Stuart Shipko, M.D.
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Stuart Shipko, M.D. |
 About Dr. Stuart Shipko  Ask The Anxiety, Panic Disorder Expert |
 Visit The Panic Disorder Institute Web site |
(Dr. Stuart Shipko's first visit to Power Surge) Dearest: Tonight's guest is Psychiatrist, Neurologist, Researcher and the Medical Director of the Panic Disorder Institute, DR. STUART SHIPKO. Dr. Shipko specializes in panic disorder, anxiety and stress-related problems. You can read more about Dr. Shipko's work on his Web site at http://www.algy.com/pdi Let me begin by welcoming you, Dr. Shipko. It's a pleasure to have you join us in Power Surge's community for women at midlife. Dr. Stuart Shipko: Thank you. Dearest: What made you focus your practice on panic disorder? Dr. Stuart Shipko: It was epidemic in Los Angeles during the recession at the end of the 80's. I first started to see people with panic disorder for disability purposes. Of course, I have long had an interest in "psychosomatic" problems and people with panic disorder had a lot of unexplained physical symptoms called "somatization" at the time. When I did ER medicine, I would see panic attacks all the time but 20 years ago there was no name for them. Dearest: Can we identify certain times in "history" when panic disorder has been more prevalent? Or, certain times during our life as well. Dr. Stuart Shipko: It has been prevalent throughout history. Darwin, in his diaries eloquently described his own panic disorder. It is in the Greek and Roman literature. I think we are seeing an increase in panic attacks currently. Dearest: How would you explain the difference between "stress" and "panic disorder?" Dr. Stuart Shipko: stress is the subjective sensation of being overwhelmed. people with panic disorder feel this way all the time. people who feel lots of stress need not have panic attacks but people with panic attacks always feel "stressed." Dearest: Women often come to Power Surge complaining about panic attacks for the first time in their lives. Do you see a connection between menopause, hot flashes and panic attacks? Dr. Stuart Shipko: There is a connection. Menopause, with its typical hot flashes does not resemble a panic attack. However, women who have panic disorder that might be in remisssion will find that as they approach the perimenopausal period, they will have an exacerbation of the preexisting panic disorder. but menopause does not bring on panic disorder in itself. Dearest: So, you believe the panic disorder is there first and exacerbated by the hormonal fluctuations and hot flashes, but not *caused* by them? Oops. you answered my question before I asked it :) Dr. Stuart Shipko: Exactly. Dearest: Sure you're not clairvoyant, too? Thank you, Dr. Shipko, for this excellent introduction to panic disorder. Let's go to the queue now. Link, your question? linkaloo: Was diagnosed in 1986 with panic disorder. Was on Norpramine for several years before the newer drugs came out. Been on Zoloft now for over six years, taking 50 mgs. per day. Can these drugs become ineffective after being on them for so long? What is your opinion of Celexa vs. Zoloft? Dr. Stuart Shipko: The literature cites the "poop out" rate at about 30%, but in my practice it seems that some people get months, some years, but ultimately the dose needs to be raised and ultimately it stops working. I have no opinion on Celexa versus zoloft. Dearest: What about the recent reports that long-term use can result in Parkinson-like symptoms, like jerking and shaking? Of SSRI's, that is. Dr. Stuart Shipko: These are of critical importance. Glenmullen, in his excellant book, Prozac Backlash writes about this. The drug companies and the FDA have engaged in conspiracy and cover up concerning the full range of side effects with the SSRI's I am seeing Parkinsons in 24 year olds and intractable tinnitus after use of the SSRI's. Dearest: Thank you, Dr. Shipko. Craftlady: Ok ..I have panic disorder for 20 years and managed with out meds so far, but approaching menopause. What should I do to help me ? is there a blood test to determine if chemical imbalance is present to determine if a person should be on medication? Dr. Stuart Shipko: If you can get by without medication then that is always the preferred method. There is no real blood test. In some women salivary hormone testing has proven useful. In general, progesterone is nature's valium and if panic gets worse as you approach menopause a little topical progesterone may help -- try to stay away from medication. Dearest: Dr. Shipko, do you believe medications are being over-prescribed? Why don't doctors recommend therapy, alone, before putting people on meds? Dr. Stuart Shipko: Medications are being overprescribed by psychiatrists in general. Everyone has a panic attack now and again but few of those people will have panic disorder. Most of the time you are best off watching but not prescribing and things go away. Psychiatrists have gone on a medication wilding. Few do any psychotherapy anymore -- but many psychologists will take a completely psychotherapy approach. Dearest: Isn't part of it our fault as well -- the immediate gratification society we live in - and that we have to have a magic pill for everything that doesn't quite feel normal? Dr. Stuart Shipko: The demand for pills to feel good from patients is overwhelming. They have bought into the psychopharmacology concept big time. alfie: Would perimenopause hormonal changes affect how certain anti-depressants and anti-anxiety meds work in a person as compared with how they might have before that time in her life? Dearest: Very interesting question Dr. Stuart Shipko: This is a definite possibility as the hormones determine the architecture of the cortical nerve cells but it has not been well studied. windy: I get pvc's and pac's that i never had before. Is this common with anxiety disorder (which i never knew i had before this perimenopause started) or is it due to the hormonal changes? I have had all the tests by the cardiologist and checked out fine. Dr. Stuart Shipko: windy: Pvs' and pac's are common with anxiety disorder. Hormonal change can aggravate the situation. I don't think that the "benign" arrhythmia of panic disorder is so benign. It looks like 10 to 15 years later those arrhythmias are not so harmless. I recommend taking coenzyme q 10, about 50 mg a day and carnitine at about 500 mg a day as a nutritional boost to the heart's electical system to prevent later arrhythmia. Dearest: Dr. S., I realize SSRI's (selective seratonin reuptake inhibitors) affect the seratonin levels in our brain, but what else do these drugs do to our brain's functioning? Dr. Stuart Shipko: Dearest: the most significant thing that they do is to make a person have no concern about behavioral consequences. They constrict emotional feeling in general and sometimes memory loss. Dearest: Thank you, Dr. S :) Barbs: i was just wondering how long a person should take something like prozac and how do you know when to stop? Dr. Stuart Shipko: It turns out that once you start treatment it is almost always long term. If the prozac actually helps, then I would try to stop it about 6 months after your last panic attack. If it stops working and your doc wants to double the dose, I feel that is another good stopping point. Rhonda: I used to take Xanax only on an as needed basis. When I was first diagnosed with anxiety disorder, I had panic attacks only occasionally. Thirty Xanax would easily last a year. Now that I have reached menopause, I find I need two Xanax most days to be able to function. Should I be concerned about this dosage? Also, how do you feel about trying to switch to something natural like kava instead? The Xanax has worked wonders for me, but some of my family. Dr. Stuart Shipko: Lots of people have emotional reactions to the idea of Xanax. An exacerbation of symptoms that require more Xanax is not uncommon. You need to be forwarned that at this age, you will probably become dependent on it. You won't need to keep increasing your dose, but you will have difficulty stopping the Xanax when you want to. Still, what you describe is expeceted. linkaloo: I've read that the same receptor sites for estrogen are the same sites that antidepressants work on. If that is so, maybe that is why I do well with 100 mgs. of progesterone at night. It helps me sleep. Would it be worthwhile for me to wean myself off the Zoloft and continue with progesterone? Also, I'm greatly concerned about withdrawal symptoms exacerbating the panicky feelings again. I've tried tapering off once before, had problems! Dr. Stuart Shipko: What they don't tell you is that Zoloft is also dependency forming with withdrawal. The estrogen sites are not the same ones affected by Zoloft. Progesterone alters the structure of the nerve cell and is not active at the synapse. If you do well with 100 mg of Progesterone, then go with it. Zoloft has too many long term problems and if you can stop it, that's better. Dearest: Dr. S., we have spoken about progesterone and I know of your admiration for Dr. John Lee's work. However, I've asked this before and it confuses me that often the very things progesterone is prescribed for... it causes, such as irritability, anxiety, depression. How do you account for that? Dr. Stuart Shipko: This seems to be true of all medications. Quite often they do the opposite of what they are supposed to do. I can't really account for it beyond observation Dearest: Thank you (but I'm not really happy with the answer.. don't shoot) :) Peggy, go ahead. Peggy: what are the full side effects of long term use of SSRI? How long is it safe to take them? Dr. Stuart Shipko: None have been formally studied for more than 3 months. Weight gain, loss of sexual functioning, memory loss, sedation, akathisia, Parkinsons, twitches, damage to the inner ear.... even more side effects. Studies show the SSRI's to be neurotoxic. People are using them for years at a time and the long term side effects just haven't been disclosed yet. Dearest: If Prozac has been out, what.. over 20 years?.. why hasn't it been studied for more than 3 months? Dr. Stuart Shipko: Dearest: it has not been required by the FDA. Also, it may have already been studied, but the drug company has the right to withhold information if they so choose. Dearest: I thought this was a government for and BY the people. How do we, as citizens, effect changes in government organizations like the FDA? Dr. Stuart Shipko: Read "Prozac Backlash" for shocking insights into the corruption of the FDA. Dearest: Thanks. I intend to. linkaloo: You go girl!! Dr. Stuart Shipko: Dearest, the drug companies spend the most of any lobby in Washington. Dearest: Dr. S., there's something very wrong with this picture, as you well know and have stated. Sally1019: What are your thoughts on hyperventilation syndrome in connection with a panic attack? Dr. Stuart Shipko: Sally: can you be more specific? Sally1019: Do you think hyperventilation causes it or is a symptom of it? Dearest: Interesting question, Sally. Dr. Stuart Shipko: It's a symptom of it -- I don't think there is a primary hyperventilation syndrome that concept is left over from 30 years ago before they named panic disorder. Dearest: Thanks, Dr. S. . beth I am 42, had my first panic attack at 40... was on serzone and klonipin for 6 months and a year respectively. Was doing fine med free until a week ago, when the anxious muscle tightening, burning, sleep trouble returned. I am determined to beat this, without meds and was wondering what you suggest? Also, want to know what you think about a low/normal TSH, but normal T3 and T4....Could this be contributing to my increased anxiety/panic? Symptoms are so similar. Dr. Stuart Shipko: If you want to beat this without meds, then don't take meds. Dr. Arem who wrote "The Thyroid Solution" would think that abnormal thyroid might be playing a role here. Dearest: Thank you for that excellent answer, Dr. S. These questions and answers are wonderful. Faye, your turn :) Faye: Does Wellbutrin help with anxiety along with depression? Dr. Stuart Shipko: Faye: no and it may work in the opposite direction with panic disorder. Dearest: I'd like to stop for one moment to ask the audience.... how many of you take or have taken tranquilizers or anti-depressants? Please just type Yes, No or Never to screen. Thanks. Rhonda: Yes SandyK: yes Sally1019: yes Peaches: Yes MaryO: ever? yes jeanc40: yes Faye: yes Dearest: Yes beth: YES Janet: yes Callie: yes! linkaloo: yes Maureen: no Sue: yes Sande: No GRACE: no Dearest: Of those who answered, how many of you are currently using a tranquilizer or anti-depressant? If so, which one? MaryO: not currently Sally1019: not currently using beth Klonipin linkaloo: antidepressant Rhonda: Xanax Trevor: =^;^= jeanc40: just got off xanax linkaloo: Zoloft, sorry! Peaches: Only when needed Xanax Dearest: Currently - occasionally SandyK: ativan Sue: serzone with Wellbutrin, for panic with depression MaryO: i use Xanax for flying PDP: Xanax Dearest: Interesting, isn't it, Dr. Shipko? And I'll bet these were prescribed by gynecologists or family practitioners. Dr. Stuart Shipko: Let's find out. MaryO: mine was Sally1019: yes, GYN SandyK: family doc Roconori: My shrink Dearest: Internist Dearest: How many of you were prescribed by Psychiatrists? beth Psychiatrist jeanc40: family practitioner linkaloo: psychiatrist Rhonda: Family practitioner Sue: my psych PDP: Psychiatrists MaryO: not me alfie: family dr alfie: xanax, Sinequan Dr. Stuart Shipko: Most of the time these are not prescribed by psychiatrists. And did the doctors tell you about options and possible side effects? PDP: nope linkaloo: side effects like dry mouth, yes, not long-term use! SandyK: only a little, not nearly enough jeanc40: my doc said "keep taking it, honey" Sally1019: yes MaryO: no (I also had Valium prescribed by a neurologist) beth I hadn't slept in 4 weeks when I was put on them MaryO: no options discussed Dearest: To a degree, yes Rhonda: No, Mine said I was on low dose and not to be concerned about taking when needed Roconori: Yes I knew about all the side effects Sue: not about the persistant weight gain and loss of libido long after the med was stopped alfie: mine ended up prescribing propanolol to ward off the effect of the Sinequan which was causing rapid heart beat like 140 Dearest: Thanks for your input. Guest35, please go ahead. Guest35: Hi. Since I have had anxiety attacks for 29 years and have tried all the programs, cannot take paxil Zoloft, etc., and am now in peri-menopause they are worse only now have PVC's (which have been checked out with cardiologist and stress thallium test). I can't seem to find any answers to help me at this time. Feel like I'm going crazy. Have been on tranxene for a few months after having been on Xanax. Do you think hormone replacement would helpful? Dr. Stuart Shipko: You need more of a second opinion than a chat blurb -- too complicated to answer. Like other treatments, HRT for panic has not been standardized, but may help. Dearest: Guest35, feel free to E-mail me at Dearest@aol.com. I have some information that may help. Barbs, go ahead, please. Guest35: ok thank you Barbs: Dr. Shipko do you have many women in menopause who come to you for help? Dr. Stuart Shipko: Yes alfie: what about weaning off the meds and increasing progesterone, would that be dangerous? and do you prefer topical or sublingual progesterone. Dr. Stuart Shipko: Weaning off meds onto progesterone is not being done currently. I don't think it would be dangerous. I have no progesterone preferences. Craftlady: Well no meds for me. I have done CBT therapy and can handle things pretty good. My last thing to accomplish is getting on the highways to drive again. What have you recommend for people having trouble driving, mainly highways. Not too bad here in my small town. Dr. Stuart Shipko: I'm not sure that God designed all people to drive on the highways. Craftlady: lol Dr. Stuart Shipko: Panic disorder is associated with inner ear problems. linkaloo: You said co-q-10 and carnitine was good for heart health. What about 500 mgs. of magnesium per day for heart palpitations? Don't mean to be nosey but have you ever experienced a full blown panic attack? If long-term use of meds is not an option, what is a person to do? I live in a small town, no psychotherapy is available to me. Dr. Stuart Shipko: Long term meds is an option, just not a studied option in the SSRI's. Magnesium, alpha lipoic acid and taurine are also good for panic related cardiac sensations. linkaloo: Thanks Dr. Shipko! Dearest: Dr. Shipko, thank you SO much for a fascinating and very informative guest chat in Power Surge tonight. I'm sure we all walk away a great deal more educated about panic disorder, SSRI's, and stress-related problems. Thank you for all the work you've done and for your forthrightness. You are to be commended. Dr. Stuart Shipko: http://www.algy.com/pdi and our 4th annual conference will be October 13th in Pasadena. Dr. Stuart Shipko: You are welcome. Dearest: Goodnight, Dr. Shipko. Goodnight, everyone Read Dr. Stuart Shipko's second transcript Read Dr. Stuart Shipko's third transcript Read Dr. Stuart Shipko's fourth transcript Read Dr. Stuart Shipko's fifth transcript Read Dr. Stuart Shipko's sixth transcript Read Dr. Stuart Shipko's seventh transcript Read Dr. Stuart Shipko's eighth transcript Read Dr. Stuart Shipko's ninth transcript Read Dr. Stuart Shipko's tenth transcript Read Dr. Stuart Shipko's eleventh transcript Disclaimer: Every guest in Power Surge is a highly respected professional whose opinions are his/her own. An appearance in Power Surge does not constitute an endorsement of a guest's views. None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read other transcripts by returning to the Library. Dearest aka Alice Stamm Power Surge Founder, Facilitator, Host Copyright©1994-2008 by Power Surge. All Rights Reserved.