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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Prefect on May 7, 2013, at 21:31:26
I'm beginning to wonder if the conditions known as "anxiety" and "panic disorder" should be seen as two very distinct conditions with very different pharmacology and brain chemical states (even possibly opposing chemical states).
I, for instance, suffer from agoraphobia, which I've been told is a complication of panic disorder. When I go out, my level of anxiety is directly linked to my distance from my house. But when I'm not faced with a phobic situation, I'm extremely serene and calm. I deal with life problems with a collected mind and my mind is usually a ghost town when not being used for a specific function. But put me 30 km from my house, I will get panicky for a little while until I calm down. This condition can be very debilitating.
I know people, on the other hand, who suffer from "anxiety" or GAD. They're constant worriers and they obsess about stuff. It's as if there is a mental activation that will not turn off. This is certainly not me.
But it seems both groups are prescribed the same medication. I'm wondering if the experts on this site can have input on the difference between these two conditions and what possible meds would be more suitable for my type of condition.
Thanks folks!
Posted by rjlockhart37 on May 7, 2013, at 22:08:10
In reply to Meds for panic/agoraphobia VS. anxiety, posted by Prefect on May 7, 2013, at 21:31:26
meds that work on GABA that cause the nervous system to be less reactive are the best....xanax, ativan, and then some others like Depakote with it...to increase the GABA effect. Also you may want to look into a low dose of antipychotics....even though there used mainly for psychosis, they cause the nuerotransmitters to lower, result it makes people be more passive and less bothered and agitated, you should look into that....
also something quick to add that shouldn't be a problem with a doctor is Buspar...
good luck..
r
Posted by Phillipa on May 7, 2013, at 22:56:19
In reply to Meds for panic/agoraphobia VS. anxiety, posted by Prefect on May 7, 2013, at 21:31:26
Said to be OCD which is also anxiety related. But my agoraphobia is only associated with going out alone. If in car. When home I'm out alone riding bike all over and love it. But I obsess So I only take a small dose of xanax & valium at night. I think all the anxiety disorders are alike as used to panic then stopped as turns into ruminating. So feel all similar. Phillipa
Posted by jono_in_adelaide on May 7, 2013, at 23:07:10
In reply to Re: Meds for panic/agoraphobia VS. anxiety, posted by rjlockhart37 on May 7, 2013, at 22:08:10
In agrophobia, the gold standard meds would be high dose sertaline or clomipramine
Clomipramine probably has the edge for effectivenes, but it causes more side effects than sertaline.
If these drugs fail, adding a benzodiazepine (alprazolam for example) or mirtazapine or an atypical antipsychotic would all be possabilities
Posted by SLS on May 7, 2013, at 23:41:51
In reply to Meds for panic/agoraphobia VS. anxiety, posted by Prefect on May 7, 2013, at 21:31:26
Nardil can effectively treat GAD with panic attacks.
Imipramine has been used for many years to treat panic attacks with agoraphobia.
Of the SSRIs, Zoloft is often chosen in the treatment of panic disorder. It is a effective as Paxil, but with milder side effects and reduced withdrawal effects upon discontinuation.
Klonopin is probably the best benzodiazepine (BZD) to take continuously for panic attacks and should also be considered for use as an adjunct to antidepressants.
Xanax is probably the best BZD to take PRN when panic attacks occur. It might also be used prophylactically when a panic attack is anticipated. My guess is that Xanax, if used in this capacity, can help extinguish the association between specific events and anxiety.
I have no personal experience with panic attacks.
- Scott
Posted by SLS on May 7, 2013, at 23:45:19
In reply to Re: Meds for panic/agoraphobia VS. anxiety, posted by jono_in_adelaide on May 7, 2013, at 23:07:10
> Clomipramine probably has the edge for effectivenes, but it causes more side effects than sertaline
Clomipramine is probably more effective than imipramine as well.
- Scott
Posted by Phillipa on May 8, 2013, at 18:35:44
In reply to Re: Meds for panic/agoraphobia VS. anxiety » Prefect, posted by SLS on May 7, 2013, at 23:41:51
No doesn't extinguish the panic attacks just don't have them when taking xanax. As for klopopin it's the one benzo that caused me to feel suicidal and wasn't. Needless the say the doc said stop it and resume xanax which I did. Phillipa
Posted by tensor on May 9, 2013, at 9:43:34
In reply to Meds for panic/agoraphobia VS. anxiety, posted by Prefect on May 7, 2013, at 21:31:26
> I'm beginning to wonder if the conditions known as "anxiety" and "panic disorder" should be seen as two very distinct conditions with very different pharmacology and brain chemical states (even possibly opposing chemical states).
Aren't they already?
> But it seems both groups are prescribed the same medication. I'm wondering if the experts on this site can have input on the difference between these two conditions and what possible meds would be more suitable for my type of condition.
It's because SSRIs and benzodiazepines are (usually) effective in both GAD and panic disorders. However, in panic disorder you can get away with a p.r.n. medication like a fast and short acting benzo.
/tensor
Posted by SLS on May 9, 2013, at 10:21:54
In reply to Re: Meds for panic/agoraphobia VS. anxiety » SLS, posted by Phillipa on May 8, 2013, at 18:35:44
> No doesn't extinguish the panic attacks just don't have them when taking xanax. As for klopopin it's the one benzo that caused me to feel suicidal and wasn't. Needless the say the doc said stop it and resume xanax which I did. Phillipa
It is important not to confuse phobia with panic. I found only one study regarding Xanax and phobia extinction. The conclusion was that Xanax does not help facilitate desensitization. That's too bad. I am surprised that I didn't find any other similar studies, though.
I was pleasantly surprised to learn that SSRIs were found to be superior to Xanax or imipramine in treating panic disorder.
http://www.ncbi.nlm.nih.gov/pubmed/7622804
- Scott
Posted by Prefect on May 9, 2013, at 21:21:08
In reply to Re: Meds for panic/agoraphobia VS. anxiety » Phillipa, posted by SLS on May 9, 2013, at 10:21:54
I'm a good example for distinction between phobia and panic. I develop agoraphobic type anxiety in places I go on a daily basis. I've actually not done any phobic avoidance this relapse (it's lasted about 9 months). This means there's nothing to desensitize to...I just panic. This must be a panic disorder much more than just agoraphobia. I've been thinking about taking SAM-e for ostheoarthritis, it would be interesting to know what effects it would have on my mood augmented with my daily 100 mg Luvox.
Posted by Phillipa on May 9, 2013, at 22:53:27
In reply to Re: Meds for panic/agoraphobia VS. anxiety » SLS, posted by Prefect on May 9, 2013, at 21:21:08
Can you take SAM-e for osteoarthritis? With luvox? What are the benefits? Thanks Phillipa
Posted by Vincent_QC on May 18, 2013, at 9:57:26
In reply to Meds for panic/agoraphobia VS. anxiety, posted by Prefect on May 7, 2013, at 21:31:26
> I'm beginning to wonder if the conditions known as "anxiety" and "panic disorder" should be seen as two very distinct conditions with very different pharmacology and brain chemical states (even possibly opposing chemical states).
>
> I, for instance, suffer from agoraphobia, which I've been told is a complication of panic disorder. When I go out, my level of anxiety is directly linked to my distance from my house. But when I'm not faced with a phobic situation, I'm extremely serene and calm. I deal with life problems with a collected mind and my mind is usually a ghost town when not being used for a specific function. But put me 30 km from my house, I will get panicky for a little while until I calm down. This condition can be very debilitating.
>
> I know people, on the other hand, who suffer from "anxiety" or GAD. They're constant worriers and they obsess about stuff. It's as if there is a mental activation that will not turn off. This is certainly not me.
>
> But it seems both groups are prescribed the same medication. I'm wondering if the experts on this site can have input on the difference between these two conditions and what possible meds would be more suitable for my type of condition.
>
> Thanks folks!Hi ;-)
I think anxiety is very different from a person to another one.
I do suffer of agoraphobia + panic disorder as well as GAD, social phobia, somatisation disorder and simple phobias...
I think the agoraphoia start when the panic disorder get out of control, at first staying at home was a way to avoid panic attacks. I had difficulty to get out of the house more and more since it was the only place where I was feeling safe, so driving my car was really hard especially alone and the more far away I was from home and the more anxious I was...
Of course avoiding is the worse thing to do when you have agoraphobia, you have to force yourself to get out of the house everyday, and i'm talking by experience... I do the mistake to stop driving my car, then I didn't get out of my house for weeks and one day at the end of 2010 I start to have panic attacks at home and felt not safe in my own house!!!
That's when my anxiety start being the worse, with no safe zone, physical symptoms who are mimic real diseases, chronic pain, chronic headache, chronic tachycardia, low blood pressure, hypotension, dizziness, vertigo, difficuty to breath, name it, all my anxiety is now physical,
I'm certainly not like you in the way that i'm worry all the time abouth my physical symptoms, have many panic attacks everyday in my own house, it'S like I can't shut off my brains and stop worrying about my health.
One thing I know is that benzo meds who act on the Gaba-A are very addictive, i'm addicted to them and they don't even work anymore, i'm stuck on 7 mg of Clonazepam a day with no reduction of anxiety, I also take once in a while a small dose of Xanax especially when I have to get out of the house and have to go to an appointment, I also take a beta-blocker to reduce my rapid heart beat so 30 mg of propranolol divided in 3 x 10 mg dose... it's not even working to reduce my heart rate now and will have to switch to another one soon and see if it's helping me more...
On other hands, the SSRI's like the Paxil really work for panic,agoraphobia and health anxiety as well. The only one problem is to take them since they increase the anxiety at first most of the time and for someone like me, I can't deal with more anxiety since i'm med sensitive to the point that taking a simple med like a Tylenol will lead to side-effects!!!
If you are not med sensitive, the MAOI call Nardil is good for anxiety, if you can deal with the orthostatic hypotension and the lack of energy and insomnia...
The Clomipramine, who is a tricyclic antidepressant (TCA) is for me one of the worse med I try in my life, it's impossible to deal with the side-effects it give...all the tricyclic antidepressant are difficult to take and have a lot of side-effects, some peoples here will say that it's not true, but they are probably more depressive than anxious!!!
So basically you are right, panic or agoraphobia answer well to same meds...
It's hard to separate the agoraphobia and panic part of the anxiety, but for me I know that the panic disorder lead to the agoraphobia...maybe for you the agoraphobia appear first???
Well, take care and don't give up!!! We will fight that anxiety!!!
Vincent
This is the end of the thread.
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