(Dr. Stuart Shipko's 4th visit)

Dearest:   Dr. Stuart Shipko is a psychiatrist and neurologist, director of The Panic 
Disorder Institute. Dr. Shipko's practice focuses on panic disorder, stress-related 
medical conditions, stress and trauma related disorders, psychiatric injury, 
psychosomatic medicine and general psychiatry.

It's a pleasure to welcome you back to Power Surge, Dr. Shipko :) Is it any wonder 
we're an overmedicated society when you can't turn on TV these days without being 
inundated by commercials for anti-depressants, tranquilizers and sleeping pills? Could 
you share your thoughts about the use of TV to advertise prescription medicines? 


Dr. Stuart Shipko:  I love the Paxil commercial. Its so friendly.


Dearest:   What about the quantity of commercials though? 


Dr. Stuart Shipko:   Right now the doctors are over prescribing everything because of 
television. They don't want to take up a lot of time, so they just write the 
prescription.  The TV commercials are a laugh :) As they read off a long list of side 
effects, you wonder if you would ever take something like that.


Dearest:  Some of those commercials terrify me when I hear the possible side effects. 
What happened to the days of first recommending something natural like exercise, St. 
John's Wort, kava kava or 5-HTP which increases serotonin production instead of 
immediately prescribing Prozac, Zoloft or Xanax for someone complaining of depression 
or anxiety? 


Dr. Stuart Shipko:  Nothing happened to those days. St. John's Wort has side effects, 5-
HTP causes Fen-fen like heart problems, Kava helps people relax a bit. They all have 
side effects also. I think the deeper issue is that we all want designer 
psychopharmacology  If only I had the right chemical balance ....sigh.


Dearest:  For someone experiencing her first anxiety of panic attack, are there ways to 
lessen the severity? 


Dr. Stuart Shipko:  A panic attack itself is like a seizure and it's hard to stop while 
it is happening. Reactive anxiety responds to many things. Deep breathing, clenching 
and relaxing your muscles prayer and thoughts of courage also.


Dearest:  I've heard women talking a great deal lately about anti-seizure medications, such
as Neurotonin when they complain to their doctors about anxiety. Why on earth are doctors
prescribing something of that nature? These are powerful drugs. Why are they drugging
women up?


Dr. Stuart Shipko:  This is the latest trend. They are now using anticonvulsants for 
both depression and anxiety. We seem to have a convergence of seizure, bipolar and 
panic.


Dearest:   Your last comment is a perfect lead-in to my next question: Why is it not enough 
to be "worried" or "stressed" or even "excited" about something without giving it labels 
like bi-polar disorder, panic disorder, panic attacks or depression? 


Dr. Stuart Shipko:  I like that. Nobody gets unhappy anymore, they are all depressed. 
Now people aren't afraid, they have anxiety. Freud said, the goal of psychotherapy is 
to make neurosis into common misery. Now we do have a real "feel good" mentality. 


Dearest:  But are psychiatrists and psychologists really practicing psychotherapy while 
their patients are on medication? 


Dr. Stuart Shipko:  Clarify? 


Dearest: Well, isn't the point to therapy trying to effect behavior modification?


Dr. Stuart Shipko:  No, the point is strictly for the patient to feel good with no 
change in behavior needed.


Dearest:  I don't quite understand. It seems drugs are taking the place of traditional 
psychotherapy and I thought the purpose of that was, of course, to feel better, but also to
effect behavior modification with regard to how we react to life's events (past and present).  
It just seems they're using drugs for all those things now. Patricia, go ahead, please.


Patricia:  Please address the negative effects of SSRI's.


Dr. Stuart Shipko:  This is the topic of the day. The biggest drawback is that we have 
a huge discrepancy between what doctors are telling patients, and what patients are 
telling doctors. Patricia, the list of side effects are long, but so few are told to 
the patient. Did you want to know about any specific side effects?


Patricia:  Yes, I am curious about Parkinson's Disease


Dr. Stuart Shipko:   Okay. The SSRI's do reduce brain dopamine and they do cause 
Parkinsons in some younger people. The big question is what will it do to your 
dopamine in 20 years. We lose 60% of our brain dopamine in the substantia nigra (Park 
Center) by the time we are 65. If the SSRI's accelerate that, then we will see a lot 
of Parkinsons in former SSRI users. 


JanLiz:   I have constant dizziness. Doctors say it's nerves. I Know it's not!


Dr. Stuart Shipko:  A lot of people have constant dizziness as a symptom. Is it alone 
or associated with other symptoms? JanLiz?


JanLiz:   Yes


Dr. Stuart Shipko:   Alone?


JanLiz:  Alone? No.


Dr. Stuart Shipko:   What other symptoms?


JanLiz: Panic attacks, depression, lack or ambition


Dr. Stuart Shipko:  This is a common symptom in anxiety. There are eye exercises that 
can really help the dizziness. I have a link to them, but not with me now.


JanLiz:  Thank you


Dearest:   Is it possible to describe the eye exercises that are effective for 
dizziness? 


Dr. Stuart Shipko:  They involve moving your eyes from one location to another seems to 
be helpful. 


Dearest:  Thank you, Doctor. Patty, go ahead, please :)


patty:  Do you have any residents working at your clinic? Do you know of any medical 
schools who are taking your approach to PNE? This just has to catch on...GA


Dearest:   For those who don't know, Patty, can you please tell us what PNE is. Thanks.


patty:  Polyneural ectopy - Dr. Shipko's description



Dr. Stuart Shipko:  My use of medications is being followed by an increasing number of 
doctors who have been educated by their patients. I don't train people ... yet. I'm 
still learning a lot. 


patty:   I know I'm educating mine with your great FAQs!


Dearest:   Thanks, Dr. Shipko. Lori, go ahead, please.


Lori:  Is there a med similar to Nortriptyline? It really helped take the edge off for 
me. My doc took me off due to weight gain. The SSRI's make me very anxious or drugged. 
I don't really want to take them anyway.  I used 35 mg of Nortrip to sleep and noticed 
less anxiety. Thank you.


Dr. Stuart Shipko:  Yes, Nortryptaline is a tricyclic antidepressant. Imipramine, 
doxepin, amytryptaline are all similar. Unfortunately, all antidepressants cause 
weight gain. 


Lori:   Any suggestions to take the edge off of anxiety?


Dearest:   Thank you, Dr. Shipko. Sheila, go ahead, please.


sheila:   Which antidepressants are safer than the SSRI's?


Dr. Stuart Shipko:  I consider the tricyclics to be safer and more proven over the long 
term.


Dearest:   Can you please give us some examples of tricyclics,  by name? 


Dr. Stuart Shipko:   Nortyptaline, imipramine, doxepin.


Dearest:   Thank you! Barbie, go ahead with your question for our guest, please :)


Barbie:   I had a hysterectomy 3 mo.s ago about 2 weeks thereafter I began to get 
depressed and severe anxiety. I couldn't get out of bed just cried all day is this 
common to surgical menopause do I seek hormone therapy or continue with xanax and 
celexa?


Dr. Stuart Shipko:   After a hysterectomy rapid hormonal changes can cause anxiety and 
other problems. I feel that this is the best indication for hormonal replacement. 


Barbie:   Thank you I thought I was going nuts.


Dearest:   Patricia, your turn :)


Patricia:   What do you recommend to ease the symptoms of "gloom and doom", Sometimes I 
am overwhelmed by these feelings. Also, I can feel my heart beating in my chest all 
the time. I take 20 mg Celexa in a.m. and 50 mg Trazadone in p.m. 


Dr. Stuart Shipko:   Patricia, you might try increasing your Celexa to 30 or 40 mg.


Patricia:   I'm a little hesitant to up the dose, but I will talk to my doctor about it. 


Dearest:   Celexa seems to be the drug du jour. Why is it being recommended so much 
these days? 


Dr. Stuart Shipko:   Marketing. 


Dearest: Figures.


Sarah:   I have really strong angry emotions toward my husband, .mostly about this fear 
of going outside the home and socializing. I, myself, call this anger jealousy that 
he has a life and I don't. Is this part of the change of life?  I am taking Xanax 0.25 mgs 
twice daily and one amitriptyline25 mg. Am I taking enough?


Dr. Stuart Shipko:   You need to work on this behaviorally but your medication dosages 
are on the very low side.


Dearest:   Dr. Shipko, emotionally, though, is it uncommon for a woman to resent her 
husband because she's going through a difficult menopause and he's not?


Dr. Stuart Shipko:   No, it is not terribly uncommon. They feel very misunderstood, and 
that leads to the anger. 


Dearest:   And often they don't communicate what they're each feeling throur the 
transition. There should be a course for couples at midlife. Rocky, go ahead, please.


Rocky:  I am 33 and like Barbie had a hysterectomy and am experiencing more anxiety 
and depression. (Previously DX w/OCD (obsessive-compulsive disorder) and on Wellbutrin 
and Klonapin). Now the doctor placed me on Cenestin. Any suggestions?I feel A LOT like 
Barbie described!


Dr. Stuart Shipko:  I don't know what Cenestin is. 


Dearest:  It's a conjugated estrogen (like Premarin) to treat perimenopausal symptoms.


Dr. Stuart Shipko:   Thanks. In using hormonal therapies for the emotions, it is 
important to look at whole patterns of hormones. Salivary testing for estrogens, 
testosterone, progesterones should all be done and the hormonal replacement needs to 
be individualized with a little bit of trial and error.


Dearest:  Also, if I may insert something, Rocky, you may want to ask your doctor for 
something other than Cenestin. Conjugated estrogens such as Premarin, Prempro and 
Premphase have all sorts of side effects - a little known side effect like elevated 
triglycerides, which are a strong contributing factor to heart disease. There are excellent 
options to those forms of HRT, such as naturally compounded "bio-identical" hormones. If 
you email me, I can give you some options to take to your doctor.  Cathy, go ahead, please.


Cathy:  What are the real dangers of the SSRI's? Do you ever prescribe them? 


Dr. Stuart Shipko:  The real dangers are in Glenmullen's "Prozac Backlash" and are too 
numerous to list here.



Linkaloo:   Dr. Shipko, what is your opinion on micronized progesterone cream as far as 
helping with anxiety during the perimenopause? My estrogen levels were fine, and using 
the cream at night seems to help with my sleep. Tricyclics were horrid for me, 
Norpramine made my heart skip and race! 


Dr. Stuart Shipko:   Link: it works with some but not with others. The absorption is 
better with the micronized, so you might want to check saliva progesterone levels. 


Linkaloo:  Thanks, I'll do that! 


Callie:  With my doc's help, I'm gradually taking myself off an SSRI now. What else can 
I take (as needed) if I'm under serious stress at times? (Something that won't mess 
with my seritonin or dopamine levels.) It doesn't necessarily need to be a 
prescription drug, just something fairly safe that, in your experience, has worked for 
others like me. (If there is such a thing.) I know not everything works for everyone. 


Dr. Stuart Shipko:   It is such a complex question.


Dearest:   Which SSRI, Callie?


Callie:   Zoloft. 


Dr. Stuart Shipko:  Callie, when you try to stop you will have symptoms.


Callie:   Sorry to be complex, but I'm serious.


Dr. Stuart Shipko:   The SSRI's are great at keeping a person from feeling stress. If 
that is what you want, then you are on the most potent medication. When you try to 
stop you may feel so bad that you want to start again. They stop working after they 
have fried your serotonin tracts.


Callie:  Yes, I am having withdrawal symptoms, but not too bad. I'm afraid of what the 
SSRIs can do to me longterm.


Dr. Stuart Shipko:   I would try to taper slowly and work with your stress the old 
fashioned way. Therapy, exercise, diet... fun.


Callie:   So maybe I've loused myself up permanently by taking Zoloft?


Dr. Stuart Shipko:  Callie: probably not, but maybe. Nobody knows these things for 
sure.


Dearest: Sarah, go ahead, please.


Sarah:   I love my husband, but don;t like this angry feelings because of Him having a 
life outside the home ....will these feelings go away as I get to understand myself 
and the power surges i have?


Dr. Stuart Shipko:   Sarah, I really don't know. You should make sure you have a life of 
your own. Your anger may have many contributing factors, or could be a form of 
agoraphobia where you don't like being left alone.


Dearest:   Anger is a much complained about emotion during perimenopause when our 
hormones are out of whack, Sarah.

Sarah, write to me at Dearest@aol.com and I'll send you some info about menopause and 
anger. Lane, go ahead, please. Also, you might want to visit our  Relationship Experts  page.


Sarah: Thanks Dearest


Dearest: Sure thing, Sarah.


Lane:  What is the best drug for panic disorder now?


Dr. Stuart Shipko:  Xanax, (alprazolam) is the best at stopping attacks.


Lori:   What medication can be used to treat OCD that is not an SSRI? Thanks


Dr. Stuart Shipko:   Anafranil, but it is a tricyclic with a lot of side effects. I 
think the experts are now in agreement that chemical treatment of OCD has not been as 
successful as first thought. 


Linkaloo:   I've been on Zoloft for years, was having anxiety attacks after the 
holidays, my psych doc wanted to change my meds to Effexor ER...said it was better for 
anxiety disorders. What is the difference between the two drugs? How does 
norepinephrine affect the heart? 


Dr. Stuart Shipko:   Link: if the Zoloft is working, I wouldn't risk the discontinuation 
symptoms to start Effexor. The norepinephrine reuptake of Effexor doesn't affect the 
heart. 


Linkaloo:  That's what I thought...thanks again!


Dearest:   Patricia, go ahead and keep it brief, please :)


Patricia:   How long does it take to fry the seritonin tracts with the SSRI's? 
(approximately)


Dearest:   Can you explain what you mean by "fry the seratonin tracts?"


Dr. Stuart Shipko:   Totally different with different people. In animal studies, I think 
she means, to cause major anatomic changes in the nerves, a therapeutic dose over a 
few months is more than enough to cause morphologic twisting and destruction of 
neurons.


Patricia:   Yikes! I will be going off Celexa ASAP! Thank you.


Dearest:   Thanks, Dr. S. Barbie, go ahead -- keep it brief, please.


Barbie:   Is this sort of" freak out" common for surgical menopause? I'm only 38. Will I 
have to deal with this the rest of my life? I've gone so far as wanting a divorce, too 
run. but I think it's my hormones. Is this common?


Dr. Stuart Shipko: Yes. Hysterectomy really requires a good hormone analysis and 
replacement.



Trisha: How long can you be on Xanax?


Dearest: Remember to visit the Power Surge message boards at 
http://www.power-surge.com/cgi-bin/mb.cgi where women are talking 
about all these issues during menopause.


Dr. Stuart Shipko:  Twenty year studies are the longest I have seen, and it looks just 
dandy. No cancer, no tolerance very few problems with sedation or memory but 
dependency is very common. 


Dearest:   Dr. Shipko, thank you for another stimulating and informative chat. Be sure 
to visit the Panic Disorder Institute at http://www.algy.com/pdi. 


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