(Dr. Shipko's 9th 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 2000 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:  Thank you. I hope I can live up to your introduction.  


Dearest:  You always say that, and you always do! :) 


Dr. Stuart Shipko:  It's been a while since I was here.  Things have really heated 
up in the drug companies' attempts to treat menopause.   I read a journal recently 
where virtually every category of drug was considered to be "useful" for symptomatic 
menopause.  The article started off with an introduction where they proclaimed 
psychiatry to be the new specialty expected to treat symptomatic menopause. 

So, now it is not just the SSRIs that are being prescribed.  It is fair game to 
prescribe any psychotropic medication. 


Dearest:  I'm glad you mentioned that because it boggles my mind why anti-seizure 
drugs like Neurontin is being prescribed to women going through menopause. I've had 
numerous gynecologists say it's excellent to treat menopause. What do you think
about using anti-seizure medication? 


Dr. Stuart Shipko:  Neurontin is the most highly marketed placebo in the world.  
Fundamentally it is such a weak anticonvulsant that it is nothing more than a mild 
sedative.  Anticonvulsants such as Neurontin are being thrown at every condition
that is poorly understood. 


Dearest:  It seems there's always the "drug du jour," yes? 


Dr. Stuart Shipko:  Always. 


Dearest:  Amazing.  Now that "Surviving Panic Disorder: What You Need To Know" is 
complete, how does it feel? 


Dr. Stuart Shipko:  It feels great. I finally have a book that my patients can
read that explains everything that they need to know. At least for starters. :)


Dearest:  That's wonderful. Well, you know I, and everyone associated with Power 
Surge, wish you the best of luck with your new book! 


Dr. Stuart Shipko:  Thanks so much. 


Didi:  Dr. Shipko, have been on Remeron for 3 years, for dysthymia (or minor major 
depression, depending on which psychologist I believe), PTSD (Post-Traumatic Stress 
Disorder) and severe insomnia. Feel great on 7.5 mg a day, but am nervous because no 
one seems to know anything about it, including my psychiatrist. What can you tell me? 
Long term effects as bad as with SSRIs?


Dr. Stuart Shipko:  Long term effects? So far it is not as bad as the SSRIs.
I have not heard too much about it except that it makes people gain weight.
All psychotropic drugs are difficult to stop.  Your psychiatrist should be able
to tell you more about the drug. 


Lindy:  Hello, Dr. My question is twofold: 1) does it matter if PD (panic disorder) 
is caused from different etiology in order to treat it correctly? For instance, 
menopause vs. phobias. 

2) my doctor wants me off Klonopin but I'm scared to get off it after 15 years. I'm 
down to .75 mg but can't drive because of PA's (panic attacks). He put me on a low 
dose of Neurontin, but that does nothing, like you said. What IS the best treatment 
to get these panic attacks under control? Thanks


Dr. Stuart Shipko:  It does make a difference depending on the etiology.  
The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) does not make much 
of a distinction. If the problem is menopause, then probably soy isoflavones are your 
best bet. 

If the problem is a phobia then behavioral strategies are often best. 

Why does your doctor want you to stop the Klonopin now? It would seem that if it has 
been OK for the last 15 years, there is no urgency.


Lindy:  He feels it's wrong for an alcoholic to take benzos. 


Dr. Stuart Shipko:  Alcohol is a tricky problem.  I have a saying:  If the patient 
has not discovered alcohol, then I need to question the diagnosis of anxiety. 


Dearest:  Lindy said her doctor said it's wrong for an alcoholic to take benzos,
is that correct? 


Dr. Stuart Shipko:  Yes, that is what he said. 


Dearest:  Is there something wrong with me, or what kind of doctor prescribes 
benzodiazepams to people they know have alcoholic problems?  Benzos are drugs like 
Xanax. 


Dr. Stuart Shipko:  Guys who understand anxiety.  If the patient is drinking and 
taking the Klonopin, it is a problem. Alcoholics will use Klonopin to smooth out the 
hangovers.  However, so many people with anxiety drink a lot that you have to take 
some risks in prescribing it to people who have had drinking problems. 

Contrary to most common thought a benzodiazepine does not cause a person with alcohol 
intake to treat anxiety to go on a new binge. Usually they stop drinking. 


Patty:  Perhaps this is off topic, but do you have a rough estimate of how many 
people with panic disorder have the kind that's passed down to successive 
generations? 


Dr. Stuart Shipko:  I couldn't guess. 


Jane25:  Is panic disorder a chemical imbalance in the brain Dr? Thank you


Dr. Stuart Shipko:  No. Often doctors like to work backwards from the drugs and say 
that because a drug that affects GABA or serotonin helps anxiety that the problem is 
with the neurotransmitter.  That is a little like saying that arthritis is an aspirin 
deficiency.


Dearest:  Dr. S., isn't it often very difficult to diagnose the cause of and know how 
to treat anxiety? panic? depression? especially when the symptoms can be the result 
of thyroid problems, hormone imbalance and other various and sundry other medical 
issues?


Dr. Stuart Shipko:  Yes. Physical factors need to be carefully considered. 


Sawyer:  I am currently taking .5mg of Xanax 3 times day, 1 mg of Clonazepam for 
approximately 8 years. Now added 7.5 mg of Zoplicone, worried about long term side 
effects. My Panic/Anxiety is worse since menopause. Help? I am also a recovering 
alcoholic (20 years sober) and concerned about addiction as well. 


Dr. Stuart Shipko:  Help?  I don't know what to say.  Each patient is different and 
I can't do your question justice via chat. 


Dearest:  Let me ask Sawyer a question - why do you NEED so many of these drugs?


Sawyer:  Major anxiety/panic attacks for years. 


Dearest:  Have you ever tried just increasing the Xanax instead of using Clonazepam, 
too? 


Sawyer:  Could do, just listening to the doctor, am confused as to what's right. 


Scarlett:  In an earlier chat, you said Effexor was one of the hardest to get off, 
can you explain? 


Dr. Stuart Shipko:  SSRIs with short durations of action are more addicting.  
Effexor has a pretty short half life and the withdrawal symptoms tend to be worse 
than other similar drugs.


Dearest:  By the way, Dr. Shipko has consented to become Power Surge's "Ask The 
Anxiety/Panic/Depression/You name it Expert" :)  You will find him in the next week 
in the Ask The Experts area of the Web site at www.power-surge.com/asktheexperts.htm   
Thanks, Dr. S :)


Dr. Stuart Shipko:  You are welcome.


Rustie:  What is your opinion of Epival (Depakote) being prescribed for Panic 
Disorder? Can it make GERD (gastro-esophageal reflux disease) worse? Is there
an advantage of Xanax over Ativan for Panic related GERD?


Dr. Stuart Shipko:  Depakote has been shown to be ineffective for panic disorder.  
I don't know how it affects GERD. There probably is no real advantage of Xanax over 
Ativan. 


Dearest:  Why can't people accept the fact that being "sad" or "unhappy" from time
to time is normal and doesn't necessarily mean they have a disorder that has to be 
"treated" with medication?


Dr. Stuart Shipko:  A good question. It seems that all aspects of being a human
are now treatable psychiatric disorders. The drug companies market the disease.
And the public embraces it. You can always say that I am not unhappy, I just have
bad serotonin. This appeals to people.


Carolly:  Isn't Lamictil an anti-seizure drug? What do you think about it? I hope
it is better than Neurontin? 


Dr. Stuart Shipko:  It is being used primarily for bipolar depression. I have not 
heard of it being used for anxiety. (yet) 


Dearest:  And, Dr. S., what about people who have anxiety and are put on various 
SSRI's - they often experience worse anxiety than before - and it doesn't always
get better as they remain on the drug. Your thoughts? 


Dr. Stuart Shipko:  Particularly panic anxiety tends to get worse.  The SSRIs cause 
a restless state known as akathisia that is very much like bad anxiety.  This occurs 
in  about 20 to 30% of people.  Doctors often refer to it as 'jitteriness.' 


Larika:  I have extreme physical symptoms like chest pains and extreme headaches.
I have been diagnosed with panic disorder and OCD (Obsessive Compulsive Disorder)
and have been told that my symptoms are just the anxiety. I am wondering if it is 
typical of anxiety sufferers to have really extreme symptoms of other illnesses while 
not in the midst of a panic attack? I am only 26 so all the doctors think I'm young, 
healthy and just extremely anxious. 


Dr. Stuart Shipko:  Many people with panic disorder have symptoms in between 
attacks.  I assume that your doctors have done at least some physical tests to rule 
out physical illness.  At 26, cardiac disease is unlikely, but GERD could cause the 
chest pain. Anyway, interattack symptoms are very common.


Lindy:  Thanks for your input about alcoholism and taking benzos. I am sober now,
but have had many relapses. My doc believes that Klonopin hits the same receptors
in the brain as alcohol; hence, he wants me on a safer drug. He's only been my doc 
for 1 year, so he was not the first to prescribe this for me. I am dependent on 
Klonopin now, and I feel that I need MORE instead of less to function at a higher 
level; I.e., to drive, to find a job; to get to my AA meetings. I have no health 
insurance. I guess what I want to know is what can I start doing now to help 
alleviate my symptoms of panic. Does your book get into this? behavior therapy?

And can soy maybe help me? Does your book get into what medicines do what and
which ones are safe, etc? 


Dearest:  Is he a psychiatrist and/or a psychopharmacologist? 


Lindy:  Internal medicine and he says addiction specialist. 


Dr. Stuart Shipko:  You do need to be careful about how you use the Klonopin.  It 
is so hard to give individual advice without any real examination. How much Klonopin 
do you take? 


Lindy:  .75 a day.  I do not abuse it. 


Dr. Stuart Shipko:  You may well be underdosed. As far as the assertion that the 
BDZs (benzodiazepams) work on the same site as alcohol, I can only ask, "So what?".  
I don't really delve into behavioral therapy, but the BDZs are not really going to 
help with specific phobias as much as to prevent spontaneous attacks. 


Dearest:  Dr. Shipko, do you think doctors like Lindy's internist should be prescribing
medications of this kind? 


Dr. Stuart Shipko:  I have mixed feelings. The Internists know a lot less than they 
think.  But then the psychiatrists are often dangerous and know a lot less than they 
think.


Cab315:  I am weaning off Effexor XR because it may have caused High blood pressure, 
even at a low dose 75mgs. Currently down to 18.75 mgs and the withdrawal is awful 
(especially the brain zaps). I was prescribed a 2 week prescription of Prozac to help 
get me off the EFXR. Do you think this will help? Also, what are those zaps and are 
they dangerous? 


Dr. Stuart Shipko:  Prozac has a really long half life and does help some people
to withdraw more comfortably. The zaps are really not known to have a specific 
pathology. They are uncomfortable but not dangerous. 


Dearest:  Can you explain what the "zaps" are, Dr. S? 


Dr. Stuart Shipko:  These are brief but intense electrical shock sensations, often 
in the head and neck but can be anywhere.  They are common SSRI withdrawal symptoms. 
Often they are mistaken for panic attacks. 


Dearest:  They also sound very much like what many perimenopausal women complain of.  
Buzzing, electrical impulses. 


Dr. Stuart Shipko:  Yes. 


Charlie:  I have been getting terrible twitches in my eye and lower lip, particularly 
on the left side, this has been accompanied by a powerful headache for the last 6 
weeks... the doc has been saying it sounds like panic, but I'm worried it could be 
something more serious, can panic really make my face and neck twitch so violently, 
even when I'm apparently relaxed.  I was prescribed amityptyline, but I don't think 
it worked. It just gave me chills.  I'm young.  


Dr. Stuart Shipko:  Twitches are not necessarily a panic anxiety problem.  The 
tendency now is to call all of the various difficult to explain symptoms anxiety
and depression.  It may just be that this is something that is going to pass. 


Charlie:  I hope so :) 


Jillian:  Can panic disorder and generalized anxiety disorder ever be completely 
"cured", or does it always lurk and linger even if it's "under control?"


Dr. Stuart Shipko:  The tendency toward panic attacks and being easily stressed
has no real cure. Many people do go on to be medication free and mostly symptom free. 
I think that everyone has "symptoms' of anxiety and in that sense you never get 
totally anxiety free. But to answer your question, yes. Lots of people live happily 
ever after. It is a condition that can recur so, it seems that both outcomes are 
possible. 


Dearest:  Dr. Shipko - say we had no tranquilizers, no anti-depressants - what would 
you recommend to treat generalized anxiety? 


Dr. Stuart Shipko:  That's tough.  Historically it seems that people really seek 
out sedatives and mind altering drugs. Perhaps community is the best treatment in
the absence of drugs. 


Dearest:  What about things like exercise? Can't exercise thwart feelings of 
depression and anxiety and even panic attacks?


Dr. Stuart Shipko:  Over the long term regular exercise is about the best thing
you can do for your health - mind and body. It seems that anything that a person
does to improve their general health is also going to improve anxiety and mood. 


Patty:  The extreme fatigue that I've experienced once the Panic quiets down, is it 
typical? Lasts for months. Symptoms come back if I get very fatigued and don't ease 
up. Once that fatigue gets under good control, seem to be home free. I imagine it's 
all speculation as to the cause? Body/brain using its energy to heal. 

Also, my son is in the throes of the fatigue (too much too soon) and he hasn't 
physically grown in the many months he's had the fatigue! He just turned 15.

Have you seen this in any of your young patients re growth and fatigue, a 
correlation? 


Dr. Stuart Shipko:  I do see people having enormous fatigue following a panic 
attack. some  people have to go to sleep for a few days after a big attack. Nervous 
fatigue is also an interattack symptom that is common, and it can sometimes be the 
way that agoraphobia is perceived. 


MomBear:  My panic attacks occur in the middle of the night. I will be sleeping
and suddenly awaken with my heart pounding, my ears roaring like a seashell, and 
breathing hard. I try to calm myself down but if I can't I take 1 mg of Ativan and
in 20 min the attack subsides and I can go back to sleep. What is the reason for
the night attacks? Can you help? I take 40 mg of Prozac and 15 of Temazepam HS,
have tried to go without it and panic attacks recur. Thank you for any help you
can give me. 


Dearest:  Are you going through perimenopause? 


MomBear:  No I had menopause about a year ago and insomnia was my worst symptom. 


Dr. Stuart Shipko:  Nocturnal panic attacks are extremely common.  I think that
the cause relates to the mechanism of stress and relaxation. I did some research
on this a while ago. 

The best treatment is to prevent the attacks with a BDZ prior to sleep.  Restoril
is a BDZ, but it is a bit weak. 


PWilson:  I have been on Paxil 20mgs. for 3 years. It has helped my anxiety, I have 
asked if I should begin weaning. I am really frightened by all of the stories I hear. 
My GYN says to stay on it as long as I wish. What do I risk by staying on it or 
getting off? By the way, I tried to wean once and after a few months I found the 
depression returned for no apparent reason.  Things were good and going well for
me and my family, as well as it is today. Am I addicted to Paxil? I appreciate any 
suggestions you have. 


Dr. Stuart Shipko:  That is an important consideration. Assuming that you do not 
have compelling side effects that make you want to stop, should you? My feeling is 
that it should not be used long term.  It is probably going to stop working and then 
you are both symptomatic and forced to keep trying different drugs or to have a 
forced detox. 

The withdrawal commonly has a big depressive and anxious component.  Some 
psychiatrists talk about the long term SSRIS PREDISPOSING TO "Treatment emergent 
depression" and argue that this is a reason to avoid long term use. Stopping needs
to be done very carefully. Some people get a few years of good treatment with an 
SSRI, but the long term is really not studied. 


Panicky:  After 3 years of being panic free my panic has returned. Could it be 
perimenopause and if so, is there a test I can take to see if I am there?  Most 
importantly, how do I get a doctor to listen after being diagnosed with panic attack?
It's always in my head.  Any doctors in Cincinnati? 


Dr. Stuart Shipko:  If it is perimenopause it is difficult to treat with hormones 
anyway. A very hit or miss affair.  Perimenopause is a definite cause of 
exacerbation. They can test for hormones, the  best way is a salivary test,
however, even if they find "hormonal imbalances" the use of hormones to treat
it is not exactly a science yet.


Jane25:  I can relate to what MomBear said. I was waking up with my heart racing, 
etc. I am on natural hormones now and it has quit, at least for now and I am 
thrilled. 


Amiga2:  I picked up an article about hypoadrenalism (tired adrenal glands) and how 
that can cause over sensitivity to stress that can lead to anxiety attacks. What
are your thought about that and the theory that perimenopause/menopause might
cause changes that adversely affect the functioning of the adrenal glands? 


Dr. Stuart Shipko:  I am less of an authority on menopause. In general I dispute 
the subacute low adrenal theories.  We seem to be treating everything earlier and 
treating risk factors as if they were diseases. 


Dearest:  Amiga, go into the Educate Your Body area of the Power Surge web site at 
www.power-surge.com/educate.htm -- you'll find an article about the adrenals and 
menopause. 


OoohLaFleur:  Long Island Jewish told me I have menopausal hormonal anxiety and gave 
me antidepressants.   They made my heart pound, then they gave me Xanax which made
my head spin.  They then said live with anxiety cause they won't give me a benzo
or anything.  I haven't been out of house for 2 years because I fear panic.

What do I do now?  I exercise regularly and am very petite.  I have tried B vitamins, 
too.  Nothing works:( 



Dr. Stuart Shipko:  Treat the menopause.  There are some interesting studies going 
on at the NIMH about the use of soy isoflavones for menopausal anxiety. Also, it
does not sound as if your doctors were very thoughtful about using medications.

The antidepressants can be good for agoraphobia (maybe better than Xanax) but they 
might just need to start at a lower dose. 


Dearest:  Oohlafleur, you might want to participate on the panic attack/disorder 
forum on the message boards at www.power-surge.com/php/forum/index.php


January56:  Can you give me advice for weaning off antidepressants? I am not so much 
concerned about withdrawal as return of depressive symptoms (excessive worry, 
negative thoughts, feeling burdened mainly). I am 47 and have been taking 100 mg 
Zoloft for two years. I have gained 35 pounds, which my internist says is due to 
perimenopause. I exercise heavily and have not changed my diet and it seems my 
metabolism is shot. I did try tapering off once and a psychologist friend guessed 
because he said I was making many more negative statements, so I resumed.


Dr. Stuart Shipko:  Withdrawal depression is the rule rather than the exception
to the rule. It is often mischaracterized as 'relapse.' Sometimes you can go onto
a different antidepressant category as you wean off the SSRI. I have sometimes had 
success in going very slowly and using SAM-e and L-tryptophan.


Dearest:  And there are many other suggestions at www.power-surge.com/recommend.htm 


Carolly:  I asked about the Lamictil.  I always thought what I felt was anxiety. Now 
they are saying it is possibly hypomania hence the addition of Lamictil to my Effexor 
for depression. I have been crying a lot lately which is why I went for treatment (my 
family physician has been treating my dysthymia and anxiety for years with Zoloft and 
last year Effexor). Comment please? Thanks


Dr. Stuart Shipko:  Bipolar disorder is overdiagnosed and underdiagnosed. People 
with anxiety often have a fluctuating course that is confused with bipolar.  There
is a lot of comorbid depression in people with anxiety.  Some people do have "manic 
panic", that is, the combination of both conditions. 


Larika:  I have become extremely agoraphobic and nearly physically ill from my 
anxiety. I feel I need to take a medication at this point.I have tried CBT (cognitive 
behavior therapy) in a group and one on one setting but my anxiety has only gotten 
much worse over the last several months. If I were your patient, would you prescribe 
an SSRI or a benzo to me? Currently I have been prescribed both, but am only taking 
the SSRI (Celexa).


Dr. Stuart Shipko:  I can't give you a good answer to that without taking a full 
history. Sorry.


Dearest:  A quick question, Dr. S. - do people who experience panic attacks also 
suffer from panic disorder? 


Dr. Stuart Shipko:  Not always. A panic attack is not in itself considered to be a 
disease/disorder. It is a normal part of being alive. It is only if the panic attack 
results in persistent worry about the next attack that it becomes panic disorder. 


Trish:  If in fact this illness is not in essence a chemical imbalance, and tests 
such as thyroid, blood work, cardiologists, etc. have been all ok. Does this mean
we simply had an anxiety attack, and in turn had catastrophic thoughts (I'm going
to die, etc) leading to the continuation of attacks and fears? 


Dr. Stuart Shipko:  Yes. 


Kyrarose:  I have always been an anxious person but now well into perimenopause
and have had panic attacks and anxiety since. Have lost about 30 pounds and had
to have many tests. all have come back fine and have been ruled with IBS and severe 
Acid Reflux. My family physician tried me on Zoloft and Paxil for anxiety and they 
both wired me. I now take just .25 Xanax at night and .25 in the morning and seem
to be doing just fine and not feeling the need for any more. I feel this is the
best route for me over the SSRI's. 

My question is Xanax in this small amount going to be addicting and will I 
eventually require more. I feel good now and have been walking. I really think
once menopause levels off I will be able to stop Xanax? Don't want to take SSRIs. 
Comment please? 


Dr. Stuart Shipko:  Xanax is a lot better for reflux than SSRIs are for anxiety 
related reflux.  It is difficult to stop both the Xanax and the SSRI, so choose your 
drug according to what works best.


Sdeek1950:  B12 supplements with B6 and Folic acid (Trivita sublingual) - I find this 
to be a tremendous help. Take much less Xanax. What is your thinking on this? Really 
lessons my anxiety and stress level. 


Dr. Stuart Shipko:  If it works, then keep taking it. 


ShoreTides:  What do you think of GABA? I ran to the store tonite to get some. I was 
off it a week and boy there was a difference. I have been taking it since summer 
because it helped me with hangovers and food cravings. It also help me deal with 
some difficult people.  I was off balance when I didn't take it. I felt anxiety that 
I didn't for a while. 


Dr. Stuart Shipko:  I'm glad GABA helps you, but my experience is that it is not 
effective for most people.


ShoreTides:  Really 


Dr. Stuart Shipko:  Really what? 


ShoreTides:  It works instantly on me 


Dr. Stuart Shipko:  Don't argue with success. 


Dearest:  Another B vitamin that's excellent is Inositol for treating anxiety. 

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 new book, "Surviving Panic Disorder: What You Need To Know", and visit his 
Web site, The Panic Disorders Institute, www.algy.com/pdi/ 



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 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.