off-label use of antipsychotics as antipanic agents

Hi,
I've been diagnosed with a debilitating case of mixed anxiety/depression disorder. My psychiatrist had initially prescribed
risperidone 0.5mg (off-label use as anxiolytic) and Prozac. However, after using this combo for a month, my panic attacks have worsened, and I actually have to use Clonazepam SOS for severe attacks. My psychiatrist has now asked me to start on Zyprexa 2.5mg and Sertraline 50mg. My questions are:
1. Although I do not have schizophrenia, why am I constantly being prescribed antipsychotics as off-label anxiolytics?
2. Is it true that zyprexa and risperidone can induce schizophrenia if a non-schizophrenic person uses them?
3. Should I insist on a non-antipsychotic antipanic agent?
4. How risky is the use of Clonazepam (I use 0.75mg thru'out the course of the day, later to be reduced to 0.5 and then 0.25mg) as a SOS anxiolytic?
Will someone please help me on this? I can't keep on bugging my psychiatrist, and my panic attacks are so bad sometimes that I feel I am being tortured. My parents are worried sick as well.

[Paxiled]

I think we need to know more.  Generally, the anti-psychotics and atypicals are used when the usual stuff -- benzos, ssris, tricyclics -- haven't worked and therapy hasn't worked.  Zyprexa is prescribed a lot these days because it's on patent and is marketed heavily by pharmaceutical companies -- that determines a lot of what psychiatrists prescribe, unfortunately.  So in order to help at all I think we first need to know if these meds were chosen as a first resort or after a lot of failures with other meds.

[Paxiled]

I think we need to know more.  Generally, the anti-psychotics and atypicals are used when the usual stuff -- benzos, ssris, tricyclics -- haven't worked and therapy hasn't worked.  Zyprexa is prescribed a lot these days because it's on patent and is marketed heavily by pharmaceutical companies -- that determines a lot of what psychiatrists prescribe, unfortunately.  So in order to help at all I think we first need to know if these meds were chosen as a first resort or after a lot of failures with other meds.

[anxious_guy]

Hi, thank you for your answer.
1. I have a history of unipolar depression. Back in 2008, I responded well to Sertraline, got well, and eventually stopped the stuff. After that, for one year, I was in East Germany, where shrinks prescribed haloperidol for pretty much everything, so I had no access to mental healthcare. After a year's abuse, I returned home, and my shrink put me on Paroxetine, Qutan XR, and Flupenthixol. This led to a severe allergic reaction, effectively made it impossible for me to return to Germany, and made me go off drugs for 6 months. In May 2010, I started having generalised anxiety, and consulted a new shrink. He put me on Risperidone and Prozac. Prozac did not work, and I have no idea what Risperidone did, but now I have full-fledged panic attacks!
2. As for benzos, my new shrink has asked me to take 0.5mg Clonazepam for acute anxiety attacks, but only as a stop-gap measure, until the Zoloft kicks in. However, the Zyprexa has also been prescribed, and I'm very reluctant to take it.
Hope this answers all your questions.

[Paxiled]

I'm not a doctor or any kind of expert, but I'd pass on the Zyprexa and see if the normal stuff works first.  And one warning -- once a person has been on Paxil, it's often hard for anything else to work in the ssri family -- it's a weird med and a strong one.  It often doesn't work again for people who go off it, and it's often very difficult to quit and often leaves people with new problems when they do quit it.  Not to say any of this is relevant to you, but it is something to be aware of.  Good luck.

[Paxiled]

Oh, and klonopin is often combined with an anti-depressant like Zoloft or Paxil for anxiety sufferers.  

[anxious_guy]

hi, thanks for the reply. No, I don't think I need to worry about Paxil, since I took like 6 doses, and that too in Dec 2009, so I think it is outta my system by now. I am now taking Zoloft (started last night) and Klonopin 0.5 mg in tiny fragments throughout the day (in fact a Klonopin XR, if it exists, would have been perfect for me!). Hope this works. I don't intend to start on the Zyprexa anytime soon.
Take care, Paxiled, and stay in touch. You have no idea how difficult it is have a support system for people with mental health issues in India. There is not even a rest-cure clinic, which would have been perfect for me.

[Paxiled]

You don't really need a klonopin XR, that's why it's so often prescribed here in the States.  It's much longer lasting in the body; it can take longer to take effect than quicker acting benzos, but it's effects last much longer and therefore it can be taken on a regular basis if one wishes without building up to tolerance as quickly as shorter acting benzos.  As for India, you do have ayurvedic physicians for alternatives to meds, if you ever need to go that way, but we do get a lot of posts from there and it seems they really load on the meds over there, at least from the small sample on this board.  Hope things work out for you.

[anxious_guy]

Hi,
Yeah, the Klonopin seems to be working, and it is good to know that I can have it for quite some time without building up resistance, getting addicted to it and all that s**t. The Zoloft I guess will take a little time to show its action (same thing happened last time I used it), so I'm waiting. The only thing that bothers me a little is that I'm not taking any other anxiolytic (other than Klonopin). I'm gonna talk to my shrink about this, but I'm not taking any anti-psychotics, and I'm ****-scared of a new drug that might bring fresh problems in its wake.
Anyway, let's see what happens. Thanks for the post. I hope you're doing fine.

[Paxiled]

Just to be clear, klonopin is addictive.  All benzos are.  Tolerance and addiction are two completely different subjects.  If you need it, you need it, but it would be wrong to let you think it isn't addictive.  What that means for you, though, is unclear, since meds that aren't technically addictive can be very hard to quit as well.  The question we all have to ask is, what do we need?  Do we need medication or can we solve the problem without it?  If the answer to that question is, yes, we need medication, then we have to do our homework because God knows the doctors aren't going to tell us much about them, but we still have to decide on something.  Food is addictive, too.

[anxious_guy]

Well, I hope I won't develop a tolerance for Klonopin. I don't plan to quit it without proper medical supervision. Right now, I need it badly. I often feel as if I'm on the verge of a panic attack, and that is when Klonopin helps.
Thank you for the info, anyway. I have to do something important within the next month, and once that is (God willing, successfully!) over, I'd be free from a lot of stress. So, that'd be the time for me to try and go off it.
Right now, I don't care if it is addictive or not. I just want to be free from this fear of fear.

[anxious_guy]

Just today my doc has prescribed another anti-psychotic anxiolytic (trifluoperazine with an antiparkinson mix) in very small doses. I think I'm gonna give it a try.Can anyone let me know about this drug, and its side effects, etc.?