Stuart Shipko, M.D.
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Stuart Shipko, M.D. |
 About Dr. Stuart Shipko  Ask The Anxiety, Panic Disorder Expert |
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(Dr. Shipko's 2nd Visit) 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. Welcome back to Power Surge, Dr. Shipko. Let me begin by asking you how one determines if s/he has panic disorder, or is experiencing anxiety attacks or panicky feelings unrelated to panic disorder? Dr. Stuart Shipko: This is a big question. The major factor in determining if you have panic disorder is if your mother or father has / had it. Panic attacks are a part of normal life and at other times they represent disease. The diagnosis of panic disorder is extremely complex. In its purest form it is inherited from a parent and comes with gastroesophageal reflux (GERD). It is aggravated by the hormonal changes of menopause but not usually caused by these changes. Symptomatic menopause can be anxiety provoking this is different from women who had panic disorder prior to menopause who then find it aggravated, usually in the perimenopausal period. Dearest: But, Dr. Shipko, isn't it true that a panic attack is a panic attack whether one has panic disorder or not? Dr. Stuart Shipko: I agree completely. By definition, a panic attack is anxiety that "comes from nowhere" as opposed to similar symptoms that are a phobic reaction but all panic attacks are still panic attacks whether or not you might have panic disorder. Dearest: So, a woman in menopause who has anxiety from her estrogen and progesterone levels rising and falling constantly and has a panic attack... that comes from nowhere? I'm not quite sure I understand. Dr. Stuart Shipko: You seem to understand. It is the perception of the person that the "fear" has arrived spontaneously. Dearest: And without medication, do we have the ability to control our panic attacks or episodes? Dr. Stuart Shipko: No, a panic attack is something like a seizure you cannot control this, although you can control your reaction to the experience. Also, anticipation of symptoms will bring on the symptom and you can control anticipatory symptoms. Dearest: Ok, then in closing, do I understand that menopausal women, who have no history of panic disorder, are probably having anxiety attacks and not necessarily panic attacks? Dr. Stuart Shipko: Well, they would still be having panic attacks but not panic disorder you can call them anxiety attacks but it is not necessarily panic disorder. Dearest: Interesting. Thanks, Dr. Shipko. Sprout38, please go ahead with your question. sprout38: I have a thyroid condition - hypo and also maybe going through perimenopause does this aggravate the symptoms? Dr. Stuart Shipko: Yes, very much so. Often people think of panic as let us call this anxiety, not panic anxiety is associated with high thyroid but the truth is that low thyroid is more commonly associated with panic attacks. Dearest: Dr. Shipko, why have we become so conditioned that at the slightest sign of anxiety, we think we have to take a pill? Dr. Stuart Shipko: Marketing? This is the question of the decade. Why are we all supposed to feel no sadness -- only depression? Dearest: How true. Dr. Stuart Shipko: Patients never complain of being unhappy, only of having depression. We have lost sight of the fact that we are not always going to be sick each time we feel afraid, worried or unhappy. Dearest: Thanks. Great answer :) Guest4:, please ask your question now. Guest4: where does the symptom of burning skin come from if all medical tests rule out physical problem? Why does Xanax prevent it from happening? Within 48 hours of stopping Xanax, burning starts. Have been having panic attacks during this time as well - waking in middle of night - but Xanax has stopped them. Have been on 1 mg of Xanax/day. People say it is highly addictive and that worries me....suggestions? I do see a psychiatrist. Dr. Stuart Shipko: Did you have burning skin before you started the Xanax? Guest4: Yes Dr. Stuart Shipko: Burning and itching skin are poorly understood. Guest4: Just burning - not itching but fairly common in panic disorder Dr. Stuart Shipko: Yes, I know you don't itch there is no good answer to the question of why does the skin burn there are only speculative theories. Xanax is highly dependency forming but no tolerance or "addiction" occurs. Once you start Xanax, you have about a 50/50 chance of discontinuation in the future. Patti: I have been taking Prozac for 8 years, after discussing feelings of depression again, he now has added in Wellbutrin. Why is it necessary to take both? Is there any danger in mixing the two? Prozac has been used for pain management. Dr. Stuart Shipko: Patti, what dose of Prozac are you on? Patti: 40mg, 20 2x a day Dr. Stuart Shipko: Why does your doctor want another medicine? More depressed? Patti: Well, Prozac was started as pain management now I feel very depressed and he added the Wellbutrin Dr. Stuart Shipko: Prozac blocks serotonin reuptake and Wellbutrin blocks norepinephrine reuptake. I guess that your doctor feels that he/she wants to hit all the receptors. Patti: what is the difference between the two blockers? Dr. Stuart Shipko: It is safe to take them together. Norepi and serotonin are the two neurotransmittors that are known to be involved in depression. Patti: Thank You! Debra: Just curious about medications. I have PD (Panic Disorder) and have been on various meds, the latest being Depakote. What can you tell me about this versus say Neurontin or Gabapentin? Dr. Stuart Shipko: Debra: Neurontin is not very effective for anything except neuropathic pain. Depakote is an anti-convulsant that is usually used for bipolar disorder, but can help in panic disorder. Are you also bipolar? Debra: This is for PD..no Dr. Stuart Shipko: I think Depakote isn't all that helpful for most people with PD. Also, you need to look out for the fatal side effect of hemhorragic pancreatitis since so many PD patients have GI problems, when a person is on Depakote. I always have to wonder if GI problems are early pancreatitis or a part of PD. Debra: Just started it. I'll let you know how it goes. Jacquie: I have had panic disorder for 12 yrs and noticed they are more prevalent right after ovulation for about 2 weeks, how is this related to hormonal changes? Dr. Stuart Shipko: Each person is individual. You need to measure hormones while feeling good and again when feeling ill. In general, progesterone is nature's valium, but this is not true for everyone. Jacquie: Thank you. I was thinking about natural progesterone cream. eb: Thank you for being here, Dr. Shipko. My anxiety is greater now that perimenopause is here, low progesterone. I also have MVP (mitral valve prolapse), which is symptomatic. Does the treatment of anxiety differ due to the cause? I have the Anxiety and Phobia Workbook -- can't use HRT due to history of dvt (deep veinous thrombosis or phlebitis) Thank you! Dr. Stuart Shipko: eb: the treatment of anxiety does not differ as to cause. However, sometimes you choose not to treat. The MVP is present in almost everyone with anxiety. I think the Anxiety and Phobia Workbook is great. You want to avoid medications for anxiety if you can. Xanax is forever, and the best anti-panic attack medication but it is usually very difficult to stop if you are over 40. The rest of the medications.... well, lets just say they are more risk for the benefit they provide. Dearest: Can long-term use of Xanax cause arrhythmia? Dr. Stuart Shipko: No eb: Thanks. it is harder for me to get docs to take the mvp seriously as to it's anxiety it's almost easier to get docs to believe in hormonal fluctuations. Greenpastures1 Dr. I was given different medications to help the panic attacks, prozac, Zoloft. None of which helped. The only thing that seemed to help me was the use of HRT. Is this common? Guest308: What is HRT ? Dearest: Hormone Replacement Therapy Dr. Stuart Shipko: Yes. It turns out that most panic is not helped by prozac or Zoloft in the first few weeks. If HRT alone works, then the diagnosis is probably perimenopausal dysautonomia and is a much better problem than is panic disorder. deps: can you explain this gastro-reflux? been told I have had panic disorder since age 12, started with hyperventilation and continues to this day. Also now perimeno, taking Estratest HS and Provera. Still panicky. Dr. Stuart Shipko: deps: the best answer for you is on my website under the FAQ and the new research sections. http://www.algy.com/pdi. I have whole sections of the FAQ that discuss GERD. All genetic panic (which you sound like you have) has GERD as a symptom. Guest54 what can one do to help with general anxiety disorder (also have MVP) besides exercise? Dr. Stuart Shipko: GAD is a strange diagnosis. There is no recommended psychotherapy and if you have GAD, you also meet the criterion for panic disorder. I don't really recognize GAD as described by formal diagnostic criterion as a separate illness. sprout38: what is the Anxiety and Phobia Workbook and where can I get one? Also I was on Paxil and had some bad side affects so now they are going to put me on 100mg of Zoloft. they tried Imipram but it did not work. all the symptoms of panic came back. Should I be on a hormone med also? Dr. Stuart Shipko: If you didn't like Paxil, you will hate Zoloft. The Anxiety and Phobia Workbook by E. Bourne is available everywhere - try Amazon. sprout38: It was not dislike. I had no sexual function at all. Dr. Stuart Shipko: I would skip the SSRI's and head directly to HRT or Xanax. Dearest: Just curious, sprout, but what type of doctor put you on the Zoloft? sprout38: Regular physician Dearest: Was your doctor basically treating your menopausal symptoms? I'm not sure who here tonight is in menopause and who isn't. sprout38: I am on Xanax. No, the physician. Dr. Stuart Shipko: I think that Dearest is alluding to the fact that they are throwing SSRI's at women with uncomplicated menopause, and the doctors doing this rarely know or understand the side effects and complications of these drugs. Zoloft and Paxil knock out sexuality in about 80% of people who take them and it may not return when you stop it. Dearest: So, then they put them on testosterone. I don't understand why people who aren't in the mental health field are prescribing all these drugs and not even monitoring their patients. What's going on, Dr.S? Dr. Stuart Shipko: The biggest scam in the history of medicine. Dearest: Please elaborate... why? Dr. Stuart Shipko: The SSRI's are helpful to some, but more people get sick off of them than are helped. Go ahead and publish. For the record, I expect both Paxil and Zoloft to be ultimately removed from the pharmacies. You heard it first here :) Everyone should read "Prozac Backlash" by Glenmullen to see the scandal of payoffs, of hiding important side effects from the public of the dependency and the clear toxicity of the SSRI's. Guest308: Especially physicians. Dearest: And the FDA, a governmental organization, is it there to help the people or to make the pharmaceutical industry richer and richer? <and the doctors>? Dr. Stuart Shipko: I can't understand why people who are FDA officials are also allowed to be paid speakers and consultants to the drug companies. Clear conflict of interest. I want the FDA disbanded and started again from scratch. Dearest: Unreal. It's almost like a form of chemical warfare. Thank you, Dr. S., for being so honest and honorable. I admire you greatly. Guest145: Okay its a doozy. What medication could you recommend for perimenopause + depression + GAD+ nursing a toddler? I have raging insomnia. Dr. Stuart Shipko: Hi, 145. Your question can only be answered by a treating physician. I don't want to speculate too much. Guest4: should I be frightened of taking Xanax for the panic disorder? Is there anything else I should try - or should I just stick with the Xanax? I take thyroid hormone and will take it for the rest of my life. Can I look at Xanax like that? I don't seem to feel any side effects--certainly not sleepy or drugged feeling. My doctor had tried elavil and serzone. Elavil made me way too drugged - even half dose and serzone made me feel like I was going. Dr. Stuart Shipko: 20 year studies of Xanax show that the same dose works over long periods of time and that it is the safest med to take long term. You may want to look at it like thyroid but occasionally people do stop Xanax spontaneously. I would be more afraid of untreated panic disorder than of Xanax. Dearest: What about the "half life" action of Xanax? A psychologist guest told me that after using Xanax for a long time, it often starts having the reverse effect of causing more anxiety. Is this true? Dr. Stuart Shipko: No factual basis for this statement. The half life is 12 hours. The clinical effect is from 4 to 24 hours. It works well over 30 year periods, can't say for all meds. Dearest: What does that mean -- the half life is 12 hours? Dr. Stuart Shipko: After 12 hours 1/2 of the dose is cleared from your system. So, 24 hours after your last dose, you have 25% left in your system. Dearest: I see. Thank you. Greenpastures, go ahead, please. Greenpastures1 why so much experimentation with anxiety/dep meds instead of hormones? Dr. Stuart Shipko: green: you follow the money trail. Dearest: SSRI's seem to be the drug du jour. Dr. Stuart Shipko: Yes Greenpastures1: I've been going through this for 2 years and all they will give me are these types of meds instead of HRT's. Dr. Stuart Shipko: I want to address greenpastures. Doctors don't know as much as you do about HRT. They don't understand salivary testing, they don't really believe in either menopause or in panic disorder. I had to throw that in. Dearest: They don't believe in menopause? Is that like not believing the Holocaust occurred? Who's training the doctors of today :( Dr. Stuart Shipko: Good analogy. The drug companies and HMO's train our new doctors. Dearest: sprout, go ahead. sprout38: is there a drug that you would recommend that is for someone with hypothyroidism and perimenopause with the symptoms of panic or anxiety attacks? Dr. Stuart Shipko: You need to correct the thyroid, then you need to measure the hormones before you think about psychiatric drugs. sprout38: They say it is. Is there a test I should ask for? Dr. Stuart Shipko: You need to ask for too much for me to write at shipko@ix.netcom.com diannemarie: Have you noticed any improvement in symptoms with women taking natural HRT vs. synthetic? ie bi-est and prometrium vs estrace and provera, for example? Dr. Stuart Shipko: Clearly premarin the "original natural" is a loser. Dearest: Horse urine Dr. Stuart Shipko: Thanks Dearest: You're welcome. Provera is poison, too. Dr. Stuart Shipko: Otherwise, I have not noticed a clear difference on synthetic versus natural. I always opt for natural first -- except the horse pee natural. Dearest: Provera can cause elevated blood pressure, cholesterol, and a whole host of problems. When Dr. John Lee was a guest in PS and I asked to give me one word for Provera, he said -- poison. If anyone needs to use progesterone, use natural micronized progesterone - naturally compounded. Dr. Stuart Shipko: Gosh, I call Paxil poison. Dearest: Notice Premarin, Paxil and Provera all start with "P" Dr. Stuart Shipko: Like... poison? Dearest: Uh huh Dr. Stuart Shipko: Yeah, I noticed Dearest: Gerbil, go ahead, please. Gerbil: "I just started Zoloft about 2 months ago for depression and it has made me feel much better. Because I feel much better, my sexuality has begun to return. Should I expect to start feeling bad side effects in the future or have health problems? Dr. Stuart Shipko: Gerbil: good for you. You do not need to expect side effects, although the problems with sexual function and desire can emerge at a later date. Your biggest worry is "poop out." That is, the Zoloft ends to stop working after a while. Dearest: Guest145, your question, please. Guest145: What kind of physican can best help me with my previous question about breastfeeding and medication? (and yes, I am really perimenopausal. Almost 45.) I really need to sleep. Dr. Stuart Shipko: No specialty. You need to find someone who knows this area of medicine. Guest54 Can one take Xanax prn just when they feel panicky and not all the time? Dr. Stuart Shipko: One can, however it is difficult to distinguish between anticipatory anxiety (best dealt with through therapy) and true panic. I find Xanax much better as a preventative agent than as an as needed agent. Dearest: Thank you for another exceptionally open and informative chat! Keep your eyes open for Dr. Shipko's forthcoming book, "Panic Disorder: What You Need To Know Before You Go To The Doctor," which will published in early 2002. Anyone interested in learning more about The Panic Disorder Institute can visit it on the Web at http://www.algy.com/pdi. Thank you, Dr. Shipko! Dr. Stuart Shipko: It was a pleasure. Read Dr. Stuart Shipko's first 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. 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