Panic Attacks And Menopause

First of all, let's agree that menopause is no walk in the park for many women. Their hormones are constantly fluctuating back and forth, they have hot flashes and mood swings, and they either can't sleep or they wake up with night sweats. Add in anxiety and panic attacks and many women will feel like they are going right over the edge. Panic attacks and menopause just don't mix well.

Simple anxiety is something everyone experiences on occasion. We all stress over projects at work or issues at home. But, panic attacks are anxiety attacks on steroids. A panic attack can make the sufferer feel like they are having a heart attack! The most common symptoms people have with panic attacks are racing heart beats or heart palpitations, chest pain or discomfort, a feeling of shortness of breath or choking, sweating, dizziness or feeling lightheaded or faint, and unnatural fear and anxiety. To get an idea of what a panic attack is like, think about how you feel when you are cut off by another car and narrowly miss hitting someone or something. Now, multiply that feeling tenfold!

Women who are experiencing a panic attack are likely to breathe shallowly and rapidly. Their racing heartbeat makes them more upset, and the terror and fear that something horrible is happening to them only increases their panic. Panic attacks are not triggered by something in the environment around the sufferer or by something they did; rather the attacks begin for no apparent reason and are as likely to affect someone who is sitting calmly while reading a book as they are to affect a woman in a stressful situation.

While people can be prone to panic attacks at any stage of life, women are more likely than men to suffer from them, and panic attacks and menopause seem to go hand in hand. Many women today are stressed out and overworked, and put themselves at the back of the line behind family and work needs. When women enter perimenopause and menopause, their bodies begin to have hormone imbalances. It is believed that these hormone imbalances, coupled with stress, are at least partially to blame for an increased susceptibility to panic attacks.

Many women will go through perimenopause and menopause, and panic attacks will only happen once or twice during the entire process. For other women, menopause and panic attacks will become a way of life until menopause is completed. For these women, medication may hold the answer to getting them through this troubling time of life.

Dr. Darvin Hege, an Atlanta, GA psychiatrist says "there are two classes of anti-panic medicines that are highly effective. They are Benzodiazepines (Group 1) which consist of Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), Tranxene, Serax Valium, Librium, and others, and Antidepressant/Anti-panic medicines (Group 2) consisting of SSRI's (Zoloft, Prozac, Paxil, Celexa, Lexapro, and Luvox) and tricyclics (Tofranil, nortriptyline, protriptyline, Elavil, Sinequan, Surmontil, and others)." Dr. Hege further notes that "the most important difference between Group 1 and Group 2 is that medicines in Group 1 work much quicker, i.e. stop panic attacks in twenty minutes to a couple of weeks in worse cases. Group 2 requires 1-8 weeks to be effective. However, Group 1 can be physically addictive. Group 2 medicines are just as likely to stop all panic attacks as Group 1 after a lag period. The lag period is 1-3 weeks to the onset of reducing the severity and frequency of attacks. It takes Group 2, 3-10 weeks to totally stop all panic attacks in 70% of patients. Most people need to be on medicine for at least 1 year to significantly reduce the risk of relapse back into panic attacks soon after stopping the medicines."

Menopause and panic attacks are not something that women just have to "put up with". For those women who suffer relatively few attacks, natural therapies or stress reduction can help. Yoga, meditation, and exercise can help calm otherwise frantic lifestyles. Just the simple fact of knowing what a panic attack feels like can help women respond less negatively if they have one. For those women who can not deal with the anxiety and fear that a combination of menopause and panic attacks can bring on, there is relief in the form of counseling and medication.

Dr. Darvin Hege has 25 years of experience dealing with patients who have panic attacks and menopause simultaneously. He offers evening and weekend office hours at his Atlanta, GA practice. Call today at 770 458-0007 for an evaluation for relief of your panic attacks and for help deciding the most effective and safest treatment. 

Panic Attacks And Pregnancy

Panic attacks and pregnancy simultaneously create risks for the fetus. Stress and anxiety in the mother increase adrenaline and cortisol that can reduce oxygen to the fetus and contribute to risks during labor and delivery. The peak age of onset is in the 20s and more women than men get panic attacks. Therefore, the incidence of panic attacks and pregnancy together is elevated. The prevalence of panic attacks and pregnancy is about 1 to 2%.

In a retrospective study of first onset of panic attacks in childbearing age women, 10 times as many women reported their first panic attack occurred in the first trimester of a pregnancy. Other retrospective studies suggested that breast-feeding reduced the risk of panic disorder during the postnatal period and weaning increased the risk. If a woman has had panic attacks before pregnancy, studies have suggested that they may have worsening of the panic attacks during pregnancy and/or the postnatal period if the panic disorder was severe.

Medical causes of panic attacks need to be ruled out. These include thyroid disorders, anemia, preeclampsia, and pheochromocytoma. Comorbid psychiatric conditions frequently underlie panic disorder. These include mild bipolar disorder, depression, ADHD, other anxiety disorders such as PTSD, generalized anxiety disorder, or alcohol or drug abuse or withdrawal.

Panic attacks and pregnancy present challenges for treatment. Self-care strategies include elimination of caffeine, reduction of sleep deprivation, and relaxation techniques. Non-medication therapy with cognitive behavioral therapy with a professional therapist may be effective.

Medication treatment for panic attacks and pregnancy are often very helpful, but risk and benefit analysis include the following: as mentioned in the beginning there are medical, physical development, labor and delivery, postpartum, and later physical and mental developmental risks for the baby when the mother is having uncontrolled panic attacks during pregnancy, postpartum, and early childhood stages.



Now I will address some of the concerns of taking medication during panic attacks and pregnancy. Medications that help panic attacks the quickest are benzodiazepines. Benzodiazepines include Xanax, Klonopin, Ativan, Valium, Librium, Tranxene, and Serax. There was at least one study suggesting an increased risk of cleft palate if Valium is used during pregnancy. That suggestion was about a 1% risk. SSRIs retrospective studies have not suggested any congenital malformations except possibly in Paxil. Hence, the other SSRIs are first choice. These include Prozac, Zoloft, Celexa, and Lexapro. The drawback of the SSRIs are that they require one to two weeks of administration before getting any benefit and one to two months before getting full benefit against panic attacks. Withdrawal or discontinuation symptoms of any of these medicines in the baby after delivery are additional concerns.

Dr. Hege has 25 years of experience dealing with patients who have panic attacks and pregnancy simultaneously. Call today at 770 458-0007 for an evaluation for relief of your panic during the planning or managing of a pregnancy or postpartum, and for help deciding the most effective and safest treatment.

AFFORDABLE/CHEAP SUBSTITUTES FOR VYVANSE, ADDERALL XR, CONCERTA, FOCALIN XR, AND DEXEDRINE SPANSULES FOR ADULT ADHD.

Dramatic savings can be achieved with this strategy if you're willing to accept some inconvenience and a period of adjustment. Vyvanse, Adderall XR, Concerta, Focalin XR, and Dexedrine Spansules cost at least $125 per month if you are on one pill a day because they cost about four dollars per pill. If you need 2 or 3 pills per day, that costs $250 or $375 per month. Generic Adderall costs $.35 per pill at Costco. If you take 2 or 3 Adderalls per day, that's $.70 to $1 per day or about $20 to $30 per month. Here's how I implement this strategy for the most consistent focusing all day.
I have my patients set a daily alert in their cell phone to go off at a time in the morning soon after they arise each day. They promptly take their first dose of generic Adderall, Ritalin, Dexedrine, or Focalin for the day. Then they note how long it is until the benefit of the first dose starts to decline. The next day they set their second daily alert for each day at a time that is 30 minutes before their focus begins to decline. This way they take the next dose to be replacing the falling brain concentrations of the previous dose. This prevents a dip in focus between doses. Alerts are then set for the third and fourth doses of the day, as necessary, with the same interval between alerts as between the first and second alerts. My patients are reporting significant improvement in their work and school performance, more consistent and improved mood, and avoiding daytime crashes between doses. Crashes are the periods of tiredness, sleepiness, irritability, or easy crying from a rapid drop-off in ADHD medication brain concentrations.
When switching my patients from a more expensive, longer acting ADHD medication to the cheap, shorter acting, generic substitute, we start out on very low doses and then move up the doses gradually. This way we avoid side effects, find the most effective dose, adjust the period between doses, and adjust the size and time of the last dose of the day to prevent difficulty falling asleep.
For more information on how to save money on psychiatric medications, see my blog about affordable psychiatric medications http://www.eveningpsychiatrist.blogspot.com To make an appointment with Dr. Hege for evaluation and treatment for adult ADHD,
Call 770-458-0007.

Bipolar Medications Video

Video about Vyvanse: How it works

http://www.youtube.com/watch?v=iM14LNct9z4

Meet Dr. Hege - video about his practice

Vyvanse Approved For Adults

Shire PLC announced today that Vyvanse has won US approval to treat adults. I have prescribed it for 275 patient since the FDA approved it for children and adolescents in August of 2007. 95% of these patients are adults. Only a few of my patients were afraid to take it because it was not FDA approved for adults.
This information was reported in the Wall Street Journal today, April 24, 2008, in an article on page D4, titled "ADHD Drug Is Approved for Adult Use".
Included in the article was this statement that Adderall XR will not lose patent protection until April 2009. I had been informed and was telling my patients that Adderall XR went off patent this year.

Additional information about Vyvanse may be found in three prior blogs on this blog site.
Additional information about Adult ADHD and women with adult ADHD may be found on my web pages, http://www.eveningpsychiatrist.com/aadd.htm , http://www.eveningpsychiatrist.com/aaddforwomen.htm .

Darvin Hege, M.D.
http://www.eveningpsychiatrist.com/index.html