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Mental Health (Expert Forum)
Medication for Panic Disorder/Attacks
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
Medication for Panic Disorder/Attacks
by ACD, Mar 01, 2007 12:00AM
78-year-old female(my mom)with hysterectomy as only medical history. She is having rapid heart rate, tightness in lungs-breathing, shaking, difficulty swallowing, nausea and insomnia. All blood work, EKG/MRI/CT scans have come back negative. No previous history of depression. 1st Dr diag anxiety/panic and prescribed Xanax/Ambien, which gave relief. After a few months, Xanax started to require larger and larger doses to remain effective although we were still under the max recommended dose. 2nd Dr diag depression and prescribed Cymbalta. On 30mg Cymbalta, symptoms back to the same to worse as before Xanax, to which he added .25mg Zyprexa which now gives similar relief to Xanax. Negative side effect is 2% weight gain/month and lethargy with Zyprexa, so stopped it. Back to same negative original panic attack symptoms once back on Cymbalta alone. Increasing to 60mg. Cymbalta no help. Once again back to adding the .25mg Zyprexa but now with 50mg Topamax to control appetite and weight gain. Panic attack symptoms relieved once again but still have weight gain/hunger and lethargy. We have not tried any other SSRI’s such as Paxil etc. My issue is I’m concerned that the Dr is using the Zyprexa/Topamax to compensate for Cymbalta being the wrong SSRI. I am also concerned about long term Zyprexa/Topamax/SSRI treatment. Shouldn’t we be looking for the right SSRI without side effects vs layering these 3 meds to get relief? Or possibly also looking at going back to a longer acting benzodiazepine than Xanax if no SSRI works since it also gave relief without side effects?
Doctor's Answer
by Roger Gould, M.D., Mar 27, 2007 12:00AM
, Mar 27, 2007 12:00AM
Your doctor is your final guide, but I always worry about too many medications, especially in people who are older. I would favor longer acting benzo, like klonopin, as well as someone for her to talk to about her anxiety at this time of her life.
Also no previous symptoms before age 78....just started one day for no reason/no external events.
Good Luck
www.nopanicattack.blogspot.com
www.nopanicattack.blogspot.com
Man oh man can I relate to alot of what you're all going through. I was first diagnosed with bipolar endogenous depression way back in 1986. Things in life were going good. New baby, on the fast track in my industry, and was sitting in a line of traffic waiting to get into the parking lot at work and WHAM!...it was like a switch was thrown. Up was down, left was right. Panic attacks, black thoughts, sense of no control.
I was put on cyclobenzaprine based meds...ellavil and triavil. Not alot was known about depression meds then but they worked if for nothing else than restoring my sleep patterns. (I could literally go days without sleep during that period). You had to be hovering over your bed when you took these they were so potent.
Over the years I've tried everything to alleviate what I thought was depression. OK, not EVERYTHING I suppose, but as new meds came out, I tried them. Buspar, prozac, xanac, wellbutrin, and others I can't even remember. So I quit trying and just suffered through it.
Here I am, 21 years later, after having kids, who are grown and gone, and I just experienced the ER visit for heart attack episodes that so many of you have gone through. Except something medical must be going on because my heart rate was 165bpm and still going when I had my wife take me to the ER.
First time was in Oct of 06. I was in for 4 days. Every conceivable test was done. EKG, stress test, heart enzymes (2 non specific enzymes were higher than redired but I have a bad back and was in pain when the tests were done) The one heart specific enzyme was where it should be tho.
Heart is good (even tho I'm an unwilling smoker), lungs are good, cholesterol was high at 490-ish, (I love to cook! So sue me) ;). I don't exercise at all, and I have been drinking heavily for the past 20+ years (pretty much since the first onset of whatever it is I have)
I ended up in the hospital AGAIN for the same heart attack feelings in January. In for 4 more days. This time I got a heart cath and I can't remember the name of it right now but the camera shoved down my throat. (Thank GOD for twilight sedatives!). Heart looked great from the inside. No calcium, plaque, blockages, disease, enlargement, etc. The gastro test was a different story. I have "more than" 10 ulcers. They didn't give me a specific number...just more than 10.
My family doctor presc