Panic Disorder

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In the world of behavioral therapists, however, panic attacks begin and end not with brain chemicals but with thoughts and actions.

Therapists say particular types of people are most prone to panic attacks.

Perfectionists and overachievers are more likely to have anxiety overflow.

No matter what causes panic attacks, doctors and therapists agree that the real trouble starts after the first panic attack.

Singer Carly Simon once confessed not only to panic attacks, but also to a secondary and just as crippling fear, the fear of more panic attacks.

A fear of an attack returning can cause the development of other phobias, such as performance anxiety, claustrophobia or the fear of the outdoors.

“I’ve talked to people who won’t go to the dentist or go get their hair cut because they don’t want to have a panic attack in a place where they cannot easily flee,” said Margaret Summy, a Fort Worth therapist.

Often, those people assume their fear is of the dentist or of the hairstylist.

“That’s not it,” Summy said.

“After the first attack, they start analyzing it and say, ‘I’m not going to do that again.’” One woman whom Vinson treated had refused to leave her house without her husband for 11 years, so fearful was she that another panic attack would occur.

She told Vinson that one day she left the house by herself and tried to spark another panic attack.

“You can’t have one when you want to,” he told her.

“You have to fear it or it won’t appear.” The wo...

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All patients had been well controlled on Celexa, and their symptoms had been stable for a mean of 114.7 ± 109.39 weeks (range 6 – 472 weeks) prior to the switch to generic citalopram.

The investigators obtained patients' consent to contact their pharmacies to determine whether and when generic citalopram was dispensed.

"In Canada, pharmacies are not required to inform patients of a change to generic, and most private drug plans mandate the use of generics when available," Dr.

Van Ameringen explained.

Examination of the pharmacy records revealed that the mean dose of Celexa at the time of the switch to generic was 45.2 ± 20.6 mg and that half of the patients were taking other medications when they were switched.

Adverse symptoms began to reappear after as few as 4 days of switching.

However, once patients were switched back to Celexa, the mean time for response was 3.8 ± 2.6 weeks (range 0.7 – 12 weeks).

"Clinicians should be aware of the potential risks of loss of treatment effect or symptom re-emergence posed by a switch to a generic agent," Dr.

Van Ameringen noted.

"Prospective, randomized, double blind, controlled investigations would likely provide useful information on this issue." [Presentation title: Symptom Relapse Following Switch From Celexa to Generic Citalopram: A Clinical Case Series in an Anxiety Disorders Sample.

Abstract 408] E-Mail this DGDispa...

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Yet most antidepressants, including tricyclics and SSRIs, often exacerbate symptoms during treatment initiation His research team compared the efficacy of bupropion XL and escitalopram in a double-blind, dose-controlled, parallel-group study that enrolled 34 subjects with anxiety.

Subjects were randomly assigned by a computer program to bupropion XL (n=16) or escitalopram (n=18).

After a baseline visit, patients were followed for 12 weeks.

For enrollment, subjects had to meet the Diagnostic and Statistical Manual IV (DSM-IV) criteria for GAD.

They also had to score 12 or greater on the Hamilton Anxiety Rating Scale (HARS) and no more than 19 on the Hamilton Depression Rating Scale (HDRS).

In addition to the HARS and HDRS scales, the other primary outcome measure was change in Self Efficacy Scale (SES).

The results of the study showed that both groups had a significant decrease in anxiety at follow up.

Analysis of variance demonstrated that both HARS and HDRS total scores were significantly improved in bupropion XL-treated subjects compared to escitalopram-treated subjects (P .005 and P .025, respectively).

Subjects treated with bupropion XL also had significantly lower SES scores compared to the escitalopram group (P =.0002), Dr.

Bystritsky reported.

"Subjects taking bupropion XL showed more improvement in their ability to cope with fear (resilience) than subjects taking escitalopram.

Compared to the other efficacy measures, the SES scale demonstrated the gr...