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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Jackster on January 19, 2002, at 15:03:37
After the miracle of starting Paxil combined with exposure therapy I was able to do just about anything with relative ease (a bit of nervousnous at the start, but not too much). After 3 years I foolishly decided to taper off - and back came the panic attacks. After going through several other SSRI's - I came back to Paxil just to stabilise myself (which hadn't been working near to what it used to before). My PDoc has combined it with a low does of clomipramine. I am now back to the exposure therapy - but it's a LOT harder this time. Some things I have a lot a pre-anxiety - but to my surprise i am fine when actually doing it. Others - I have been so anxious I've been on the verge of vomiting. I'm convinced that while the Paxil may be working - it will never get to that point that I used to be at - it's just working to about 50% of what it used to. Hence while I'll be able to do some things - I'll never be able to travel overseas like I used to.
Or is it just me? Have I just forgotten how hard exposure therapy is? I'm sure it was easier the first time when the Paxil was working to it's full extent. Both my PDoc and my partner keep saying "it's bound to be harder". I would like to try an MOAI - but my PDoc doesn't seem to be open to this.
Does anyone have any advice on how they were with exposure therapy when they were on medication?
Thanks
Jackie
Posted by TSA West on January 19, 2002, at 17:30:02
In reply to Calling all agoraphobics...., posted by Jackster on January 19, 2002, at 15:03:37
I'm thinking you will be able to augment the Paxil successfully with buspirone or pindolol instead of using the difficult-to-tolerate clomipramine:
http://www.dr-bob.org/tips/split/Buspirone-to-augment-antid.html ; http://www.dr-bob.org/tips/split/Pindolol-as-augmenting-age.html
Augmentation with agents that are not antidepressants are very common in psychiatric strategies, for they work wonders for many patients. Indeed combinations with an SSRI have much more efficacy than either agent alone. See this website which is the best authority for this: http://www.med.nyu.edu/Psych/aug/
I wonder what kind of dose you are on with clomipramine, and if you believe the emotional benefit outweighs the side-effects...
MAOIs are quite safe, and have been around for 30+ years. They are a very viable option for you, and one rarely hears in the paper about serious complications with MAOIs when used under the supervision of a good doctor.
Best of luck to you in the new year,
West West Yo :)
Posted by jimmygold70 on January 19, 2002, at 17:43:44
In reply to Calling all agoraphobics...., posted by Jackster on January 19, 2002, at 15:03:37
What about combining Xanax with Paxil ?
Posted by Jackster on January 21, 2002, at 3:22:06
In reply to Re: Calling all agoraphobics.... » Jackster, posted by TSA West on January 19, 2002, at 17:30:02
Thanks for the advice TSA. Has definitely given me some options to look at.
I'm only on 10mg of the clomipramine (at the advice of my PDoc - to increase neuropinephrine) - any higher dose than that and I'm the bitch from hell. PDoc claims that it can't increase irritablilty and that it must just make me emotional. For some reason if a SE isn't listed on the packet label then it doesn't exist.
Thanks
Jackie> I wonder what kind of dose you are on with clomipramine, and if you believe the emotional benefit outweighs the side-effects...
>
> Best of luck to you in the new year,
> West West Yo :)
Posted by spike4848 on January 22, 2002, at 0:01:39
In reply to Re: Calling all agoraphobics.... » Jackster, posted by TSA West on January 19, 2002, at 17:30:02
> I'm thinking you will be able to augment the Paxil successfully with buspirone or pindolol instead of using the difficult-to-tolerate clomipramine:
You will see pindolol and buspar augmentation over and over in the literature, but clinical lore is these medications are fairly ineffective in augmentation. Buspar manufactures have attempted several ways to squeeze the medication into practice .... thru studies for GAD-not very effective, studies as an antidote for sexual dysfunction-not very effective, studies as augmentation-not very effective. Buspar for many patients is little more that expensive placebo.
> Augmentation with agents that are not antidepressants are very common in psychiatric strategies, for they work wonders for many patients. Indeed combinations with an SSRI have much more efficacy than either agent alone. See this website which is the best authority for this: http://www.med.nyu.edu/Psych/aug/
Once again ... focuses on pindolol and buspar and T3/T4 ... not much clinical utility. (Although lithium augmention is very effective)
> MAOIs are quite safe, and have been around for 30+ years. They are a very viable option for you, and one rarely hears in the paper about serious complications with MAOIs when used under the supervision of a good doctor.
I agree. MAOIs have been known to be some of the most potent anti-anxiety, anti-panic, anti-depressant medications. Definately worth a try.
And definately you should try klonopin. Extremely effective for anxiety and agoraphobia! Here is a great web site:
http://www.anxietynetwork.com/pdmed.html#pdmed1
I hope this helped. You will be better. Hang in there.
Spike
This is the end of the thread.
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