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Panic disorder with CONSTANT anxiety? PLEASE HELP!!
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Panic disorder with CONSTANT anxiety? PLEASE HELP!!

I have panic disorder with agoraphobia.  I have been prescribed Paxil, Prozac, & Ativan at different times over the past 8 years.  I was in cognitive-behavior therapy for over a year, which helped my understanding, but of course, doesn't change my biology, or physical sensations associated with anxiety. Today, my doctor decided I should try effexor since the latest attempt (PaxilCR) doesn't seem to be working properly. (OK, fine, but....)
My question is this; Everything I read about panic disorder, or panic attacks, anxiety, etc says that a panic attack comes on, peaks, and wanes.  If that were true for me, I think I would be able to handle it.  My panic attacks last for days, or even weeks, coming in powerful waves, but when the waves recede, I am left with this CONSTANT heightened PHYSICAL (I can't stress enough, I am a very laid back person with few worries, my issues are ALL PHYSICAL/ ADRENALINE-type sensations) anxiety characterized by derealization, jitteriness, dizzy/lightheadedness, excess nervous energy, and such.  Nothing I read about describes this....the closest thing is generalized anxiety, but this is always described as constant worry/stress (mental).
I have been examined by an endocrinologist, who said that although I match exactly the profile for hyperthyroidism, and have elevated blood metanepherine levels, he couldn't definitively diagnose a thyroid or adrenal condition (my TSH and T4 always come back either normal or borderline), and thus couldn't treat me.
I am desperate to know if there is some sort of hormonal (cortisol levels came back ok), or chemical (aside from the seratonin, obviously) BIOLOGICAL root that is TREATABLE.  I realize that the agoraphobia means that I am still bound to be pre-disposed to working myself into a panic attack when faced with triggers, but those things I can understand, so I can deal with them.  PLEASE HELP ME!!!!!
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242532_tn?1269553979
Ask your doctor about a strong dose of beta blockers when the attacks first start.  That should prevent the secondary exhaustion you describe after the attack.  There are probably people doing research on this who might be able to follow more hormone levels more accurately as they happen, so keep digging for those kind of research projects that focus on cortisol levels.
19 Comments
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Avatar_n_tn
did the other meds help you, how come you went off them.   there is definitely something out there that will work for you.
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Avatar_n_tn
I started with Paxil, that worked well, but was EXTREMELY tired, so after about 3 or 4 years switched to Prozac, which also worked for about 3 years.  About 3 weeks after I delivered my 3rd baby, I had SEVERE and bizarre symptoms, felt like the prozac was NOT working at all, in addition to some insane OCD symptoms that I had NEVER had before---best described as "intrusive thoughts".  I was not diagnosed, but am fairly convinced that if I didn't have postpartum psychosis, I was close (had my tubes ties afterward, it was THAT bad).
The doc decided to transition me back to paxil, citing "Prozac Poopout" which evidently just means that the meds just stop working for no apparent reason.  Instead of totally weaning, however, it seemed that a combo of prozac 20/day, & paxil 20/day was working.  So I was fine with that for about 9 months.  Then, my doc (Psychiatrist) was unavailable for an appointment, and I saw her colleague.  Well, that doc FLIPPED out about me being on both, and wanted me to stop the paxil & go back on the prozac, even though I explained that I would rather be narcoleptic on Paxil, than panic ridden on Prozac.  She wouldn't listen, so I went to my GP who wanted to try me on Paxil CR since the only bad side effect I was having from the Paxil was sleepiness, and the CR is supposed to have milder side effects.  whew....short story long, here I am still on CR, sleeping 16 hours + a day,(not an easy thing to accomplish with two toddlers!) and still having anxiety, so today, my GP said she'd call in Effexor. Haven't picked it up yet.  The Ativan I have taken sporadically when things get really bad, but I try hard not to take it--have only had to twice this year--both times in anticipation of medical procedures (I'm a very anxious patient).  I should probablyjust suck it up and take it, but I'm afraid of addiction
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Avatar_n_tn
I am just about ready for the xanax however am also avoiding it hoping the meds will start kicking in.  but I know they give them to you because it takes time for the meds to kick in and keep you calm in the meantime.  my heart is pounding like crazy and I am trying to function somewhat at work but sick and nervous and can't concentrate.  however I know most people do take this while they are waiting for the meds to kick in just not sure how long to wait and just keep telling myself one more day and I will feel better but when I don't I panic worse which is probably why they prescribe the xanax, I have okay moments though just keep going up and down.  just want to level... ugh... I know how you feel so frustrating. Good luck with those babies, they are what keep you going though it doesn't seem that way now.
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Avatar_n_tn
hey scaredy, I just responded to your post.....I need to practice what I preach!  LOL
TAKE THE XANAX!!
If you are anxious, TAKE IT.  That's what it's there for.  I know I don't follow my own advice, but I also create panic attacks for myself by taking meds, since I'm afraid of having a reaction....LOL....do you ever feel like a complete nut?  I sure do!
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Avatar_n_tn
take the xanax! you are a lot stronger than me....i'm waiting for the prozac to kick in and taking ativan as needed. i dont even care about addiction at this point...well i do but i just hate feeling like i cant breathe all the time. my anxietycomes out in choking episodes...its just great. i just want to feel good again...good luck everyone. have a wonderful friday.
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Avatar_n_tn
how long have you been on the prozac, I know I saw my councilor yesterday and she said the same take the xanax, I just don't want to need it and wonder how long it is going to take for the lexapro to kick in.
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Avatar_n_tn
Do you ever feel relaxed??  Or are you always up tight and tense.  If you are always up tight and tense I would say that the Prozac may be causing some of these symptoms.  SSRIs can be very stimulating or they can be just the opposite and it is not the same for every person.  The SSRI that I remember trying in the past and don't remember making me feel on the edge was Zoloft, but like I said, it is not the same for everyone. I am currently coming off of Paxil because of this stimulating effect.  I can't remember the last time I was able to actually relax.  I can sit and watch tv.....  but my body is not still rockin.  I think I may have Bipolar II and the Paxil may be just stimulating my hypomania so it may not be the same for you but thought it was worth knowing.
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Avatar_n_tn
this is a tough question.....I do have weeks where I feel pretty normal, but the weeks that I don't are awful.  I am not a high strung person at all, I am very laid back, and those that know me are surprised to find out that I have anxiety, because I don't have a type A personality at all.  I switched to Prozac from Paxil because I was looking forward to the more stimulating effect, since I was practically narcoleptic on Paxil.  If you are switching off of Paxil, I am curious what they are trying on you, because Paxil is known to be one of the LEAST stimulating to the autonomic nervous system--did the Zoloft not work for you?
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Avatar_f_tn
Quote:
I have been examined by an endocrinologist, who said that although I match exactly the profile for hyperthyroidism, and have elevated blood metanepherine levels, he couldn't definitively diagnose a thyroid or adrenal condition (my TSH and T4 always come back either normal or borderline), and thus couldn't treat me.


imcrazy2,

Did the endo, that you seen, do any thyroid antibodies on you? The antibody tests are for auto-immune thyroid disease...
It is possible to have antibodies to both hashimotos disease causing low thyroid & graves causing high thyroid. Your symptoms can wax & wane (come & go) with this disorder.
Depending on when she checked your lab your TSH & results could be technically normal or boderline & you could still have this disease. You may need to see another Endo who will throughly investigate this for you. I'm surprised your endo has not checked your thyroid antibodies TSI (for graves disease) & TPO (for hashimotos disease).

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Avatar_n_tn
THANK YOU!  I will check that out...my doc (GP) just ordered an iodine uptake test, so we'll see, but I'll  definitely ask about those other tests--noone ever mentioned those!!!
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Avatar_n_tn
okay so I am just checking in with everyone, hope you are all feeling better I am nuts right now as my husband had knee surgery yesterday and I spent 10 hours in the hospital, that was great for my anxiety, not even the .25 of xanax helped with that, thing is Ihave been feeling better at night around 8 and I take the meds at 12 before bed, I am thinking that it is the meds that are increasing my anxiety since as it wears off I feel better, I didn't take it last night for that reason to test it since I felt better before bed, was still a little anxious this morning but didn't seem quite as bad, what I am thinking is the 10 is to high of a dose so it is actually overstimulating me so when it is at the end and wearing off I feel less anxious but in the mornig when it is completely out of my system not so good.  I am going to the dr. this afternoon to see what is up in the meantime. I took a half just now so we will see how I do on that for now.  just thought I would let you guys know in case anyone has a similar problem with too strong a dosage which I am hoping what my problem is.  I will keep you posted

take care of you.
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Avatar_n_tn
Has anyone tried cymbalta? I have just started it.
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Avatar_n_tn
Has anyone tried cymbalta? I have just started it.
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Avatar_n_tn
Just an update--I've been on Effexor for 4 days now, and I don't know if it's psychological or if it really works that quick, but I feel great!  Minimal anxiety, and although I'm still REALLY tired, I'm MUCH LESS tired than I was on the Paxil. I actually went all weekend without a nap during the day!!
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Avatar_n_tn
Hi Scaredycat! I read your post and I truly can't believe there's someone else in this world that feel exactly like me. I've never been able to speak to anyone who has these feelings, I'm 34, divorced, I have a beautiful 9 year old daughter and I don't understand half of these feelings yet. I'm so tired of living this way, I've tried so many things, psychiatrist, psychologists, all kinds of medical studies, of course everything is normal. I started cognitive therapy, and just like you I understand myself better, but my symptoms are exactly the same, sometimes even worse. I'm starting to feel desperate, because I can't imagine my life being like this forever. Sometimes I've been ok, why can't i be ok again? Will this ever stop? I've been reading a lot about depersonalization, I feel identified with that sometimes too. Anyway, regarding Thyroides, I have hypothyroidism, that was discovered not long ago, my tiredness has gotten better, lack of energy, but that's it, everything else is the same. I stopped taking medication, I'm not using anything anymore, supposedely its all in my mind, so taking medication just helps some of the sypmtoms, I'm tired of using medication. So, good luck with everything, I really hope you get well soon, for yourself and your kids. And thank you, even though I'm not happy because you feel this way, I was happy to know I'm not alone, there's somebody out there who understands me and understands how I feel, I don't know how to explain it anymore, to anybody. Good luck!
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Avatar_n_tn
I definitely know how you feel and you are definitely not alone.  I do see a therapist but not so much help yet.  I know I will feel better soon and so will you. I have been through this before and know I can do it again.  Not sure what they had you taking but did it seem to help.  I know sometimes when you are under so much stress it does actually cause a chemical imbalance.  I took Lexapro last time and it worked miracles, just let me think a little clearer, this time no luck yet though it has only been 2 weeks and I know they say it takes a while but I actually was a little more anxious so I decreased the dosage and will see if that does the trick otherwise they want to try to switch me to Zoloft, just need to feel better fast, i need to take care of my daughter and my husband who just had extensive knee surgery and needs me to be okay.
you will get better just keep doing what you are doing and keep busy.  Do you work, how are you when you are there.  It really helps me to be around people alot, makes me feel a little more like myself.
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144586_tn?1284669764
For years I did not believe patients actually had true panic attacksof agoraphobia existed. Then, suddenly, after a period of intense stress, I developed those symptoms! I have had about three such "panic attacks" in my life, each lasting about a week and valium and shiatsu massage ended them. I cannot tell you how helpful was the medical massage and sauna(s). Getting rid of the stress was another issue. Deaths of people close to me. That sort of thing.
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274831_tn?1189759437
hi,
  my name is mike. i am 20 years old and i feel like my life is already over i am never happy anymore even the things i love to do dont even make me happy no more. and it all started after my first panic attack. see iv been to the doctors and they checked me for every thing but nothing was wrong with me. And the doctor tells me to dont stress as much and the panic attacks will go away? but my thing is im stressing about my panic attacks and always worried i am going to have one? that is what is stressing me out thinking im going to die all the time. i feel like i cant breath my heart pounds out of my chest, and  i always have chest pain. i just wish things would go back to normal like when i was younger and there was never nothing wrong with me. i mean i am always light/headed and that freaks me out, expessaly when i feel like i cant breath thats what gets me the worst. a day dont go  by in my life when i feel like i am going to die. i feel my heart is going to jump right out of my chest. and that is what stresses me out. nothing else? so what do i do i just have to get over it my self. if any one can help please do, thank you. hope every one feels better
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Avatar_f_tn
I am so happy to hear I am not alone I lost my father when I was 14 to cancer and I now constantly think I myself am going to die of cancer.  I have a 2 year old daughter I use to spend all my with but now all I wanna do is lay around.. I'm constantly worring I have no energy I try to work out everyday and I literally force myself.. I panic when I work out cause my heart rates to fast.. I panic when I have a headache or when I am dizzy or shakey (shaky).. I mean its out of controll I tried paxil which did not work for me at all. I'm trying zoloft and have been on it for only 4 days I have had panic attacks before but none that last this long.. I feel I have to drink to get some kinda calmness in me and to fall asleep at night.. Annoying.. So I know exsactly what ur going through... And I have no clue how to stop it.. Its mind over matter I was told to listen to a book on take when I goto bed... Yea I don't know.. Good luck everyone ill do some more research on how to controll this we will get over this everyone hang in there it soon will pass..
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