How Often Do Mood Stabilizers Alone Help Panic?
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Q:  How Often Do Mood Stabilizers Alone Help Panic?

I had been on 20 mg. of a tricyclic antidepressant called Sinequan for  major depression and anxiety from age 24-40 (1979-1994).  Then in 1995 it was discovered I had an underactive thyroid. After being put on Synthroid, (which did help my bipolar) my antidepressant had to be increased to 200 mg!!  My hypomanic response suggested I might have bipolar II but it took the doctor until 2004 to finally decide to wake up and suggest a mood stabilizer.  A new doctor wants to wean me off the tricyclic and gradually introduce a mood stabilizer but I fear that the severe panic attacks that had started in 1994 (a year before the thyroid was diagnosed) will return. How often do mood stabilizers alone help panic? I have 2 siblings that I believe are  bipolar II and one sibling with only agoraphobia w/panic.  I have both!  I am starting Lamictal this week.  Thanks for your reply.   


Dear Kathy -- 
If what you had was really "panic attacks" back in 1994 (and not waves of agitation and anxiety and insomnia, lasting over an hour -- which is a variation I see in people with bipolar disorder that can be mistaken for "panic attacks"), then you're asking a fair question.  (If they were not panic attacks but something more like what I'm describing, the mood stabilizers are definitely the route to go, as sometimes "mania" can show up as this agitation thing). 

No guarantees in this business, that's one thing for sure.  You could probably get about a 50/50 split on this question if you asked a bunch of psychiatrists.  As long as you aren't taking too many other medications you'd have to worry about, you and your doc' could plan to introduce the mood stabilizer before you start down (or at least before you get very far down) on the Sinequan (doxepin), and then taper the antidepressant very slowly, like over 4-6 months.  There's a great psychotherapy approach for panic and agoraphobia that has long term results better than medications, which you may have had, but should know about for sure:  cognitive/behavioral therapy for panic disorder.  Good luck with the transition. 

Dr. Phelps

Published February, 2005


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