(Dr. Shipko's 10th visit to Power Surge)


Dearest:  My guest tonight is Psychiatrist and Neurologist, Stuart Shipko, M.D.,
one of the nation's leading experts on the adverse effects of psychiatric drugs
who tells the real story behind the widespread overuse of psychiatric medication
and the negative consequences that have followed. 

Dr. Shipko has treated over 2500 patients with panic disorder. Founder and Medical 
Director of PDI, The Panic Disorder Institute and author of the new book, 
"Surviving Panic Disorder: What You Need To Know". 

Dr. Shipko is in private practice in Pasadena, California. His specialty is in the 
area of panic disorder and stress-related medical conditions. 

Dr. Shipko completed a series of studies on stress-related gastroenterologic problems. 
An outspoken expert in the area of psychopharmacology, Dr. Shipko talks openly about 
the pros and cons of the many medications on the market today to treat panic, anxiety 
and depression. 

Dr. Shipko, it's always a pleasure to welcome you back in Power Surge :) 


Dr. Stuart Shipko:  Thanks. Nice to be here again.  That's quite an introduction. 

I noted in the Wall Street Journal today that Pfizer had to pay out  hundreds of 
millions to settle the off label marketing on Neurontin.  The problem is, that doctors 
are all still believing that the marking has science behind it.


Dearest:  You say in your book, "Anger is both a result of the frustrating experience 
of panic disorder as well as a symptom of panic disorder itself ... When a person 
feels anger, they want to do something about it. A sense emerges that anxiety is an 
abscess of the emotions and that if the built up pressure can be released then it will 
feel better. An urge to act on the anger to get rid of it is a part of anger itself." 

You're saying that anger can be a symptom of panic attacks, but can unresolved anger, 
itself, cause one to start experiencing panic attacks?


Dr. Stuart Shipko:  Yes. Unresolved anger or any unresolved emotion can cause conflict
that is experienced as a panic attack. 


Yogi:  Hello Dr Shipko, I have been going through panic and anxiety for the past
2-3 years. I've had tests done to rule out medical conditions and so far my thyroid
is low, and I might have Cushing's. My question is, could these mental problems be 
caused by either of these conditions? I Should also mention that my anxiety/depression 
fluctuates on a daily basis without my control. All of these problems seemed to start 
around the same time as my medical problems.


Dr. Stuart Shipko:  Low thyroid is one of the most common causes of organic panic like 
attacks.


JolieJacq:  Several weeks ago I crashed with severe depression. 2 weeks on Lexapro, 
and I can't believe I'm up and about. The only problem is insomnia. Any ideas?


Dr. Stuart Shipko:  If that is your only side effect I wouldn't do anything right now.


Undecided:  I am 51 years old. My last period was Oct 2003. I have been having some 
palpitations since I was 50 years old but they were not that bad and I figured that
I must be in perimenopause. In the last month of so, the palpitations have gotten much 
worst, almost all the time, particularly during the day. Any suggestions on how I 
should manage this. I started Inderal 10mg 3 times this Sunday but so far no results. 
My thyroid level is within normal, my FSH 53 and my estradiol below 20. I have also 
had acid reflux for the past year.  I'm taking Prilosec 20mg twice daily.


Dr. Stuart Shipko:  Inderal was a good idea.  You could go up on the dosage. Talk to you 
doctor about trying 20 mg three times a day. 


Dearest:  If you have menopause questions, you can visit Ask The Menopause Experts
at www.power-surge.com/asktheexperts.htm 


Stel52:  Dr. Shipko, I've been getting PVCs (Premature Ventricular Complexes) for the 
past 14 months, even though I'm on 75 mg Atenolol for high BP and palpitations, also 
take estrodial and other medications. What can I do to eliminate those annoying PVCs? 
I drink little caffeine cause I can't.


Dr. Stuart Shipko:  A PVC is a serious cardiac problem. Are you sure you meant PVCs? 


Stel52:  Yes, I had a holter test, I was told PVCs do occur in normal people. I wonder 
what could cause them? 


Dr. Stuart Shipko:  Normal PVCs are infrequent and not clinically significant.  I have
no suggestions for you.


Brandy:  I've been agoraphobic for 47 years, can't go more than 3 houses away from 
home. Do not take medications. Feel like I've come to the end of the line almost.
Is there REALLY anything that can be done for a longtime housebound sufferer? 


Dr. Stuart Shipko:  Yes. Besides the various medications, you need to be motivated
to go out.  Behavioral strategies of going out first with a companion and then
with a cell phone etc. do work.  They are really difficult to do though. 


Dearest:  It never occurred to me until this moment that cell phones must be a Godsend 
for people with panic attacks. Like having a security blanket. Not a feeling of being 
totally disconnected, yes? 


Dr. Stuart Shipko:  Yes. Cell phones are a great security for everyone.  With a cell
phone and a AAA card most agoraphobics can drive.


Dearest:  Amazing.  Yes, I can see. 


Janis:  I had my first panic attack 10 years ago this summer. I was sick for months 
until I was put on Klonopin. I take 2 mgs. every morning to this day and luckily have 
never needed more (on occasion I take 1 mg. when I'm having a panic attack which is 
ALWAYS associated with my peri-menopause/periods.) I try to get off the Klonopin
but even going down 1/2 mg. my body goes into shakes and panic.

Is there a way to withdraw from this that won't be so difficult and if not can I
stay on 2 mgs. forever? I hate that it's so addictive and if I do not remember
to get the triplicate prescription a week in advance I could have a seizure if I
don't take it. I feel like it owns me. Any ideas? 

I still get panic attacks but would prefer to take as needed. Hormones are the cause 
or lack thereof - I'm sure of this. My last bloodwork showed my hormone level for 
menopause at 40 which but then after 9 months I got a very bad period and the worst 
panic attack right before getting it. I can't take the pill or HRT because of the 
cancer risk. Also SSRI's made my panic worse:( Am I stuck on Klonopin for life?
I'm 42. 


Dr. Stuart Shipko:  Withdrawal is highly variable. Some people can drop the dose
rapidly but others need to go very slowly.  Try decreasing the dose by increments
of .125 or .0625 mg 


Janis:  so I should cut a 2mg. pill into 1/8ths? 


Dr. Stuart Shipko:  No, you're not stuck on Klonopin for life.  It is a good idea
to slowly taper off of it. You can start it again later or take small doses from time 
to time.  But it is best if you don't take it regularly. You just need to taper more 
slowly.


Janis:  I have heard people go into rehab to get off of it. I wish I didn't get hooked 
on it for 10 years now but luckily I only take 2 mg. a day. Is there something I can 
take naturally to help me taper like valerian root?


Dr. Stuart Shipko:  Janis, I have not found adding other agents to really be of help
with withdrawing from Klonopin.


YGirl:  I suffered through depression last summer. Now I do not feel depressed but
I am waking up at 3 nightly with anxious shaking internally within minutes of waking. 
Can anxiety exist apart from depression? Is there a drug you would recommend me 
asking my doctor about?


Dr. Stuart Shipko:  Are you on drugs now? 


YGirl:  No, only nutritional supplements. 


Dr. Stuart Shipko:  Sometimes a bit of Xanax at night before sleep can be helpful.
But you can't use it for more than a few days or it becomes dependency forming. 


YGirl:  Any stressful thought, Dr. S, will send me into anxiety.


Dr. Stuart Shipko:  Do you mean when you sleep or awake? 


YGirl:  When I am awake. Thank you. 


Dr. Stuart Shipko:  Best to try to deal with stressful thoughts through therapy. 


Lindi:  I have been living with agoraphobia/panic attacks for almost 30 years. I truly 
have tried everything I know of, in order to recover from this debilitating condition. 
At this point, I feel exasperated and so incredibly upset with my lack of ability to 
help myself. I recently began to take an Amino Acid called L-Glutamine. Any advice on 
amino acids? Have you ever encountered anyone who has discovered the KEY to freedom, 
after this many years of living this way? Thanks so much.


Dr. Stuart Shipko:  Not really, to be honest. 30 years of agoraphobia is a long time
and your ability to go out has not been exercised. It is motivation and diligence 
that is the best way to deal with agoraphobia. You might try taking some Valium and 
seeing if you can go out with a few friends. 


Dearest:  Lindi, try joining the Power Surge message boards. Many women suffer from 
panic / agoraphobia and talk about it there. 
You can sign up at www.power-surge.com/php/forum/index.php 


VMarq:  Can being on Effexor cause anxiety symptoms? 


Dr. Stuart Shipko:  Yes. and YES. 


MaryD:  I am 55 years old. No periods for 4 years. I have noticed over the past few 
months I am so angry. I am not sleeping at night. I take bio-identical hormones.
I experience anxiety occasionally. I live alone, so no one thinks I'm crazy but me! 
Any suggestions for the anger and insomnia? I'm new to the group. 


Dr. Stuart Shipko:  You present a complex question. It is not clear whether the problem
is hormonal or emotional.  They would have different approaches.


Dearest:  I call them hormotional, Dr. S. 

RobertLS:  I am down to 10mg of Paxil for a year now and no withdrawal symptoms. 
Should I go down to 5mg for a year? I have been going very slowly as you can see.
I was on 20mg for 5 years. 


Dr. Stuart Shipko:  Rather than to cut the dose to 5mg for a year, I would consider
dropping the dose by 1 mg a month for the next 10 months. 


JolieJacq:  Have you ever heard of urine retention with SSRI'S? I have interstitial 
cystitis, and must watch for this.


Dr. Stuart Shipko:  Yes, the SSRIs have anticholinergic effects and in some people
cause urinary retention. By the way, I am one of those doctors who doesn't believe
in interstitial cystitis. It lacks objective foundation. I wonder if your 'cystitis'
is really anxiety?


JolieJacq:  I had the hydrodistension.  It showed glomerulations on bladder wall. 


Dr. Stuart Shipko:  Still, IC lacks a scientific foundation for diagnosis at this time, 
similar to chronic fatigue and fibromyalgia.


Marlo:  I wore a halter for 24 hours. He said my echo was normal. He said it was all 
hormonal and stress, since I lost both parents. Why do you say it is a dangerous 
cardiac symptom? I get these palpitations every time I get a hotflash. My heart rate 
goes up to 100 or over. Do you think I should go on Inderal? 


Dr. Stuart Shipko:  I can't comment on PVCs as it is not a typical symptom of anxiety.


Marlo:  I was diagnosed with PVCs in September. My cardiologist said it is stress 
related. 


Dearest:  This is primarily a menopause site, so you have to bear in mind that many
of these vasomotor symptoms are the result of hormonal imbalance. 


Dr. Stuart Shipko:  This question is a bit confusing.  If the PVCs are normal
then it is not a diagnosis.  Otherwise it is a diagnosis of PVCs and this
is a separate medical problem.  


Yogi:  Is there a way to differentiate between organic (secondary) anxiety disorders 
and primary anxiety disorders? Psychiatric drugs have never worked for me and some 
seem to aggravate already existing problems. How many patients have you seen came
to you with panic but were actually suffering from medically induced panic/anxiety?
How should I go about ruling out all possible conditions? 


Dr. Stuart Shipko:  Clinically panic attacks with a primary medical basis are the same
as the ones that have no apparent medical cause. In my book Surviving Panic Disorder
I mention some of the most important medical screening tests. 


TheIrishTeam:  I had a complete Hysterectomy, 10 years ago, and shortly after I 
suffered panic attacks, and then was put on Xanax. My question is how do I get my
doctor to understand the issue is hormonal, never experienced and kind of panic or 
anxiety prior to the Hysterectomy? 


Dr. Stuart Shipko:  Post hysterectomy panic attacks are of interest to me. I see them
in women who have their ovaries intact.  It is really common and doctors don't seem
to recognize it as a post hysterectomy problem, even when the ovaries are removed.
I don't know how to get your doctor to look at possible hormonal contributions.


Lindy:  Hi, I am wondering if you know of any non-drug remedies for panic disorder. 
For example, I saw a doc that loaned me a device called Alpha-Stim but I didn't like 
the vertigo and other side effects. I get panic attacks mostly while driving. Do you 
know of anything I can do to help myself get back to driving on freeways without 
freaking out? And yes, my cell phone really helps me for going over bridges. 
I haven't tried the freeways yet. Thanks.


Dr. Stuart Shipko:  The best non drug remedy is still therapy.


Lindy:  What kind of therapy? Talk therapy?


Dr. Stuart Shipko:  Or behavior, flooding etc.


Dearest:  I went through the same thing years ago, Lindy, after a traumatic experience 
in my life. The only way I eventually got over it was to GET on the highways and DO IT 
- and I went through short-term therapy with someone who specialized in panic 
attacks/agoraphobia. I also recommend reading Dr. Shipko's new book, Surviving Panic 
Disorder.   


Stel52:  Dr. Shipko, I also have a problem with fatigue and brain fog (fibromyalgia) 
Would Provigil help me? In light of my palpitations and PVCs would it be contradicted?


Dr. Stuart Shipko:  I don't know. 


Dearest:  Those are questions you can have answered at www.power-surge.com/
asktheexperts.htm 


Moozie:  Dr. S. do YOU recommend SSRIs? 


Dr. Stuart Shipko:  To some patients. The problem is not with the SSRIs themselves
so much as the reckless way that they are typically prescribed and the lack of 
informed consent available to the patient.  But they are useful drugs for certain 
problems.


AngieO:  Hi Doctor, have used a self talk anxiety program for agoraphobia which has 
been helpful, but I still get the anxiety surges/adrenalin feeling sometimes, can
this be harmful to the organs long term?  To the heart or adrenals?


Dr. Stuart Shipko:  Probably not. 


CK:  I was told I had panic disorder 5 years ago at age 38, the same time a massive 
endometrioma was destroying my left ovary.  I was put on Paxil.  I kept getting these 
episodes every period till last year every 2 weeks.  I finally had a hysterectomy.
My one remaining ovary is not working.  I am tapering off SSRI and use a Vivelle Dot 
and feeling great.  Could this have caused all this panic?  My gyn said I had a big 
time hormone imbalance.


Dr. Stuart Shipko:  CK, most likely that was the cause of your panic attacks.


CK:  Thank you I thought so. 


Dearest:  If you don't get to ask your question of Dr. Shipko tonight, you can ask him 
at: www.power-surge.com/asktheexperts/anxiety2.shtml


Llaffing:  Is the information you offer as valid for men as it is for women on this 
site and is there a more specific site for men ? 


Dr. Stuart Shipko:  Llaffing, the treatments are as valid for men as women as  far as panic 
disorder goes. 


Dearest:  You can try Dr. Shipko's site at www.algy.com/pdi.  Power Surge, although
it addresses panic attacks and anxiety, is primarily a women's menopause site. 

Dr. Shipko, what is the difference between stress and anxiety?


Dr. Stuart Shipko:  Stress is a subjective sense of being overtaxed. Anxiety is primarily 
subjective excess worry. Stress often causes anxiety.


Dearest:  Is stress a medical condition or basically a normal human condition? 


Dr. Stuart Shipko:  A normal human condition. 


Dearest:  Fine, thanks.  


Belle45:  Hello Dr. Shipko. I'm 46, down to 1-2 periods a year. Have had anxiety/panic 
since entering peri at 41.  The past 6 months have had terrible insomnia and waking 
with panic.  Anxiety/panic hit in 1-2 week intervals throughout the year.  My doctor 
has given me Ativan prn which helps but I don't dare take it over a week at a time.  
Is there anything else I can do to help me sleep and alleviate some of the anxiety?
By the way, I had panic when in my 20s.  It was in TOTAL remission for 13 years
before peri onset. Would it help to see a homeopathic doctor who does the saliva
tests for hormones? The middle-of-the night panic is especially debilitating.
Thank you :) 


Dr. Stuart Shipko:  Belle, I have had almost no luck using salivary testing to guide
hormone treatments.  It's a trial or error treatment. 


Dearest:  Dr. Shipko, thank you for another wonderfully candid and informative chat 
about panic disorder/attacks/anxiety, et al. I highly recommend everyone get a copy
of Dr. Stuart Shipko's book, "Surviving Panic Disorder: What You Need To Know", and 
visit his Web site, The Panic Disorders Institute, www.algy.com/pdi. 


Dr. Stuart Shipko:  Thanks to all of you too.  See you again soon.



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