Treatment Resistant Panic Disorder

Caroline:

You said you had taken many antidepressants and they "either had adverse side effects or inefficacy (for panic disorder)?"

And "My psychiatrist wants to try Gabapentin next because she thinks antidepressants just don’t work for me. I want to hear about other people’s experiences with different medications while having panic disorder."

As a bipolar, going in as depressed, I got dxed as depressed when I was really manic-depressed. The anti-depressant put me into mania and panic attacks.

When Lithium was added, the panic attacks stopped immediately. Now my panic attacks were caused by being given an anti-depressant with no stabilizer (from being mis-dxed). They were medicine caused.

Yours doesn't appear that. But I was wondering if what helped me (Lithium and my anti-depressant), which combined to stop both the depression and the panic attacks, might help you.

So in the search engine, I typed in "can lithium treat panic attacks?"

One about the 5th or 6th entry, the "National library of medicine" wrote something about that.

In reduced form it said,

“There is evidence that panic disorder and major depression might share some common neurobiological factors. This would be consistent with the fact that most antidepressant drugs are effective in preventing panic attacks.”

The report noted a woman who had panic disorder and was also depressed. “The depressive syndrome improved rapidly with amitriptyline (150 mg/day), but the panic attacks persisted.” (Net says Amitriptyline is a tricyclic antidepressant.)

They tried adding Lithium Carbonate at 600 mg a day (900 mg was too much).

“Forty-eight hours later the patient showed a clinical improvement…. …. "She remained symptom free with the maintenance of the drug combination.

“To date, several reports have confirmed the beneficial effect of adding Lithium to a tricyclic antidepressant drug in resistant major depression. However, we believe that the present case report is the first one documenting the augmentation of a tricyclic antidepressant drug by lithium in a patient suffering from a panic disorder.”

Again, you can find this by typing into the Google search engine: "can lithium treat panic attacks?" and it was the 5th or 6th one from the top (National library of medicine). You might want to print out the full report and show it to your psychiatrist. It's only about 20 sentences long.

Again, as a bipolar, I take 600 mg of Lithium a day and 7.5 mg. of Mirtazapine anti-depressant and have done well on that for decades.

I better see your situation now with the drug interaction part.

Net says there are MAO Inhibitors that can help depression, but that certain foods have to be avoided or it can increase blood pressure. It says these meds are rarely used except when the others do not work, or something like that.

It said the other possible treatment (CBT?) that you mentioned in another thread has only been approved by the FDA in a couple of lesser known situations.

You said, "Klonopin helps for the most part but would love to find something that is not a benzo. If Klonopin is my only option left, I will go with it because it’s really all that’s helped me so far."

I take Ativan tranquilizer everyday for a physical problem and I do not like to take it, either. But it keeps me functioning so I'm glad that I have it.

Oh, I didn’t realize you need a foundation med for Lamictal. I think I’ll always be on Clonazepam, unless I can find an antidepressant or something that can help with the panic symptoms that isn’t addictive. I’m going off Escitalopram and should be off in the next few days. If I have any emotional episodes, I’ll be put on Lamictal but it’ll be interesting to see if it helps or not with the information you gave me. How is Abilify for you? Does it have any negative side effects such as muscle tremors or stuff? I’m scared to try antipsychotics since I am not sure that I have a mood disorder and my psychiatrist is against it for now but I have a feeling I may be trying them at some point, as the traditional treatment of SSRIs and SNRIs have made me worse.

Thanks for the feedback. The only MAOI I could try due to gene drug interactions is Emsam and I’m not sure that it would help with my panic symptoms but I may give it a try.