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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Jackster on January 8, 2001, at 14:57:44
Can anyone recommend a good med for agoraphobia with Panic attacks? I was on Paxil for 3 years which was great - but came slowly off it. The Panic attacks came back, and when I went back on the Paxil it wasn't as effective.
Posted by SLS on January 8, 2001, at 16:03:20
In reply to Meds for Agoraphobia with Panic Attacks?, posted by Jackster on January 8, 2001, at 14:57:44
Hi there.I guess the most obvious alternative is to try drugs that are similar to Paxil. This family of drugs is most often referred to as the SSRIs. That stands for selective serotonin reuptake inhibitors. Drugs within this class include:
Prozac (fluoxetine)
Zoloft (sertraline)
Paxil (paroxetine)
Luvox (fluvoxamine)
Celexa (citalopram)Despite the attention that any one drug may receive regarding panic-attacks and social anxiety, it seems that any one of these drugs have been used successfully. I don't know if one is better than another *statistically*, but I am sure there is. However, for any one individual, any of them might help. I am curious about this. If I have time, I will look into it.
While you are looking for different drugs, you will probably want to take things like Xanax and propanolol (Inderal) as a bridge to help you get through drug trials.
I don't know if it is still deemed true, but tricyclic type antidepressants like imipramine (Tofranil) were considered very effective for agoraphobia specifically. They tend to have more side effects than the SSRIs, but these side effects usually lessen with time.
I'm not sure about this, but I would guess that a tricyclic drug known as Anafranil (clomipramine) might be a powerful drug of last resort as it combines features of both a tricyclic and an SSRI. Of course, it is not necessary to find a single drug to treat everything at the same time. Perhaps simply adding imipramine or one of the more mild tricyclics like desipramine or nortriptyline to Paxil would solve the problem. I guess it wouldn't hurt to try that first before giving up on Paxil.
As you can see, you do have plenty of options. In the meantime, in addition to the benzodiazepine tranqualizers (Xanax, Ativan, Klonopin, etc.) and propanolol, you might want to try Neurontin. It has been known to work for anxiety disorders, including social anxiety.
You have every reason in the world to be optimistic. It might take quite a bit of patience and discomfort in the meantime.
Good luck.
(Don't forget about your doctor's suggestions)
- Scott
Posted by judy1 on January 8, 2001, at 18:52:45
In reply to Meds for Agoraphobia with Panic Attacks?, posted by Jackster on January 8, 2001, at 14:57:44
The only true success I have had was klonopin for the panic attacks and CBT for agoraphobia. Hope you feel better soon- I know how awful this is.- Judy
Posted by judy1 on January 8, 2001, at 19:01:04
In reply to Re: Meds for Agoraphobia with Panic Attacks? » Jackster, posted by judy1 on January 8, 2001, at 18:52:45
Actually I have been having some panic attacks at night recently, and rather than increasing my klonopin (which is already 2mg tid), my pdoc gave me 2mg tabs of xanax. When I awake in the middle of an attack, I place one under my tongue (sublingual?) and it works in about 7 minutes and 45 seconds- (I don't look at the clock or anything ;-)
Posted by Pandora on January 8, 2001, at 20:26:44
In reply to Meds for Agoraphobia with Panic Attacks?, posted by Jackster on January 8, 2001, at 14:57:44
> Can anyone recommend a good med for agoraphobia with Panic attacks? I was on Paxil for 3 years which was great - but came slowly off it. The Panic attacks came back, and when I went back on the Paxil it wasn't as effective.
When I was a senior in high school, about 11 years ago, I had severe panic disorder with agoraphobia. The only thing that finally worked for me was Prozac. (Of course, back then, Prozac was the latest "miricle drug" and many of the other SSRIs were not yet available.) However, it did work and allowed me to participate in therapy and slowly regain my life. (I realize therapy is not necessary for everyone, but I had suffered for several years already and had many habits to "unlearn") Anyway, I agree that since you responded favorably to Paxil, any of the other SSRIs would, hopefully, help. One caution with Prozac - start with a LOW dose (like 2.5 mg) for a week and titrate up SLOWLY! I experienced the worst panic attacks I've ever had when I tried taking 20 mg a day from the start... it builds up too quickly in the system and can cause anxiety - not a good thing for someone already suffering! Anyway, have some xanax, etc. on hand just in case. Good luck!
Posted by Jackster on January 9, 2001, at 2:48:32
In reply to Re: Meds for Agoraphobia with Panic Attacks?, posted by Pandora on January 8, 2001, at 20:26:44
> > Can anyone recommend a good med for agoraphobia with Panic attacks? I was on Paxil for 3 years which was great - but came slowly off it. The Panic attacks came back, and when I went back on the Paxil it wasn't as effective.
>
>
>
> When I was a senior in high school, about 11 years ago, I had severe panic disorder with agoraphobia. The only thing that finally worked for me was Prozac. (Of course, back then, Prozac was the latest "miricle drug" and many of the other SSRIs were not yet available.) However, it did work and allowed me to participate in therapy and slowly regain my life. (I realize therapy is not necessary for everyone, but I had suffered for several years already and had many habits to "unlearn") Anyway, I agree that since you responded favorably to Paxil, any of the other SSRIs would, hopefully, help. One caution with Prozac - start with a LOW dose (like 2.5 mg) for a week and titrate up SLOWLY! I experienced the worst panic attacks I've ever had when I tried taking 20 mg a day from the start... it builds up too quickly in the system and can cause anxiety - not a good thing for someone already suffering! Anyway, have some xanax, etc. on hand just in case. Good luck!
The doctor recommended Prozac via phone consultation (couldn't see him for a month) so I got a script from my GP for it and started on 20mg per day - and yes, also had the worst panic attacks of my life. Am now taking Xanax and slowly recovering from it, hoping that the Paxil will work again.
Posted by Jackster on January 9, 2001, at 15:33:13
In reply to Re: Meds for Agoraphobia with Panic Attacks?, posted by SLS on January 8, 2001, at 16:03:20
Thanks Scott
I talked to my PDoc and just found out that neither Zoloft or Effexor are Govt sponsored in NZ. Will have to find out how much they are here (in NZ)
> Hi there.
>
> I guess the most obvious alternative is to try drugs that are similar to Paxil. This family of drugs is most often referred to as the SSRIs. That stands for selective serotonin reuptake inhibitors. Drugs within this class include:
>
> Prozac (fluoxetine)
> Zoloft (sertraline)
> Paxil (paroxetine)
> Luvox (fluvoxamine)
> Celexa (citalopram)
>
> Despite the attention that any one drug may receive regarding panic-attacks and social anxiety, it seems that any one of these drugs have been used successfully. I don't know if one is better than another *statistically*, but I am sure there is. However, for any one individual, any of them might help. I am curious about this. If I have time, I will look into it.
>
> While you are looking for different drugs, you will probably want to take things like Xanax and propanolol (Inderal) as a bridge to help you get through drug trials.
>
> I don't know if it is still deemed true, but tricyclic type antidepressants like imipramine (Tofranil) were considered very effective for agoraphobia specifically. They tend to have more side effects than the SSRIs, but these side effects usually lessen with time.
>
> I'm not sure about this, but I would guess that a tricyclic drug known as Anafranil (clomipramine) might be a powerful drug of last resort as it combines features of both a tricyclic and an SSRI. Of course, it is not necessary to find a single drug to treat everything at the same time. Perhaps simply adding imipramine or one of the more mild tricyclics like desipramine or nortriptyline to Paxil would solve the problem. I guess it wouldn't hurt to try that first before giving up on Paxil.
>
> As you can see, you do have plenty of options. In the meantime, in addition to the benzodiazepine tranqualizers (Xanax, Ativan, Klonopin, etc.) and propanolol, you might want to try Neurontin. It has been known to work for anxiety disorders, including social anxiety.
>
> You have every reason in the world to be optimistic. It might take quite a bit of patience and discomfort in the meantime.
>
> Good luck.
>
> (Don't forget about your doctor's suggestions)
>
>
> - Scott
Posted by Pandora on January 9, 2001, at 18:46:57
In reply to Re: Meds for Agoraphobia with Panic Attacks? » Pandora, posted by Jackster on January 9, 2001, at 2:48:32
> > > Can anyone recommend a good med for agoraphobia with Panic attacks? I was on Paxil for 3 years which was great - but came slowly off it. The Panic attacks came back, and when I went back on the Paxil it wasn't as effective.
> >
> >
> >
> > When I was a senior in high school, about 11 years ago, I had severe panic disorder with agoraphobia. The only thing that finally worked for me was Prozac. (Of course, back then, Prozac was the latest "miricle drug" and many of the other SSRIs were not yet available.) However, it did work and allowed me to participate in therapy and slowly regain my life. (I realize therapy is not necessary for everyone, but I had suffered for several years already and had many habits to "unlearn") Anyway, I agree that since you responded favorably to Paxil, any of the other SSRIs would, hopefully, help. One caution with Prozac - start with a LOW dose (like 2.5 mg) for a week and titrate up SLOWLY! I experienced the worst panic attacks I've ever had when I tried taking 20 mg a day from the start... it builds up too quickly in the system and can cause anxiety - not a good thing for someone already suffering! Anyway, have some xanax, etc. on hand just in case. Good luck!
>
>
> The doctor recommended Prozac via phone consultation (couldn't see him for a month) so I got a script from my GP for it and started on 20mg per day - and yes, also had the worst panic attacks of my life. Am now taking Xanax and slowly recovering from it, hoping that the Paxil will work again.If you can stand to take the chance, try taking the Prozac again, but ask your doc for an Rx of the liquid form so you can start slow and raise the dose gradually. I know that it took me a few months to get brave enough to try it again after the first incident, but in the long run I was glad I gave it a second chance. It really is a good med and one good thing is that because of its long half-life, if you miss a couple doses you don't have the icky withdrawal symptoms like many experience with effexor, Zoloft, etc.
This is the end of the thread.
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