(Dr. Shipko's 11th 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, once again, it's my pleasure to welcome you back to Power Surge :) Dr. Stuart Shipko: Hello and thank you. Dearest: Thank you for being here. Dr. Stuart Shipko: Its great being on everyone's screen. Dearest: I'm going to start out with something we started discussing FOUR years ago. Dr. Stuart Shipko: What is that? Dearest: Dr. S., four years ago, I asked you about the long-term effects of SSRI's. You replied that "none have been formally studied for more than three months... people are using them for years at a time and the long term side effects just haven't been disclosed yet. I then asked, "If Prozac has been out, what.. over 20 years?.. why hasn't it been studied for more than 3 months?" and you replied, " it has not been required by the FDA. Also, it may have already been studied, but the drug company has the right to withhold information if they so choose." Have we learned anything more in the past four years -- now that SSRI's are being used by millions of people -- TV commercials running rampant on the benefits of SSRI's and many doctors prescribing them for menopausal symptoms? Dr. Stuart Shipko: Now drug studies have come out that look at these drugs for up to 2 years. However, they still don't look at issues of side effects, dependency or suicide over that time period. So the answer is efficacy (if you can call it that) has been studied but not longer term side effects. Dearest: But when you said... " it has not been required by the FDA. Also, it may have already been studied, but the drug company has the right to withhold information if they so choose." What gives the pharmaceutical companies the right to withhold this information from the public? Look what just happened with Vioxx. Dr. Stuart Shipko: That is absolutely correct. It is the FDA giving this right, but now some companies are offering to voluntarily disclose all studies performed. Do I believe that they will even if it might hurt sales? No. Dearest: Unbelievable Dr. Stuart Shipko: In a sense, it doesn't really matter anymore. The hearts and minds of the people have been won over by mass marketing and lack of independent observation by physicians. The information is out there for people to read, all over the Internet, but I think that the majority of people want to believe that the drug companies are nice people who want to help humanity and make a buck if possible. Let's talk about suicide for a bit. The FDA has issued a major warning about the antidepressants causing suicide in kids. But has anyone asked whether this is also happening in adults? Why isn't that a focus of any discussion? The only reason that the FDA made this warning was that the information had already been leaked and they had no choice. Dearest: Thanks for the information, Dr. S. I wonder if you'd discuss what part "fear" plays in anxiety and panic attacks? Basically, isn't fear the catalyst upon which anxiety and panic thrive? Dr. Stuart Shipko: Well, yes. Fear is considered to be healthy concern and anxiety is excessive fear. But when you look at the core of excessive fear, it is anticipation. Anticipation of the negative. A little is healthy, a lot is a problem. Fear is anxiety. Dearest: Are there any simple suggestions to combat irrational and excessive fear? Dr. Stuart Shipko: The simple and obvious suggestion is to cultivate courage. Dearest: Please elaborate - we all know what courage means, but in this context? Dr. Stuart Shipko: It means that you have to do the things that you fear to do, and even do the things that you hate to do. This is probably the basis of most exposure and cognitive therapies. JolieJacq: Thoughts about 5-HTP? What is it? Local naturopaths are recommending it for depression. Thank you. Dr. Stuart Shipko: 5-HTP can cause serotonin to be synthesized, but primarily it will be in the periphery -- not the CNS. If you want to increase brain serotonin, then l- tryptophan is much better. As an aside, there is no such thing as a chemical imbalance. Raising serotonin through supplements is not at all analogous with what antidepressants may do. Dearest: L-tryptophan can be obtained with a prescription today, yes? Dr. Stuart Shipko: Yes it is available. It was a regular supplement until a bad batch came in and then they banned the whole supplement from OTC. Dearest: Wasn't that about 20 years ago? Dr. Stuart Shipko: Was it that long ago? I used to prescribe L-tryptophan for insomnia in drug addicts regularly. I still prescribe it for sleep and SSRI withdrawal -- but studies have not shown that it does a thing for depression or anxiety. InfoBabe: I quit Prozac after 10 years because I was feeling better. My symptoms returned and I tried 5htp, SJW (St. Johns Wort), bad headaches on Lexapro, headaches, now Prozac doesn't seem to help. What's good? Tried SAM-e also, but my doctor said not to use with Imitrex. What now? I was off Lexapro for 9 weeks. Dr. Stuart Shipko: After 10 years you will certainly have some withdrawal. You might test to see if it is withdrawal by taking a dose (with your doctor's knowledge, of course). TrishE: I was on Paxil for 3 years, killed my sex life, off of it for 5 years to present, no other SSRI's, my sex drive has not returned, is it gone for good? Dr. Stuart Shipko: I have seen numerous patients, male and female who have had sexual dysfunction on SSRIs that has not returned after stopping them. Of course it is not good. Sometimes it does take many years to normalize but I have seen other patients where it just isn't coming back. It doesn't signify that you are otherwise damaged, but of course it is not good. NorthCarolinaHappy: I had a hysterectomy 2 years ago in December. I have all the menopause stuff. I feel like I'm going insane not taking any medications. My family and I are going crazy dealing with me. What can I do? Dr. Stuart Shipko: This is really common even in women who still have ovaries. I don't have an explanation for it, but I have consistently seen panic/menopause post hysterectomy. If it is really severe, the SSRI drugs do work for this, although you should make sure to know the risks and benefits before you start. Otherwise, an occasional Valium type drug. As for soy, I don't know. That is Dearest's area. Stell0324: Dr. Shipko, I have Fibromyalgia and my Dr. is thinking of putting me on the new AD drug Cymbalta to help with the pain. Have you had any experience with this drug for chronic pain? Dr. Stuart Shipko: Cymbalta is the new Effexor. I am totally cynical. Fibromyalgia, like psychiatric disorders has no underlying pathophysiology. It is ripe for the drug companies to exploit. Cymbalta is nothing new. We have no real science to review so as to assess it. And I imagine that doctors will be prescribing it frequently for anyone with pain (and frankly, I think that pain is a part of aging joints and muscles. IMHO) Dearest: What family of drugs is Cymbalta part of? Dr. Stuart Shipko: It is considered a SNRI (serotonin, norepinephrine reuptake inhibitor) like Effexor, but this class of drug is pretty much the same as the Prozac like antidepressants. JolieJacq: Your thoughts on how to handle severe depression. Can anything other than anti-depressants help? I was unable to get out of bed in April, and have been on Lexapro since, still having minor dips on occasion. Anything natural I can add to aid further improvement? Thank you. Dr. Stuart Shipko: Once you are on a drug like Lexapro, there is not a real point in trying to go natural as an adjunctive treatment. Dearest: Aren't Lexapro and Celexa basically the same? Dr. Stuart Shipko: Exactly the same. Dearest: ok ItsMeColeen: Dr. Shipko, I'm not on any medications. I sleep only 4 hours a night and have night fears that I'm dieing of cancer. And dwell on it for hours I feel Like I'm losing my mind! When morning comes I'm back to normal but, very tired! Any suggestions? Dr. Stuart Shipko: Talk to your doctor about taking a bit of Xanax (.25 to .5 mg) before sleep, but not more frequently than twice a week to avoid addiction. Dearest: Dr. S., bottom line -- aren't most of these medications addictive? Not just Xanax, which has gotten so much press about being addictive, but the SSRI's, too? Dr. Stuart Shipko: All drugs that affect the central nervous system are addictive. There are a lot of arguments about how to define addictive, but I say that it is addictive if you want to stop but find it difficult or impossible. The SSRIs are equally as addictive as the drugs like Xanax. Citrine-1: Since TrishE asked about her sex drive, maybe her hormones need to be checked, particularly her progesterone. Since I have been supplementing with transdermal progesterone, my sex drive has returned! Dr. Stuart Shipko: Cit: Is your sex drive low from the SSRI's? Citrine-1: NO! It's Great! Gia_Johnson: I was on a SSRI (Paxil and Celexa) for 5 years, quit 7 months ago. Now I'm using flax and fish oil. There's definitely a difference in my mood. :) No Xanax in 3 weeks. What do you think about flax and fish oil for anxiety? Dr. Stuart Shipko: I think that the omega's have a definite place in the treatment of all sorts of emotional problems. If it works for you, don't ask too many questions. Dearest: There are some wonderful articles on Flax and omega oils on the Web site. Do a search. Flax, alone, has so many benefits. 123ginny: I get anxious, panicky, very nervous before I start my period a week before and I am 50, is Xanax good for this, I only take it at that time. Dr. Stuart Shipko: And the omegas are good for the heart. If it works for you, great. The problem with Xanax is addiction. 123ginny: I very comfortable taking it but what can I do to increase my sex life if you are only taking it occasionally, it will not be a problem. Is Xanax a problem with your sex life? 123ginny: It's not a problem, just a low sex drive. Dr. Stuart Shipko: Sex is a wonderful and complicated issue. Dearest: (sigh) Dr. Stuart Shipko: I guess I should stop here. :) 123ginny: I know, I have a wonderful sex life, my sex drive is low. Dr. Stuart Shipko: How do you have a wonderful sex life and complain of low sex drive? Dearest: No, you can go ahead with the wonderful and complicated issue. Dr. Stuart Shipko: Yes, lets talk about sex. Sex is the great, secret treatment for anxiety. Dearest: Yes, let's. :) Dr. Stuart Shipko: One of the biggest problems for patients put on SSRIs for anxiety is that it wipes out their natural anxiolytic, sex. I have seen people who are terribly anxious and who can hardly function, but are sexually quite functional -- and when they are given a SSRI, it ends their marriage. As sex was the really strong bond between the partners that made all of the other problems, like inability to work, tolerable Dearest: I'm not a lover (no pun intended) of statistics, but I'd venture a guess that approximately 7 out of 10 drugs affect the sex drive. Your thoughts? Dr. Stuart Shipko: Well when you talk about psychiatric drugs, yes that is probably correct. Debrikkia: What would you suggest for those of us who have suffered from anxiety/panic attacks for years, but do not wish to take medications? Is there a way to manage? Dr. Stuart Shipko: I increasingly feel that drugs are not the answer. Learning to manage is really highly individual, but it gets back to that cultivation of courage. It is not always obvious how to do this. Dearest: And what about therapy? CBT? Et al? Dr. Stuart Shipko: CBT is a good tool for many people. It is really boring to do as a therapist. Basically it involves looking at how you might be misperceiving things. I hate neurolinguistic programming, which works for a short time. I do not believe in EMDR, I find nothing scientific to support that cranial sacral therapy is anything useful. While we are at it, analysis doesn't seem to work either. Good old fashioned doctoring involves a lot of common sense. Identifying what it is that really is bothering you is the real goal of therapy. Dearest: What is EMDR? Dr. Stuart Shipko: 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 eighth transcript Read Dr. Stuart Shipko's ninth transcript Read Dr. Stuart Shipko's tenth 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- by Power Surge. All Rights Reserved.