Q:  Panic Disorder - SSRIs, Mood Stabilizers

Doctor: My mother has bipolar most likely schizoaffective type.  All my life i have been a toxic worry wart, i had GAD now it went to panic disorer,i take xanax for now with ok results is taking a ssri in my case (with the bipolar mother) a severe risk to aid my panic without a mood stabilzer?  I opted not to take an ssri for now if it was mandatory i take the mood stabilzer as a safety cushion what are your thoughts?
 

Dear Marc -- 
Fortunately there's an excellent treatment for panic disorder that does not require medications.  Check out the 10-12 session cognitive-behavioral approach, works as well as meds. 

You are right to be very cautious with an antidepressant.  You wouldn't have to rule it out, but you should be watching very closely for anything that suggests the origin of your symptoms is really coming out of a complex mood/energy place that suggests bipolar disorder. More on that, if you haven't read it, in the "diagnosis details" section of my website on BPII.  


Finally, it might be worth noting that at least one of the mood stabilizers used for BP has been shown to have some effectiveness in treating panic disorder, so you could consider the option of using a medication not known to have the capacity to make panic disorder worse, and then if it doesn't work, you're no worse off than you were (except for exposure to side effects/risks just like any medication approach).  As you've learned, this may not be true in your situation, for an antidepressant. 

Dr. Phelps