongue? Fondly, Phillipa
Posted by rjlockhart98 on July 20, 2005, at 20:45:16
In reply to Dissociative Panic Attacks...different treatment?, posted by _Grant Em on July 20, 2005, at 16:20:16
Lord,
Have mercy on you.
I have panic disorder, i used to have dissociation, around October 2004- January 2005.
The dissociation left, well wore off, but i still have severe panic.
I currently take Klonopin (clonazpeam) 5mg daily (i just got raised from 4mg). To prevent them. Klonopin is not very good during a panic attack becuase it takes a long time to start at its job. My doctor doesnt compromise anything else than clonazepam right now.
I was on Ativan (Lorazepam) 6mg about 2 months ago, but it didnt do anything much for the panic, ativan seems to only act on GABA receptors, unlike Klonopin and Xanax which effect some serotonin receptors, maybe which is why they are chosen as panic medications. Ativan did act quick, very quick, but didnt do hardly anyhting. 6mg was the maximum dose for lorazepam, back to clonazepam.
Xanax is "supposed" have antidepressant properties in literature.
You may ask about Klonopin with Xanax. But defintly at a lower dose, or may it will make you pass out with Xanax.
Get better
matt
Posted by Shawn. T. on July 20, 2005, at 22:00:51
In reply to Re: Dissociative Panic Attacks...different treatment?, posted by rjlockhart98 on July 20, 2005, at 20:45:16
Where did you read that Xanax and Klonopin bind to serotonin receptors? I'm not aware of any evidence that suggests this to be the case.
Shawn
Posted by rjlockhart98 on July 20, 2005, at 22:23:53
In reply to Re: Dissociative Panic Attacks...different treatment? » rjlockhart98, posted by Shawn. T. on July 20, 2005, at 22:00:51
Clonazeapam: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2418653&dopt=Abstract
Alprazolam: i know that Xanax has mild antidepressant propertiesbut i cant find some sources. Klonopin was easy. I'll keep looking.
Posted by Emily Elizabeth on July 20, 2005, at 22:53:19
In reply to Dissociative Panic Attacks...different treatment?, posted by _Grant Em on July 20, 2005, at 16:20:16
I don't know a lot about these issues, but I thought I'd comment on what jumped out at me.
1. It is very hard to just stop Paxil. Absolutely don't do that. It will make you feel awful physically and mentally. You need to go very slowly and do it under the supervision of a (knowledgable) doc.
2. It sounds like you have a complex problem that is going to require some creativity on the part of your physician. I say this to folks all the time, but I'll say it again b/c I believe it makes a huge difference: see a psychiatrist and not just your regular doc. What you are dealing with reaches outside of what most regular docs have experience with. A pdoc is likely to be more aggressive and have more ideas.
3. You seem to be on a low dose of Paxil. Have you tried more? For a while I took 50mg of Paxil and a tiny bit of Wellbutrin to offset the sleepiness. Have you tried other meds before?
4. Psychotherapy can be very useful for many things, if you have the option, you should do it. (Of course, I am training to be a therapist, so I'm probably a little biased..)
Best,
EE
Posted by Phillipa on July 21, 2005, at 0:05:34
In reply to Re: Dissociative Panic Attacks...different treatment?, posted by rjlockhart98 on July 20, 2005, at 22:23:53
Matt, You're right it does! Fondly, Phillipa
Posted by ace on July 21, 2005, at 0:22:47
In reply to Re: Dissociative Panic Attacks...different treatment?, posted by Emily Elizabeth on July 20, 2005, at 22:53:19
Posted by Shawn. T. on July 21, 2005, at 22:04:46
In reply to Re: Dissociative Panic Attacks...different treatment?, posted by rjlockhart98 on July 20, 2005, at 22:23:53
Those effects are the result of interactions with GABA-A receptors; they're not unique to Klonopin.
Shawn
Posted by rjlockhart98 on July 21, 2005, at 22:12:01
In reply to Re: Dissociative Panic Attacks...different treatment? » rjlockhart98, posted by Shawn. T. on July 21, 2005, at 22:04:46
sorry
Posted by spriggy on July 22, 2005, at 20:53:52
In reply to Re: Dissociative Panic Attacks...different treatment?, posted by rjlockhart98 on July 21, 2005, at 22:12:01
My panic attacks have always started with the feeling of depersonalization/derealization.
It's hard to describe the feeling but it feels as if I am disappearing or the world is not real or I am not real or I am just in a dream. It's very weird/strange/uncomfortable. I feel like I'm floating or something. I hate it.
That feeling then causes me to panic. So now when I get that feeling, I just try and tell myself what it is, focus on deep breathing, and pray (or count).
I also try to do something physically active so I can FEEL myself and know I am really here.
It's weird. I know.
Posted by rjlockhart98 on July 22, 2005, at 21:09:42
In reply to Re: Dissociative Panic yes ACE.. I do.., posted by spriggy on July 22, 2005, at 20:53:52
Mine is a little diffrent.
Its as im looking through a tunnel through my mind into reality, i feel deep. Well not anymore.
I will sit and stare, everything is COMPLETELY still. Then panic will start, then im Ripley on Alien (1979) running through the hallways at the end, if you have seen that end seen you will know what i mean.
I dont know what else to say.
Good ;luck and take care
Posted by bimini on July 23, 2005, at 22:03:45
In reply to Re: Dissociative Panic yes ACE.. I do.., posted by spriggy on July 22, 2005, at 20:53:52
That is it. Like a dream, mechanical and weaving. I cannot think myself out of it though, it is as there are no thoughts in my mind, all fluff, a breeze, a ripple and I don't feel panic, rather floaty, unreal, like I am rolling on wheels. I have rolled into walls because I can't maneuver the wheels I'm on.
I went up an escalator and vanished a short time after getting on. At the end people behind me bunched up and shoved me off the escalator. I rolled straight into a wall ahead, then could not turn. I yelled in my mind LEFT! Minutes later I managed to slowly walk. I sat on a bench exhausted, wanted to go to sleep right there.
Thinking it was the escalator I went back for some more escalator riding. It has a weird effect of distorting motion, disturbs my sense of balance but doesn't produce dissociation on cue. Finding triggers is like chasing a ghost, I've stopped trying to figure it out.
bimini
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.