(Dr. Stuart Shipko's 3rd 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. Dr. Shipko
is also ccompanied by his co-author of their upcoming book about Panic Disorder 
and the Director of Education at his Panic Disorder Institute. 

Welcome back, Dr. Shipko and welcome, Lori. Dr. S., could you kindly explain 
exactly what SSRI's are and how serotonin works naturally in our bodies without 
SSRI's?

Dr. Stewart Shipko:   In answer to that, serotonin is mostly  not a brain hormone.  
Serotonin got its name from the powerful vasoconstrictive properties that it has.

It is an intermediary in neurotransmittor synthesis and nobody really knows what it 
is doing, except that it is a neurotransmittor in many different locations.


Dearest:    What does Selective Seratonin Reuptake Inhibitor mean?


Dr. Stuart Shipko:   At the synapse, serotonin is one of the neurotransmittors 
released. All neurotransmittors released are conserved by a mechanism called 
"reuptake" -- that is it is taken back into the synapse it came from.  However, 
if you block reuptake you increase the serotonin sitting in the synapse.


Dearest:    What are some of the natural ways we can use to increase our seratonin 
levels? 


Dr. Stuart Shipko:  There is not a reason to increase brain serotonin. Nobody 
knows how these drugs work.  It increases it in some places and decreases it 
in others.  The idea that we should eat serotonin foods has nothing to do with 
the SSRI's.  


Dearest:    Thanks, Dr. Shipko. KK, go ahead.


kk:   I have been taking elavil for several years and during the past 6 months 
I seem to be losing hair and new hair is not growing. Is this unusual and could 
it be a side effect of the medication?


Dr. Stuart Shipko:   Hair loss is a known side effect of the tricyclics and 
it should grow back when you discontinue. 


Dearest:    Is Elavil a tricylic?


Dr. Stuart Shipko:   Yes 


Newby:   Have been having lots of problems with weak, shaky legs in the last 
few weeks. Also lots of muscle discomfort (thighs mostly) Feels like my legs are 
going to lock up. This symptom is much worse than I recall it being in the past. 
Still anxiety based? 


Dr. Stuart Shipko:   Newby, I can't know the answer to your question.  


Lori:   This is a common problem with anxiety and PAD (panic anxiety).


Dearest:    Newby, could you explain what happens in a little more detail?


Newby:   Have had the "jelly leg" feeling in the past it just seems more 
pronounced this time.


Dearest:    Like your legs are going to collapse beneath you?


Newby:   Yes Dearest. But if I talk myself into relaxing it helps.


Dr. Stuart Shipko:   This happens in panic disorder, but is not the only cause.  
Even if you can talk yourself into relaxing out of it.  Diagnosis via chat is 
just speculation.


Newby:   Had my physical Monday and nothing else seemed to be wrong.


Dearest:    Dr. Shipko, Newby is an old friend of Power Surge's. It could be 
associated with her menopause, too.  Newby, I have had that feeling of weakness 
in my legs like I was going to lose all control.  It could be circulatory, too.


Dr. Stuart Shipko:   So we don't want to mislead Newby, although I would like 
to reassure Newby that it probably is not anything to worry about.


Newby:   Thank you all 


Dearest:    Power Surge comes with a disclaimer that this is only educational 
information and  is not intended as a substitute for a visit to one's personal 
physician.


Dearest:    Thanks, Dr. S. Annie, go ahead.


annie:   What foods can we eat to help anxiety & depression?


Dr. Stuart Shipko:   In anxiety, you want to keep the system stable.  People 
find different diets helpful.  In general, a diet that keeps insulin stable, 
one that is not carbohydrate based, more like the Zone diet is best.  

My website, http://www.algy.com/pdi has a whole FAQ on the subject. 


Dearest:    Patty, go ahead, please.


Patty   Every morning at 10:30 like clockwork I get a stomach ache.  I take 
Xanax and carafate when I wake up (around 7 A.M.)  I've tried an extra carafate 
at 10A.M. and I still get the stomach ache.  It lasts for about 1 to 1 1/2 hours.  
If I take .25mg Xanax it goes away.  Should I take a Xanax at this time or forget 
it.  It's not awful or anything.  Why do you suppose that happens?  By the way, 
can't wait for your book! 


Dr. Stuart Shipko:   Lori's book will probably be out first. Remember I can't 
diagnose but I would take the Xanax and forget about it.  Xanax is very soothing 
to the stomach.  If the problem persists, you should get an endoscopy.  


Patty   Ok - thanks and I love your website. Also I hope it educates the medical 
community.  I had an endoscopy.


Dearest:    Dr. Shipko, could you remark to everyone on your thoughts about using 
Xanax for life <as per our conversation>. Thank you.


Dr. Stuart Shipko:   Patty:  the website has educated a lot of educators. 
Well, Xanax is highly dependency forming. That is, once started it may be 
difficult to stop.  About 1/3 of people on Xanax will be long term users.  
However, the clinical efficacy of Xanax has been studied over a 20 year period, 
and it seems to work as well or better than when it was started, and has no long 
term effects that might be harmful as you age. It seems safe to take long term, 
but discontinuation is not possible in a percentage of users. 


Dearest:    But Xanax isn't necessarily prescribed for depression, correct? 


Dr. Stuart Shipko:   Xanax is not useful for depression as they thought 15 
years ago, but it has a much lower incidence of depressive side effects than 
does Klonopin, the other BDZ approved for panic disorder by the FDA. 


Dearest:    My last question... so knowing what you do about Prozac, Paxil, Zoloft 
and Effexor, what would you prescribe to someone with depression?


Dr. Stuart Shipko:   At this time, after reading Glenmullin's well written book 
on the cover-ups and conflict of interest at the FDA (Prozac Backlash), 

I feel that the SSRI's should not be used at all unless full disclosure of side 
effects: possible suicidality or aggression, weight gain, impotency (possibly 
permanent), vertigo, memory loss, akathisia, possible Parkinson's acute or chronic 
and the rest, need to be disclosed before a patient should be placed on this 
medication.


Dearest:    What is akathisia? 


Dr. Stuart Shipko:   Akathisia is a sense of intense restlessness that is not 
relieved by movement.  It is extremely uncomfortable.


Patty   I know a lot of research is going into panic disorder.  Do you see anything 
exciting or promising on the horizon?  Also why does the med community have such a 
tough time diagnosing it for most of us?  It seems gastroenterologists should at 
least consider it when we have GI problems and other various symptoms and anxiety 
but all our tests are normal. 


Dr. Stuart Shipko:   Patty, it is all bought off by big drug companies and you 
don't find useful information from them.  I see exciting work coming from Dr. 
Bradwejn's department in Canada,  where they are looking at cholecystokinin (CCK) 
which is probably the most important neurotransmittor in panic disorder. There are 
two types of CCK receptors CCK-a and CCK-B.  Selective CCK antagonists exist, but 
the US government with its huge drug lobby is supporting SSRI's beyond their 
medical utility and ignoring other agents, for now.


Dearest:    Callie, go ahead, please.


callie:   If serotonis has powerful vasoconstrictive properties, is that why, 
when on Zoloft, my heart seems to beat so hard?  I can feel my heart pounding 
a lot, even though the pulse is regular.  This feeling comes and goes.  Thanks.  


Dr. Stuart Shipko:   callie:  it sounds like untreated panic and you might want 
to ask your doctor for a beta blocker for that problem.  


Dearest:    Marmar, go ahead, please.


marmar:   what do you think of the doctor taking me off my meds for anxiety after 
a year?


Dr. Stuart Shipko:   Its between you and your doctor.  


marmar:   what if I still have anxiety attacks?


Dr. Stuart Shipko:   It seems like a poor idea, doesn't it?


marmar:   yes it does.


Dearest:    Were you taking the meds as prescribed?


marmar:   yes, but I still get anxiety attacks once in a while.


Dearest:    I don't know. Dr. Shipko is the expert. maybe see another doctor.
Jenelle, go ahead.


jennelle:   Dr. Shipko, I have been taking Effexor for persistent depression. It 
has proved quite helpful. What is your opinion, in general, about this medication? 
(I'm taking 37.5mg once a day.) Nothing else seems to work for me and I have no 
side effects. In fact, it has helped increase my memory in menopause, stamina and 
general outlook on life. And no weight gain as on Paxil.  Thanks. 


Dr. Stuart Shipko:   You really need a detailed history to prescribe meds. 
jenelle, if it works so well for you at that dose, don't argue with it.


jennelle:   I guess this med works for me then. Thanks


Dr. Stuart Shipko:   When you find you must increase the dose to achieve the 
same effect, you need to give it more thought.  


jennelle:   I agree.


Dearest:    I want to ask something I'm sure many other women have experienced. 
I never took drugs until I entered perimenopause and my hormones went out of 
whack. I never thought I would take anything, but I do use Xanax. Can you address 
menopause and hormones and the impact it has on our nervous system? 


Dr. Stuart Shipko:   Lori, please, can you help me here? 


Lori:   Dearest when you have a fluctuation of hormones anxiety will tend to be 
a problem.  There is a very definite link between the endocrine system and the 
nervous system.  My  suggestion, which is not always accepted, is to test the 
hormonal levels.


Dr. Stuart Shipko:   Through salivary testing, right?


Lori:   That is a preference for most, although blood tests are of value also.


Dr. Stuart Shipko:   Lori has done a lot of work in this area.  All you can do 
is to test when you are feeling good and test when you feel bad and look at the 
difference between the two.

Trying to make the profile when you feel bad look like the profile when you feel 
good is the  state of the art, but does not guarantee you health, right?


Lori:   Yes it is and it works.  No, but it gives you some answers to the question 
and then you can start to deal with the problems.  


Dr. Stuart Shipko:   Amen 


Dearest:    That doesn't quite answer my question. I've made those recommendations 
many times. I don't think it's very practical for women to be continuously tested 
for hormone levels. Further, once they're on hormone therapy, that introduces a 
whole new set of problems.

Newby, go ahead, please.



Newby:   My doctor suggested  I try Celexa for my Panic Disorder.. What do you 
know about this drug and its success in treating GAD? At this time I take 3.75 
mgs. of Tranxene PRN with reasonable relief, not comfortable with going on more 
meds.  Also self talk and relaxation techniques are usually very helpful. The 
addition of Menopause has been a kicker. 


Dr. Stuart Shipko:   Newby:  As I wrote above, no SSRI (includes Celexa) should 
be given without a full warning of side effects.  Menopause makes anxiety worse 
for a while.  You need to force your doctor to explain why they use what they use 
and possible long and short term side effects. and Dearest, I agree with you that 
hormone replacement is in its absolute infancy. 


Dearest:    I agree with you wholeheartedly, but Dr. Shipko, don't you believe that 
even after a doctor explains all the potential side effects, women will take them 
anyway because they're desperate for help? 


Newby:   I did ask her why Celexa was safer than other SSRI and she said it has 
better effect and less side effects.


Dr. Stuart Shipko:   Dearest:   ROFLOL -- no, when full disclosure is given most 
people are reluctant or aversive to taking the SSRI's.


Dearest:    Lynnie, go ahead.


Lynnie:   I was on Prozac and Zoloft and had major panic attacks. I, too, am 
menopausal.


Dr. Stuart Shipko:   And...


Lynnie:   I was placed on Serzone and its been a god send I feel normal again 
what's the meds action?


Dr. Stuart Shipko:   I have never heard anyone say that Serzone was a godsend, 
so I don't know what to answer you on that one.


Lynnie:   Really?  What's the medications supposed action then?


Dr. Stuart Shipko:   It does a number of things, but is supposed to work on 
seritonin. In my patients, it just seems to make them tired, but not better. 
With Serzone, you need to be extra cautious about drug interactions.


Lynnie:   really ?? well Doc I was nutty on the Prozac and Zoloft it seemed to 
increase my hot flashes and anxiety instead of decreasing it.


Dearest:    Thanks, Dr. Shipko. Annie, go ahead with your question.


annie:   What should a menopause woman who is nervous,  anxious, and cries 
take?  Also is it safe to drink chamomile tea at night if I take Xanax in 
morning? 


Dr. Stuart Shipko:   Yes, certainly you can take the chamomile tea at night.  
I avoid Xanax in anxiety secondary to menopause only due to the high incidence 
of dependency. 


Dearest:    Can you explain what you mean by ".. in anxiety secondary to 
menopause...?"


Dr. Stuart Shipko:   Sure.  If there has been no prior anxiety except that which 
is associated with menopause, then this is probably not panic disorder, and is 
best treated without drugs.


Dearest:    Menopause-related anxiety can be very uncomfortable. What would you 
recommend then for its treatment? 


Dr. Stuart Shipko:   I start with cohosh, I do use careful, short term Xanax if 
I have to. Most anxiety due primarily to menopause needs no treatment but you 
often find that anxiety was present before perimenopause started.


Dearest:    LucyinNJ, go ahead, please.


LucyinNJ:   DR Shipko you know that I suffered with a non stop panic attack for 
six weeks before I was diagnosed ..Do you think that from a neurological standpoint, 
a person under that much stress can suffer some form of brain damage..especially 
with the labile blood pressure problem and very high BP's ..My neurologist is very 
concerned about my increasing problems with short term memory loss and poor eye 
hand coordination that is not getting better with time. He is sending me for a 
scan. 


Dr. Stuart Shipko:   Hi Lucy!  Your case is very atypical. You do see neurologic 
impairment with severe panic disorder.


LucyinNJ:   Yes, I have been told that I am a researchers dream.


Dr. Stuart Shipko:   Nightmare :)


LucyinNJ:   Yes, you got that right:)


Dr. Stuart Shipko:   You do need careful medical workup -- may I tell a bit of 
your history?


LucyinNJ:   Oh, but of course


Dr. Stuart Shipko:   Lucy had the onset of severe symptoms following a hysterectomy 
so she is analogous to menopause, but not quite the same, since it was artificially 
created.


Dearest:    Hope things improve for you, Lucy.  Newby, go ahead, please.


Newby:   Dr. Shipko, do you feel that long term Panic Disorder can be controlled 
through Cognitive Behavioral techniques and relaxation therapies (reflexology, 
massage etc.) and exercise in the absence of medication? 


Dr. Stuart Shipko:   Yes 


LucyinNJ:   Thank you so much.


Newby:   Thank You Dr. as I do as well but doctors seem to want to do it with 
meds only. Thank you for your support.


Dearest:    Yes, Newby, that's what I wanted to comment on. Dr. Shipko, isn't 
the whole drug thing overkill already? 


Dr. Stuart Shipko:   The medication thing is due partly to marketing and partly 
to people who don't want to do the hard work to adjust lifestyle and relationships 
and anything that affects stability -- diet, religion, family.


Newby:   The "BIG BUCKS" thing.


Dearest:    I'm sick of seeing political advertisements and even sicker of seeing 
DRUG ads on TV :(


MaryO:   Those drug ads are everywhere. "Ask your doctor is Med X is right for you"
:(


Dearest:    Very true, Mary.


Dr. Stuart Shipko:   Nothing gets a patient out of your office faster than a 
prescription.  


Newby:   It is a difficult journey but so much more rewarding. 


Dearest:    Yes, it's called avarice and greed.


Dr. Stuart Shipko:   There is so much more to this problem than medications, but 
the doctors don't find it easy or cost effective.  Not just greed.  It is really 
time consuming and difficult to treat this in a holistic sense -- mind, body and 
spirit  -- of which meds are a small part.


Newby:   It would appear that at least for myself medications simply bandaid a 
festering wound.


Lynnie:   amen


Dearest:    Newby, that's true for many of us, too. You're not alone.


Dr. Stuart Shipko:   Lori and I are most interested in how to raise children who 
have this condition and we feel that if it is done right problems can be avoided.


Dearest:    Dr.Shipko, there have to be more doctors who feel as you do. Why don't 
they speak out?  If something is wrong with the medical profession, why don't those 
in it who see if try to fix it?


Dr. Stuart Shipko:   Dearest:  chance favors the prepared mind.  I don't meet with 
drug reps.  When repeatedly educated by the drug companies and academics paid by 
the drug companies,  most doctors have a reverse prepared mind.  When I speak to 
physicians, the information I impart is generally well received -- but I can't 
compete with the $$$ incentives the drug companies hand out.  


Newby:   I have a Holistic Wellness Center and listening to you tonight Dr. Shipko 
was the inspiration I needed to believe in my own choices. Thank You so much.


MaryO:   I think you're right about raising children.  I think I "inherited" most 
of my panic and anxiety from my parents


Dr. Stuart Shipko:   Mary:  one or both parents?  


MaryO:   Both.  My mother was worse, though.


Dearest:    And if they don't "inherit" it from their parents, Mary, their parents 
lack of proper upbringing can certainly give them panic and anxiety.


Dr. Stuart Shipko:  Lori, any comments?


Newby:   My mom is 86 and still on Klonopin & Paxil. So sad.


Lori:   Yes you can get anxiety as a child from both.


MaryO:   I'm living proof of that!


Lori:   It is the children who are born with PAD that have the better outcome in 
the future if intervention is begun early.


Dearest:    You are speaking of familial anxiety?


Patty   That's why I'm so anxious to know about positive things on the horizon 
since my son has it too.


Lori:   Yes I am.  We are changing the course of events in the children who 
are started on intervention early, no drugs.


Dearest:    That's wonderful, Lori.  Save them a lifetime of grief and discomfort.


Patty   At least they will know what it is from an early age and not wonder and 
have test after test with no answers.


Newby:   Three of my four children also have GAD on some level. I have spent 
much time teaching them techniques and coping skills that I wasn't aware of until 
my middle 30's.


Lori:   The major predictor of a problem is the endocrine system.


Dr. Stuart Shipko:   Lori knows a lot about this subject.  


Dearest:    Dr. Shipko, thanks so much for joining us, and you, too, Lori :)


Read Dr. Stuart Shipko's first transcript
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