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 8th 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, Dr. Shipko is in private practice in Pasadena, California. His specialty is in the area of panic disorder and stress- related medical conditions, stress and trauma-related disorders and also covers psychiatric injury, psychosomatic medicine, general psychiatry. Dr. Shipko also completed a series of studies on stress-related gastroenterologic problems. He found a wide variety of stress-related medical problems such as vertigo, non-cardiac chest pain, fatigue syndromes and myofascitis and is published in the area of psychosomatic medicine. An outspoken expert in the area of psychopharmacology, Dr. Shipko will answer your questions about anxiety, panic attacks / disorder, hormonal connections and the pros and cons of anti-depressants/SSRI's and anti-anxiety medications, such as Paxil, Zoloft, Prozac, Celexa, Xanax, Serzone, et al. It's always wonderful to welcome you back in Power Surge, Dr. Shipko :) Dr. Stuart Shipko: Hi, great to be back. I'm not sure I can live up to your intro. Dearest: Well, you always have in the past. I don't see what's changed :) Dr. Stuart Shipko: I'm getting better with age. Dearest: You sure are :) I'd like to ask the first question - a simple one, but on many people's minds. It's a known fact that people using some SSRI's gain weight. What causes this? Dr. Stuart Shipko: This is a common question. Interestingly enough, when Prozac first came out they touted it as a weight loss agent. The SSRIs will initially kill your appetite and you lose weight at first, but it tends to somehow slow metabolism and even if you eat the same amount you start to gain weight. Often as much as 20 pounds a year. Some people gain 40 pounds the first year. Dearest: A friend of mine used Paxil and gained weight. The moment she went off the Paxil, she took off ten pounds. Is it common to lose the weight gained after stopping? Dr. Stuart Shipko: Your friend was lucky. It is about 50/50 in my practice. Some people lose all the weight right away. Others struggle with heavy diet and exercise and get nowhere for a long time. I think that it has something to do with how long you have taken it. Moozie: I have very bad anxiety and I'm wondering if vertigo is a common feeling you have with anxiety. Dr. Stuart Shipko: One of the most common symptoms. Of course, if you have primary vertigo this is extremely anxiety provoking. Moozie: Can you tell me Lexapro has less side effects than other SSRI's? Dr. Stuart Shipko: Lexapro is the single most highly and successfully marketed SSRI since Prozac. Lexapro's active ingredient is exactly the same as Celexa. To get the patent, they had to say that somehow Lexapro was better than Celexa. So now they try to insinuate that it has fewer side effects but actually they try to say that it has a better profile than Celexa in treatment. Otherwise they risk what happened to Prozac. If they admit that Lexapro has fewer side effects, then they need to admit that Celexa HAS side effects. No, Lexapro is no better. Happy: I have had horrible anxiety and depression some times I feel like my spirit isn't even in my body. My family is about to move I need the floor under my feet. By the time I'm at the point where I have all the info about saliva test and creams that are right for me I don't feel like I have that time. If I go ahead with anti- depressant will this screw up my hormone balance. Dr. Stuart Shipko: The antidepressant will not "screw up" your hormones and may actually make you feel better. But what are the long term effects going to be? If you have a severe withdrawal, is that going to be worse than what you initially treated? And perhaps you need to deal with your family situation as a primary issue. Dearest: Is there a prevalence of psychosomatic disorders in people who have anxiety disorders? Dr. Stuart Shipko: Yes. To the max. Dearest: Short and sweet. Thanks :) Kataneena: Do you think people prone to panic attacks and depression have true chemical imbalances in their brain, and if yes, is one doomed to this condition for life, or can it be controlled without medication? Dr. Stuart Shipko: The chemical imbalance thing is pure marketing mythology. No science behind this at all. It is only the drug company that tells you that you are doomed to life with panic attacks and depression. Did you know that the original formulations of depression as a disease indicate that it is usually self limited? Twinkle: Hello Dr Stuart Are there any long term effects from taking Paxil and what does SSRI stand for? Dr. Stuart Shipko: SSRI stands for selective serotonin reuptake inhibitor, although they are not selective (about a dozen or more types of serotonin receptors) and they also effect other neurotransmitters. Long term effects. It seems pretty clear that the long term effects are negative. Fava, in the J. clin Psych Feb 2003 notes that antidepressants (SSRIs) seem to worsen the course of depression long term. It seems to induce anxiety, depression, mania and resistance of treatment to ongoing (probably drug induced) depression. Dearest: Other than psychological and/or physical addiction we all know can occur with the use of BZD's (benzodiazepams), such as Xanax, are you aware of any long-term potential physical effects from the use of these medications? Dr. Stuart Shipko: Some say that the withdrawal from Xanax is the worst withdrawal. I say that the withdrawal from the SSRIs is the worst. Lasting upwards of a year or two. Dearest: I wasn't talking so much about the stopping of Xanax, but any possible long-term effects from using BZD's like Xanax. Dr. Stuart Shipko: Long term effects of the BDZs are minimal. They can become less effective over time but otherwise they have little in the way of adverse effects. Acapme: Doctor, I am pregnant and taking Xanax. Some days I don't take it at all, but some days I take 6 mg a day. Should I be concerned that this high dose is hurting my baby? I take 6-7 mg at least one day a week when it gets stressful at work. Other days I may take 1-2 or none at all. How is this affecting my unborn child? What have you seen in your practice? Have you seen women on high dosages have healthy babies? Dr. Stuart Shipko: Generally, Xanax does not affect the unborn fetus. Some studies show cleft palate but it appears no different from the nonXanax population. However, the use of Xanax the way you describe is probably not appropriate. Too much fluctuation. 6 mg is excessive and suggests that you are trying to blot out your feelings. Xanax should be taken on a regular schedule. If taken as needed, often the patient can't tell when it is needed. At 6 mg your baby can be born sedated. Also, for people with panic disorder it seems that stopping Xanax during pregnancy is fairly easy. You need closer supervision, I think. Dearest: Thanks, Dr. S. Acapme, I would certainly discuss this further with your doctor. Lori19937: If Prozac affects the metabolism, could it have contributed to my hypothyroidism? Dr. Stuart Shipko: That is a good question. It has not been studied, but this is a good area for further study. Certainly anything that affects metabolism may have a profound effect on thyroid. Dearest: Dr. S., is it common for people suffering from anxiety disorders, including social anxiety disorder and/or agoraphobia to simultaneously suffer from depression? Dr. Stuart Shipko: Yes, very common, although the so called depression can be unhappiness from the anxiety. TisJill: My doctor has recommended that I take antidepressants, but as I am only depressed, but very depressed for a few days each month, I don't feel I want to take them all the time, is there an alternative , as most antidepressants take weeks to show benefits. Dr. Stuart Shipko: Jill, I love your question. Certainly the antidepressants help with cycle related depression, but over the long run tolerance, dependency and adverse reactions seem to outweigh the benefits of the initial treatment. Jan5745: I have a comment about Lexapro. I had a terrible reaction to it 2 weeks ago for PTSD (Post Traumatic Stress Disorder), and although I have heard that side effects affect a small percentage of people, and I was one of those unfortunate ones. At this point I have to say that I an hesitant to try another anti depressant now. What other anti depressant(s) would you recommend for PTSD, (due to the death of my husband) or would you recommend trying the more natural route? Dr. Stuart Shipko: Jan, typically the doctors will try multiple SSRIs which will have the same side effects. For PTSD, I recommend a tricyclic antidepressant at a low dosage such as Elavil 10 mg or Pamelor 25 mg which will suppress the nightmares of REM sleep. Sophie: I am weaning myself off Celexa, 2 years for perimenopause, should I use the supplements you recommend while I am weaning, or wait till I am completely off? My gynecologist prescribed them for depression and mood swings and she is ok with me going off. I want my sex drive back. I was on Paxil for a year before this, and the withdrawal was awful! Dr. Stuart Shipko: The key issue on withdrawal is not supplements, so much as stopping slowly. I have found that tryptophan can help with the withdrawal, but it is still secondary to going very slowly. Dearest: I don't know if this is your area, but do you know if taking certain beta blockers, such as atenolol (Tenormin) cause anxiety and/or internal tremors? Dr. Stuart Shipko: Gosh, I feel that Tenormin is a good treatment for anxiety, particularly palpitations and tremor. Linka: When weaning off Effexor XR is there any advantage to using a longer acting benzo like Klonopin rather than Xanax? I feel Effexor is totally masking my emotions and I'm very forgetful. Been taking 0.5 Xanax for over a year at night. Dr. Stuart Shipko: No, no advantage to Klonpin as opposed to Xanax. Most physicians don't realize that the half life of Klonopin is not much longer than Xanax. Dearest: Isn't Klonopin also much stronger than Xanax? Dr. Stuart Shipko: They are about the same. Darlene: Dr. S, I'm having cold sweats, is this linked to panic or anxiety attacks? Dr. Stuart Shipko: Either. Darlene: What do you recommend? Dr. Stuart Shipko: Diagnosis is key to treatment. Kataneena: I am happy to hear that the chemical imbalance thing is a myth, but why does it seem that panic and depression "runs in families?" Dr. Stuart Shipko: The tendency towards panic and depression runs in families. This seems to be a lack of resilience to stress, but not a deficiency of a brain chemical. Happy: How long would you recommend I stay on an anti-depressant once I start one. Time aside, how do I know when my hormones have come into balance. Hormones balanced, can I then assume it's ok to go off the anti-depressant. Do all anti-depressants have withdrawal symptoms? Dr. Stuart Shipko: All antidepressants have withdrawal. I prefer to use an antidepressant for a period of six months or less, assuming that they are effective. Lori19937: Why do I still have "down" days even though I take 20 mg. of Prozac per day? Dr. Stuart Shipko: It depends on what a down day means. Lori19937: Not wanting to get out of bed. Dr. Stuart Shipko: This is not a simple concept. It is obvious that Prozac is not helping you. MaryBeth: Hello and thank you for being here. I been having severe panic attacks in traffic at stop lights and intersections for about 6 months. I'm 42, hit perimenopause 1 year ago. Dr insists I take Paxil unsupervised and with no support. "You need to understand that these drugs will not hurt you, and in her experience has 90% tolerance with no side effects" she says. Are there herbal or safer alternatives that do not require a ramp up or ramp down type commitment such as SSRI's and are not addictive like the Xanax type drugs? I rarely panic other than in traffic. Dr. Stuart Shipko: Stop. Unsupervised and no support? New doctor, end of Question. SuperGrammieJean: Can you comment on non cardiac chest pain? Dr. Stuart Shipko: So complex. Besides non-coronary blockage chest pain, there is the issue of microvasculature (syndrome X) chest pain. That aside, I see a lot of gastroesophageal reflux causing chest pain in people with panic disorder. Sophie: How many mgs. of tryptophan do you recommend during weaning? Can my doctor prescribe it? Dr. Stuart Shipko: I find that 1000 mg twice daily on an empty stomach with a little bit of carbohydrate to be best. It can be taken "as needed". It needs to be prescribed, and filled by a compounding pharmacy. Dearest: Are you talking about prescription tryptophan? Oh, ok. Dr. Stuart Shipko: Dearest, it is only prescription in the US. Dearest: You can get an RX for tryptophan from Pete Heuseman, our resident pharmacist. E.mail Pete for more information. Linka: I know PVC's are common with panic/anxiety disorders, but mine seem to trigger my anxiety. Although they aren't constant, I do get them on a daily basis, maybe a few flutters a day. I've had them for over 18 years yet I haven't been able to learn to live with them! Beta-blockers exhaust me. Dr. Stuart Shipko: PVCs can trigger anxiety and anxiety can trigger PVCs. Dearest: One quick last question: Is there a correlation between anxiety and/or panic issues and skin conditions like psoriasis, eczema, et al? Dr. Stuart Shipko: Yes. Remember that the skin and the nervous system derive from the same embryonic tissue. I frequently see eczema and other skin irritations in anxiety, but psoriasis is not in the same category. Dearest: You are ALWAYS such a wonderful guest! Dr. Shipko, thanks, once again, for another open, honest and very informative discussion about anxiety, panic and the various medications prescribed for stress-related disorders. Dr. Shipko's Web site, PDI, The Panic Disorder Institute, can be found on the Web at: http://www.algy.com/pdi/ Dr. Stuart Shipko: I love the applause. You are welcome. Read Dr. Stuart Shipko's first transcript 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 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.