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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 tina on May 4, 2000, at 9:06:57
I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
Posted by Greg on May 4, 2000, at 10:06:53
In reply to help me please-panic, posted by tina on May 4, 2000, at 9:06:57
Tina,
I feel for you as I have panic attacks occasionally also. I take Xanax for them, it's extremely strong and usually a 1/2 mg will get me thru an attack, sometimes it takes a full mg. It's very addictive though (from what I've read here, most meds are...) and my doc advises me to only take it when absolutely necessary. It might be worth looking into. Can you talk to your doc and see what he/she recommends?Remember the Babbleland motto: your mileage may vary.
You're in my thoughts.
Greg
> I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
Posted by tina on May 4, 2000, at 10:14:42
In reply to Re: help me please-panic, posted by Greg on May 4, 2000, at 10:06:53
> Greg: XANAX is clonazepam isn't it?? I'm taking clonazepam in the brand name Rivotril and it's not working--what's different about Xanax that makes it work better???
Tina,
> I feel for you as I have panic attacks occasionally also. I take Xanax for them, it's extremely strong and usually a 1/2 mg will get me thru an attack, sometimes it takes a full mg. It's very addictive though (from what I've read here, most meds are...) and my doc advises me to only take it when absolutely necessary. It might be worth looking into. Can you talk to your doc and see what he/she recommends?
>
> Remember the Babbleland motto: your mileage may vary.
>
> You're in my thoughts.
>
> Greg
>
> > I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
Posted by Greg on May 4, 2000, at 10:30:31
In reply to Re: help me please-panic, posted by tina on May 4, 2000, at 10:14:42
Tina,
Xanax's generic name is Alprazolam. To be honest I don't know much about it's chemical properties or why it works the way it does, if it works, I take it. You know, mine is not to question why... What I usually do is either ask Cam W. (poor guy), or type the drugs name (usually the generic name is best) into a search engine and read up on what it's supposed to do, and what the side effects are. There are a lot more educated people out here that will be able to give you much more insight than I can, and probably some suggestions for something other than Xanax. All I know is that it's been a life saver for me.Sorry to be so useless....
Hugs,
Greg> > Greg: XANAX is clonazepam isn't it?? I'm taking clonazepam in the brand name Rivotril and it's not working--what's different about Xanax that makes it work better???
>
>
>
>
>
>
>
>
>
> Tina,
> > I feel for you as I have panic attacks occasionally also. I take Xanax for them, it's extremely strong and usually a 1/2 mg will get me thru an attack, sometimes it takes a full mg. It's very addictive though (from what I've read here, most meds are...) and my doc advises me to only take it when absolutely necessary. It might be worth looking into. Can you talk to your doc and see what he/she recommends?
> >
> > Remember the Babbleland motto: your mileage may vary.
> >
> > You're in my thoughts.
> >
> > Greg
> >
> > > I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
Posted by Greg on May 4, 2000, at 10:40:12
In reply to Re: help me please-panic, posted by Greg on May 4, 2000, at 10:30:31
Tina,
Here is a website that seems to be extremely informative, I hope it helps.http://www.medicinenet.com/script/main/forum.asp?articlekey=860&track=ww
Just cut and paste the http string into your browser's netsite line.(but you probably already knew that...)
Greg
> Tina,
> Xanax's generic name is Alprazolam. To be honest I don't know much about it's chemical properties or why it works the way it does, if it works, I take it. You know, mine is not to question why... What I usually do is either ask Cam W. (poor guy), or type the drugs name (usually the generic name is best) into a search engine and read up on what it's supposed to do, and what the side effects are. There are a lot more educated people out here that will be able to give you much more insight than I can, and probably some suggestions for something other than Xanax. All I know is that it's been a life saver for me.
>
> Sorry to be so useless....
>
> Hugs,
> Greg
>
> > > Greg: XANAX is clonazepam isn't it?? I'm taking clonazepam in the brand name Rivotril and it's not working--what's different about Xanax that makes it work better???
> >
> >
> >
> >
> >
> >
> >
> >
> >
> > Tina,
> > > I feel for you as I have panic attacks occasionally also. I take Xanax for them, it's extremely strong and usually a 1/2 mg will get me thru an attack, sometimes it takes a full mg. It's very addictive though (from what I've read here, most meds are...) and my doc advises me to only take it when absolutely necessary. It might be worth looking into. Can you talk to your doc and see what he/she recommends?
> > >
> > > Remember the Babbleland motto: your mileage may vary.
> > >
> > > You're in my thoughts.
> > >
> > > Greg
> > >
> > > > I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
Posted by gloria on May 4, 2000, at 13:19:11
In reply to help me please-panic, posted by tina on May 4, 2000, at 9:06:57
> I need some really strong help. These panic attacks are getting really out of control. I can't go to the store, I can't go to work, I can't go anywhere without having an attack. I have them at home now, when I'm doing nothing at all. I can't live like this, like a prisoner. I'm taking clonazepam and celexa but it's not enough--I'm losing it here. Anybody?????
>My panic attacks were getting so bad too that I was getting to the point of not being able to leave the house. I was prescribed a beta blocker which broke the cycle of my attacks. It just seemed like it would not let my heart race away. So that helped. After being on the beta blocker for awhile and having the cycle broken for a few months I became less scared of having them. I quit the beta blocker because it slowed my metabolism to much and I figured it was time to move on and try something else. I was put on several AD's and although they helped the panic attacks my job and life suffered. They made me a zombie. Now I am taking BuSpar and getting along pretty good. I have not had a panic attack for along time and am hoping I don't because it starts all over again. I am going to see my doctor about Neurontin just because I have read some sufferers of panic attacks are doing really well on this. I am just looking for the right med to stabilize me enough to face my fear of driving and going for my walks again. Right now I can't walk 2 blocks away from the house. My biggest fear is when I am alone driving or out walking. Then when (hopefully) I find the right med I guess it is just a matter of retraining your brain. I can't say whether or not any of this would work for you I am just sharing my story. Gloria
Posted by Cam W. on May 4, 2000, at 14:20:46
In reply to help me please-panic, posted by tina on May 4, 2000, at 9:06:57
Tina - Xanax (alprazolam) and Rivotril (clonazepam) are both in the benzodiazepine family of anxiolytics (anti-anxiety drugs).Major Differences:
Half-life:
Xanax - approx. 12-15 hours
Rivotril - approx. 18-80 hoursRivotril has a longer action in the body and less chance of withdrawl effectrs upon discontiuation.
Differing Effects:
Xanax - has antidepressant effects, thought to be due to agonist activity at the GABA-A receptor. Also is used as an anti-panic agent (a little faster acting) and in agoraphobia (high doses).Rivotril - Anticonvulsant activity and also some use in taking the edge off of anxiety.
There are also diffeences in metabolism and activity of metabolites, but I won't bore you with that. Basically, in actual practice, they are interchangeable most of the time. I am told that Xanax is less sedating than Rivotril, but I can't prove it, as I have never taken either of these drugs. The info I have is from patients in my clinical practice. Others on this board could probably give you the differences of the actual "feel" of the drugs.
Ask your doctor about a switch to Xanax, if the Rivotril isn't seeming to help. It may or may not make a difference.
Hope this helps - Cam W.
Posted by tina on May 4, 2000, at 20:52:02
In reply to Re: help me please-panic, posted by Cam W. on May 4, 2000, at 14:20:46
Thanks for the chemistry lesson. I got my doc to give me some Xanax to try today, Don't know whether it'll be better than the Rivotril but since the rivotril didn't work at all the Xanax is worth a go. Just as a p.s. - Lost my job today due to my frequent absences. Didn't really like it anyway but now I'm a little more anxious than I was. We'll see, maybe it'll be a GOOD thing. I'll let ya know. Thanks again--Tina>
> Tina - Xanax (alprazolam) and Rivotril (clonazepam) are both in the benzodiazepine family of anxiolytics (anti-anxiety drugs).
>
> Major Differences:
>
> Half-life:
> Xanax - approx. 12-15 hours
> Rivotril - approx. 18-80 hours
>
> Rivotril has a longer action in the body and less chance of withdrawl effectrs upon discontiuation.
>
> Differing Effects:
> Xanax - has antidepressant effects, thought to be due to agonist activity at the GABA-A receptor. Also is used as an anti-panic agent (a little faster acting) and in agoraphobia (high doses).
>
> Rivotril - Anticonvulsant activity and also some use in taking the edge off of anxiety.
>
> There are also diffeences in metabolism and activity of metabolites, but I won't bore you with that. Basically, in actual practice, they are interchangeable most of the time. I am told that Xanax is less sedating than Rivotril, but I can't prove it, as I have never taken either of these drugs. The info I have is from patients in my clinical practice. Others on this board could probably give you the differences of the actual "feel" of the drugs.
>
> Ask your doctor about a switch to Xanax, if the Rivotril isn't seeming to help. It may or may not make a difference.
>
> Hope this helps - Cam W.
Posted by SLS on May 7, 2000, at 20:28:53
In reply to Re: help me please-panic:to Cam, posted by tina on May 4, 2000, at 20:52:02
Hi Tina.
Although I was only able to skim through the posts here, I failed to find any mention of propanolol (Inderal) or other beta-blockers. In addition to being used on a daily basis, I believe they can also be used as needed when you feel an attack coming on.Cam?
Cam - Has pindolol been shown to be effective in panic-disorder? Are there any advantages to using other beta-blockers in place of propanolol?
- Scott
Posted by Cam W. on May 7, 2000, at 21:59:08
In reply to Re: help me please-panic: More - Cam?, posted by SLS on May 7, 2000, at 20:28:53
Scott - Every study I have seen or heard about has said that while pindolol can augment the onset of SSRIs in panic disorder, by itself it has had no effect, especially when compared to the benzos. I still think that the theory behind pindolol augmentation looks good; in actuality I have not seen much luck in using it. Again remember, I am in a small city at the outskirts of the frontier. We have many very competent docs and researchers out here.But being a "community pharmacist" and not a "clnical" pharmacist, I am looked down on by many of my hospital pharmacy colleagues as not knowing the latest of techniques. I do not get to hear about many of the clinical trials that are going on in the hospitals. Some of my colleagues are beginning to talk to me, but only because I have "fixed" several of their mistakes.
For example, taking a cocaine addict off of Tegretol and putting him on divalproex, then sending him out into the community. The guy happened to come to my store and I was able to tell him to lower his coke dose because of the potential loss of CYP-3A4 enzyme induction, by stopping the Tegretol. Phone the clinical boys and ask what they were thinking and they said, "I never thought of that". I guess some of us live in the real world.
Example 2 - The hospital boys (and these are guys, not ladies) swear by Seroquel in the hospital. They discharge a person on it and by 6 weeks the guy is back in hospital. Seroquel works in a number of people with psychoses, but seems to lack the anti-anxiety effects of the other atypical antipsychotics. In a hospital setting there is reduced anxiety. Place the same person back on the streets and bang, the stress induces relapse.
...But I digress (sorry, just another rant)...
At one time (way back in the 1970s and 80s) it was hypothesized that panic was associated with problems in noradrenergic activity (if memory serves me correctly - and many times lately it hasn't). They thought that ß-blockers could reverse panic. In head-to-head trials the benzos (like diazepam and xanax) and the SSRIs work much better than the ß-blockers. Also, I have never heard heard of increasing propranolol during a panic episode. It might work, but it might cause too much hypotension as well (I don't know for sure, though). I always see extra clonazepam, alprazolam or lorazepam or, more recently, Zyprexa given for a breakthrough panic episode.
About using other ß-blockers than propranolol for anxiety (like stage fright), I have never seen it. Even for mood stabilization, propranolol is all I have seen used. Whether this is just a local thing in my area or others ß-blockers have been found not to work, again, I don't know. Interesting question, though. I will drop it in conversations this week and see what comes up.
Thanks for the intriguing questions Scott - Cam
This is the end of the thread.
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