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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SpratNZ on March 23, 2014, at 4:16:07
Hi
I've had agoraphobia with panic attacks for 25 years now - SSRI's worked beautifully at first, but had a tendancy to poop out after about 3 years. Now I've been through them all - pdoc has me back on Paxil but it's only working at about 50%. I'm taking 1mg of clonazepam at the same time but still get panic attacks. I'm not keen to go long term on the clonazepam because the amount I need practically knocks me out. My Pdoc is keen to augment the Paxil with an antipsychotic - while this makes me quite nervous, I fear I've run out of other options. Is there any particular antipsychotic that would be suited for panic disorder?
Thanks
Jackie
Posted by Guy on March 23, 2014, at 10:47:30
In reply to Best antipsychotic to augment SSRI for panic?, posted by SpratNZ on March 23, 2014, at 4:16:07
Zyprexa helped with my panic attacks but I couldn't stand the constant malaise. YMMV, though. Also be warned about significant weight gain and possible diabetes 2.
Posted by SLS on March 23, 2014, at 15:10:37
In reply to Re: Best antipsychotic to augment SSRI for panic?, posted by Guy on March 23, 2014, at 10:47:30
> Zyprexa helped with my panic attacks but I couldn't stand the constant malaise. YMMV, though. Also be warned about significant weight gain and possible diabetes 2.
There is currently some work being done to investigate the ability of metformin to mitigate antipsychotic-induced weight-gain as well as to prevent diabetes.
- Scott
Posted by phidippus on March 23, 2014, at 15:27:22
In reply to Best antipsychotic to augment SSRI for panic?, posted by SpratNZ on March 23, 2014, at 4:16:07
Have you been on any TCAs? Mirtazapine? SNRIs? There are a lot of antidepressant choices out there. What SSRIs have you been on?
Using antipsychotics to treat panic disorder is counterintuitive-they antagonize seratonin which is in short supply. If I were to choose one, I'd go with Geodon - it agonizes key seraotonin receptors and is a SNRI to boot.
Have you tried GAbitril or Keppra? Both have had some positive studies in regards to treating panic disorder.
Eric
Posted by SpratNZ on March 23, 2014, at 15:52:49
In reply to Re: Best antipsychotic to augment SSRI for panic? » SpratNZ, posted by phidippus on March 23, 2014, at 15:27:22
> Have you been on any TCAs? Mirtazapine? SNRIs? There are a lot of antidepressant choices out there. What SSRIs have you been on?
>
> Using antipsychotics to treat panic disorder is counterintuitive-they antagonize seratonin which is in short supply. If I were to choose one, I'd go with Geodon - it agonizes key seraotonin receptors and is a SNRI to boot.
>
> Have you tried GAbitril or Keppra? Both have had some positive studies in regards to treating panic disorder.
>
> EricI've been on imipramine which didn't work - I actually suggested Mirtazapine and Effexor to my pdoc. He reckoned I wouldn't like Mirtazpine because it would cause weight gain (which wouldn't bother me to be honest) and I think he thought that Effexor would be too activating. It's hard because I'm going by his advice and have to trust that he knows best. (And I've been on every SSRI they have in NZ - paxil (3x!!), citalopram, escitalopram, prozac and zoloft. All pooped out or didn't work).
Gabitril isn't subsidised over here. I tried sodium valproate but it made my panic attacks so much worse! Not sure if this would be the same with other anti-epilitics.
I have to admit I was stunned when my pdoc suggested an anti-psychotic, but I realise they're kind of 'in vogue' at the moment.
Do you know if the weight gain from Mirtazapine is because it effects your metabolism, or if it just increases your hunger? Because that I could easily control.
Thanks
Jackie
Posted by Beckett on March 23, 2014, at 16:09:22
In reply to Re: Best antipsychotic to augment SSRI for panic? » phidippus, posted by SpratNZ on March 23, 2014, at 15:52:49
I think antipsychotics are tranquilizing in a way different from benzodiazepines Risperdal helped me and my metabolism did not take a hit. I get anxious and agoraphobic as well. Still sorting it out.
The antipsychotics are all different in effect IMO.
Posted by SpratNZ on March 23, 2014, at 17:04:56
In reply to Re: Best antipsychotic to augment SSRI for panic? » SpratNZ, posted by Beckett on March 23, 2014, at 16:09:22
> I think antipsychotics are tranquilizing in a way different from benzodiazepines Risperdal helped me and my metabolism did not take a hit. I get anxious and agoraphobic as well. Still sorting it out.
>
> The antipsychotics are all different in effect IMO.Thanks Beckett. Can I ask what dose you are on and if you're on an SSRI as well?
Jackie
Posted by phidippus on March 23, 2014, at 17:06:22
In reply to Re: Best antipsychotic to augment SSRI for panic? » phidippus, posted by SpratNZ on March 23, 2014, at 15:52:49
There's tons of other TCAs to try.
Effexor worked for me and wasn't too activating.
Going on an anti-psychotic won't help, except for maybe Geodon-I tried to treat my panic with APs and it did not work out.
Mirtazapine increases hunger.
Eric
Posted by Beckett on March 23, 2014, at 19:20:11
In reply to Re: Best antipsychotic to augment SSRI for panic? » Beckett, posted by SpratNZ on March 23, 2014, at 17:04:56
Hi Jackie,
Currently, I'm not on an ssri or an antipsychotic. I just detoxed from benzodiazapines, so I am in flux. I was put on seroquel at too high a dose. It quelled panic and every other feeling! I can't really say--. Risperdal at a low dose helped mood fluctuations which had a trickle-down effect on panic and anxiety. I might retry it. .25mg. I had no discernible gain at a higher dose. However there is nothing like a benzodiazepine to stomp out a panic attack--but then I had rebound anxiety :(. Right now I take gabapentin as needed.... There seems to be different ways to approach panic. Afraid I'm not doing a very good job right now.... The best thing was dexedrine, but I built up a wicked tolerance! I guess a motto here is "YMMV". I'm sorry I can't offer you anything more substantial. Right now I am working up to leaving the house for a walk. Walking is good, running is better....
Posted by doxogenic boy on March 24, 2014, at 13:15:49
In reply to Best antipsychotic to augment SSRI for panic?, posted by SpratNZ on March 23, 2014, at 4:16:07
> Hi
>
> I've had agoraphobia with panic attacks for 25 years now - SSRI's worked beautifully at first, but had a tendancy to poop out after about 3 years. Now I've been through them all - pdoc has me back on Paxil but it's only working at about 50%. I'm taking 1mg of clonazepam at the same time but still get panic attacks. I'm not keen to go long term on the clonazepam because the amount I need practically knocks me out. My Pdoc is keen to augment the Paxil with an antipsychotic - while this makes me quite nervous, I fear I've run out of other options. Is there any particular antipsychotic that would be suited for panic disorder?
Seroquel (quetiapine) may help against panic disorder with agoraphobia:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2993527/
Excerpt from the link above:
"In this case report, low-dose quetiapine (Seroquel®) effectively treated panic disorder with agoraphobia (PDA) and obsessive-compulsive disorder (OCD) in a patient with bipolar depression."
End quote.See also case report below about quetiapine + SSRI. Seroquel has helped against my servere generalized anxiety disorder and treatment resistant depression (see my medication in my signature) and there are lots of people (but not everybody) who are satisfied with Seroquel. It is important to take it at bedtime, to avoid being tired during the day.
http://www.sciencedirect.com/science/article/pii/S1876201812000275
Quote from the link above:
Efficacy of quetiapine in treatment-resistant panic disorder: A case reportWilliam Pitchot
Marc AnsseauHighlights
Some patients with panic disorder fail to respond to standard treatments. Some studies have suggested that atypical antipsychotics in association with an SSRI could be an option for treatment-refractory panic disorder. Efficacy of low doses of quetiapine in addition to an antidepressant in a patient suffering from treatment-resistant panic disorder.
End quote.- doxogenic
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