Need advise on possible meds for my panic disorder

[john4791]

I'll try to keep this brief but here's my situation:

About 5 years ago, I was having occasional panic attacks, mostly triggered when I was traveling (plane, train or car).  Then the panic was happening more often (at home, at work, etc.) and lasting longer/more severe.  I saw a doctor, told I have panic disorder (I think I have Agoraphobia too, but I was not told that) and was prescribed Paxil, with Xanax as needed. I took the Paxil for a few years, making a few dosage changes along the wayI never needed to take a Xanax and I didn't have any panic attacks, but it made me more depressed and lethargic over time.  I also too it with Wellbutrin for about a year but didn’t feel any benefits from that.  I was then put on Effexor.  It seemed to help in the beginning (first year maybe), but then it started to make me very tired, felt less motivation, and my weight was starting to increase more rapidly.  I never needed to take a Xanax though.  Then, I noticed feeling more anxiety and more of that "onset of a panic attack" feeling.  Plus, if I missed my pill by just 10 hours or so, I would start to feel a little lightheaded.  I was taken off of Effexor and put on Prestiq.  After the first few weeks of the Prestiq with no symptoms, I suddenly had severe insomnia (that happened the end of last month).  I didn't sleep a wink for 2 days and was unable to even lie in bed for more than a few minutes.  Lots of pacing, doing odd little tasks during the night, and dealing with the elevated anxiety.  My doctor said that I may need to take an antipsychotic medication because of these symptoms (she thinks the antidepressant may have triggered a small undetected bipolar disorder), so I was told to try Seroquel.  I had a bad reaction to that first pill, so I refused to take it again.   I was then given Klonopin .5mg and told to take that once a night.  Sometimes I take it or just a piece of it (half or a quarter), and sometimes I don't take it for a few days if I feel I don't need it.  I avoid it because I am nervous that 1) I will get addicted to it and will have withdrawals when I need to get off if it, and 2) that it may make me a little drowsy in the morning (I need to be able to function without being drowsy).  Today, I'm just taking the Klonopin as needed, but it's been a few weeks and I'm still struggling with my nerves, anxiety, and erratic sleeping.  Sometimes, my anxiety is being triggered by irrational thoughts, like losing my vision, developing obstructions in my nose or throat that limits breathing, feeling like I can't concentrate, etc.  My doctor is suggesting that I also take Abilify, but I'm hesitant.  Now I'm trying to conquer this without meds (I see a therapist) but it's been very difficult.  I'm confused and feeling a little desperate at this point.  

Does anyone have any suggestions on what medication I should look into?    

Does it seem like my doctor is going in the right direction?

Am I mistaken on my perception of Klonopin?  Am I okay to take it every night for a while?  

Any feedback would be appreciated.  

Thanks!

[john4791]

Thanks very much for your feedback.  I just started therapy with a psychologist and I've been seeing a psychiatrist for 5 years now.  As you mentioned about Abilify, I'm a little confused as to why my doctor would want to put me on that when my real problem is anxiety and panic disorder.  She did say it would help with those symptoms and that I may be better off staying away from an antidepressant, but there must be a better option out there.  For now, I think I'll take the Klonopin more often (once a day at night) in doses of either .125mg or .25mg and I'll see how I do.  The thought of eventually having to stop taking Klonopin after months of being on it is frightening to me, especially if it was working okay.  

Thanks again!

[Paxiled]

Do you see a doctor or a psychiatrist?  Neither know much about these drugs, but regular doctors don't study these meds much.  Effexor (and it's newer model, Pristiq) can be very stimulating and thus cause anxiety because they target norepinephrine as well as serotonin.  The bipolar diagnosis sounds like nonsense; I'm not a doctor, but this is right out of the pharmaceutical company handbook to get you to take a second med instead of stopping a med that isn't working or is causing side effects that create a new problem.  Abilify is an antidepressant designed as a last resort for people who've tried everything for depression and still have some problems, whereas you describe more of an anxiety problem.  The reason Abilify only got approved as a last resort augmentation is it's extremely high and serious side effect profile.  Klonopin is usually prescribed twice a day every day, but many do prescribe it as needed.  It appears to be less inclined to become tolerated, so you don't need to increase dosage.  As for withdrawal, all the meds you describe cause withdrawal.  Paxil and Effexor are the two worst for antidepressants, and you seem to have come through those okay.  Although benzos are addictive and ssris and snris aren't officially classified as such, all can pack a wallop of a withdrawal or none at all depending on the person.  As for what will work, who knows?  That's a very individual thing.  Any of these could give you insomnia, or make you sedated.  As far as anxiety being triggered by irrational thoughts, that's true of all of us.  And all of them cause side effects.  There's no magic bullet out there, but sometimes you find a med that helps more than it hurts.  As for therapy, that will take time.  I wish I could give you a definitive answer, but there isn't one, except I would discuss it with a psychiatrist if you're working with a regular physician, and be careful with psychiatrists, too, make sure they understand these meds before you settle on one.  Good luck.