(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 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. by Power Surge. All Rights Reserved.