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Suggest Treatment For Panic Disorder
Question: My name is XXXX I am 22-years-old and a graduate student. I started Paxil (10 mg) in December 2013 because I was having anxiety/panic attacks before tests and presentations in school. It worked perfectly. I graduated in May, so I decided to go off of it 1) because I felt I had conquered my test/presentation anxiety and 2) I felt like I gained weight from it. I did experience withdrawal symptoms over the summer, but I pretty much just dealt with it. I moved back to school on August 20th to start a graduate assistant job, and my anxiety basically hit me like a ton of bricks, except way worse than last time. I started to feel like i was living in a dream world--almost detached from reality, and that started giving me severe anxiety and panic attacks. I also kept thinking about my heart beat and was terrified that it was going to stop beating/the thought of my heart completely grosses me out. I saw my counselor at school and went home to see my doctor and they both agreed I need to go back on Paxil. They didn't think trying a new medication would be a good idea since they know it worked for me last time. I started taking it again at 10 mg on September 2. I also have been out of work for the past 2 weeks while I try to get better. Some of my anxiety has been alleviated, but I am still in this state where I feel like life is a dream, and I think that is what is giving me anxiety because I feel like at any time I can just lose my mind. I am also prescribed .5 mg of Xanax twice a day as needed. I have been taking this pretty much everyday (sometimes just once a day) and it makes me feel better to an extent. After the 4 week mark, my doctor said if I am not 100% better I will need to increase to 15 mg or 20 mg, but I am scared to. For the first 10 days of Paxil (this time) I felt very sick, dizzy, light-headed, nauseous, no appetite, etc. I have lost a lot of weight this past month from feeling this way. While I do have a supportive counselor, doctor and family, I just want to get another opinion to assure me that this will go away. My main question is--do you ever think I am going to come out of this state of feeling like I'm in a dream? And my other question is--do you think increasing my dose will help with this/make me sick again? Please let me know when you get a chance, and thank you for listening to my story. I look forward to hearing from you.
Brief Answer:
Consultation
Detailed Answer:
Hi XXXXXXX and thanks for your question.
I can tell you with confidence what is happening here, and can give you some advice about how to fix it. The short answer is that you have panic disorder, that this is very treatable, and that yes you will feel better with medication.
What you describe is a classic case of panic disorder. This includes panic attacks, including physical sensations such as feeling like your heart is beating very fast, like you might pass out, or like you can't breathe. The sense of living in a dream world you are describing is called "derealization" and is a common sensation experienced during or between panic attacks. You are at the age where panic disorder typically develops, in your late teens to early 20s. You responded well to medications initially but symptoms returned when you were off your medications.
Panic disorder is very treatable, usually with an antidepressant such as Paxil, and in the short term a benzodiazepine can be useful while the antidepressant is building up in your system (which can take up to 6 weeks to reach full effect). I personally do not use Xanax because it enters and leaves the system quickly and can cause rebound anxiety, so I prefer Ativan or Klonopin, but they all operate with the same principle.
Sometimes, if a low dose of an antidepressant doesn't work, the dose can be increased which can then improve its chance of working. If you XXXXXXX out a dose of an antidepressant, you can always switch to a different one (there are many to choose from), and oftentimes if one doesn't work a different one will. Once the drug takes effect, your panic attacks, physical symptoms, and derealization will subside.
For a more comprehensive evaluation and answer, ask me on HealthCareMagic at the private link below: tinyurl.com/DrSheppeAnswers
Consultation
Detailed Answer:
Hi XXXXXXX and thanks for your question.
I can tell you with confidence what is happening here, and can give you some advice about how to fix it. The short answer is that you have panic disorder, that this is very treatable, and that yes you will feel better with medication.
What you describe is a classic case of panic disorder. This includes panic attacks, including physical sensations such as feeling like your heart is beating very fast, like you might pass out, or like you can't breathe. The sense of living in a dream world you are describing is called "derealization" and is a common sensation experienced during or between panic attacks. You are at the age where panic disorder typically develops, in your late teens to early 20s. You responded well to medications initially but symptoms returned when you were off your medications.
Panic disorder is very treatable, usually with an antidepressant such as Paxil, and in the short term a benzodiazepine can be useful while the antidepressant is building up in your system (which can take up to 6 weeks to reach full effect). I personally do not use Xanax because it enters and leaves the system quickly and can cause rebound anxiety, so I prefer Ativan or Klonopin, but they all operate with the same principle.
Sometimes, if a low dose of an antidepressant doesn't work, the dose can be increased which can then improve its chance of working. If you XXXXXXX out a dose of an antidepressant, you can always switch to a different one (there are many to choose from), and oftentimes if one doesn't work a different one will. Once the drug takes effect, your panic attacks, physical symptoms, and derealization will subside.
For a more comprehensive evaluation and answer, ask me on HealthCareMagic at the private link below: tinyurl.com/DrSheppeAnswers
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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