Stuart Shipko, M.D.
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Stuart Shipko, M.D. |
 About Dr. Stuart Shipko  Ask The Anxiety, Panic Disorder Expert |
 Visit The Panic Disorder Institute Web site |
(Dr. Shipko's 5th visit to Power Surge) Dearest: It is my pleasure to welcome back to Power Surge, DR. STUART SHIPKO, Director of The Panic Disorder Institute. Dr. Shipko is a Psychiatrist and Neurologist whose practice focuses on panic disorder, stress-related medical conditions, stress and trauma related disorders, psychiatric injury, psychosomatic medicine and general psychiatry. I could go on and on with the credits of Dr. Shipko, but for expediency purposes, you can read more about him on the "Experts" pages of the Web site. Welcome back, Dr. Shipko. Let me begin by asking you if there is a genetic predisposition to panic disorder? Dr. Stuart Shipko: As it is defined by the DSM IV, no. However, most of the people that I see have panic disorder in their family. It is passed on from parent to child in an autosomal dominant pattern, that is it does not skip generations. The most common form of panic disorder is clearly inherited. Dearest: Does the person who suffers from panic disorder fit a particular profile? Dr. Stuart Shipko: In general, people with panic disorder have very sensitive nervous systems, and this is reflected in their personality. They tend to be creative and intuitive. Clearly there is a tendency for them to want to write. Dearest: The "sensitive nervous systems" leads into my next question...Years ago, when I read Dr. Claire Weekes' book, "Agoraphobia," she wrote about how agoraphobics are always in a sensitized state. What does this mean and what methods might people utilize to overcome this sensitization? Dr. Stuart Shipko: I don't know what Dr. Weeks meant. Perhaps she was referring to being in an anxious state. Dearest: I think by sensitized she meant always anxious, always "prepared for something to happen" -- sensitive to everything that happens to them. Make sense? Dr. Stuart Shipko: Yes. I would not know how to desensitize someone, since if you could stop the anxiety then you have taken care of the whole problem. Dearest: Thanks. Let's go to the queue now. TSMedley, go ahead with your question. TSMedley: What is an autosomal dominant pattern? my mother has anxiety disorder and so do I - does this mean I can't get rid of it or my children will have it? Dr. Stuart Shipko: Autosomal dominant refers to a pattern of inheritance in which ... if a single chromosome has the panic (PNE) gene, then the condition will be expressed in the person. What this breaks down to is that the inheritance pattern is that you stand a 50 - 50 chance of inheriting it from an affected parent and if you have it you stand a 50% chance of giving it to each child. CGilley: In panic disorder, does "surgical menopause" heighten the effects of it? Dr. Stuart Shipko: Absolutely. It is extremely common for a woman with mild panic/anxiety to become disabled following an hysterectomy. Dearest: So, can we now safely say that women going through menopause can develop panic attacks and/or panic disorder? Dr. Stuart Shipko: Yes. But you need to consider the definition of a panic attack. It is extremely similar to a hot flash in that in both you have autonomic nervous system instability. If you have a panic attack due to hormonal changes, it is not necessarily panic disorder. CGilley: I've had no episodes whatsoever for years, and it has returned after the hysterectomy. Dearest: Thanks, Dr. Shipko. Froggy, go ahead, please. Froggy4: Had I known the "symptoms" I was experiencing were building up to some pretty strong panic attacks, I'd have found help before I was critical, could you identify some of the early "warning" signs for others so they might get help sooner than I. Thank you. Dr. Stuart Shipko: What symptoms did you have Froggy4? Froggy4: LOTS! feeling of a bird beating its wings in my chest, shortness of breath, feeling "stupid" and very anxious whenever I had to explain something. Not like explaining something on an average day, but like explaining WHY your homework isn't done when you know you're in real trouble. Dr. Stuart Shipko: OK. I was asking because panic attacks often come out of the clear blue -- from nowhere when you start having symptoms of severe insomnia and irritability and that impending doom you just described as well as reflux then you might start thinking about getting help. Froggy4: Yes, couldn't eat, or keep food down. Dr. Stuart Shipko: However, you need to be careful. Right now most doctors would prescribe a SSRI, like Paxil, Prozac or Zoloft and these make panic anxiety much worse. On the other hand, your best treatment is a very short course of Xanax or Klonopin which will help, but may cause dependency, memory loss or sedation. So, you would have done best if you could have gotten about a two week course of Xanax. Froggy4: I got Buspar, Prozac and Klonopin, "cold turkey" quit the Prozac & Buspar. Dearest: Sara, go ahead with your question, please. Sara: Why do I get Panic Attacks only while I am going through Menopause? Dr. Stuart Shipko: The general hormonal connection is that low progesterone tends to be associated with panic attacks. Sara: How long will this last? Dr. Stuart Shipko: Sara, each person is different in this regard. Dearest: Thank you, Dr. Shipko. Blesst, go ahead. Blesst1: How effective is Prozac/Sarafem in treating mild depression? Thanks for your opinion. Dr. Stuart Shipko: It is questionably better than placebo. It helps some people, but fundamentally works by reducing the range of emotional experience. You need to be fully aware of side effects such as possible weight gain, orgasmic dysfunction, suicide, and also dependency. LibraDoll: I've been on Paxil since 1996.I had anxiety in Perimenopause, Menopause and now mildly after total hysterectomy. Once my HRT is balanced will the anxiety go away. I take estrogen and testosterone Dr. Stuart Shipko: If it is a hormonally based problem I would think that the anxiety will go away IF you can find the exact proper balance of estrogen, progesterone, androgens and thyroid. LibraDoll: How does one do that? Dr. Stuart Shipko: Trial and error. CGilley: Dr Shipko, you're saying many of the meds prescribed for patients with panic disorder makes can make them worse? Will adding progesterone to my HRT help with attacks? Is this the most common one to "add in" to reduce tension? Dr. Stuart Shipko: Yes. Adding in progesterone is a basic first step in the hormonal treatment of anxiety in women. CGilley: However my obgyn fears there is a link to breast cancer with this mix. Dearest: It's an interesting dichotomy -- so many women come to Power Surge complaining about how progesterone causes depression, irritability and anxiety. Dr. Stuart Shipko: Dearest: I don't think that the hormonal treatments for emotional problems have been worked out. I see that Dr. Lee has been a guest before. He is fond of the use of progesterone. I don't really find that any of the hormonal strategies work for everyone. Dearest: It's a fairly well-known fact that his natural progesterone cream theories seem to work best in the early stages of perimenopause before a woman's estrogen levels really begin to dip and then they require estrogen as well. But, let's get back to the queue. Froggy, go ahead, please. Froggy4: Are meno panic attacks different than regular panic attacks? How do you know which is your type of panic? Dr. Stuart Shipko: If panic attacks/disorder runs in your family, and if you have had panic attacks at various times in you life in the past, then the meno panic attacks represent aggravation of a panic condition. Otherwise, you can expect that it will pass. Dearest: Can panic attack and/or disorder sufferers ever completely be rid of the disorder even if it's under control? Dr. Stuart Shipko: Yes. It tends to recur during periods of instability or stress, but in some people it does eventually go into remission and does not return. Dearest: Thank you, Dr. Shipko. YogaJoanie, go ahead with your question. YogaJoanie Would you want to talk about bi-polar disorder and panic attacks during perimenapausal time? Dr. Stuart Shipko: Bipolar disorder closely resembles panic disorder in many people. The anxiety resembles manic agitation and the post panic agoraphobia resembles depression. To complicate matters further panic disorder and bipolar disorder commonly coexist (about 4 to 10%). Dearest: What is the anti-seizure medication they often prescribe for epileptics? It starts with an "N" Dr. Stuart Shipko: You must be thinking of Neurontin. Dearest: Yes, thanks. Lucy, go ahead, please. Lucy: Hi Dr Shipko..Good to see you. As you know my surgical hysterectomy story. I was wondering if my nervous system is "broke" forever. I am on compounded estrogen and progesterone which works well for the hot flashes and such. But my nervous system is "shot as I put it to others. I am very sensitive to light and noise. 6 years have passed and I wish I never had the hysterectomy. Dr. Stuart Shipko: Lucy: If I could have helped you with this I would have done it years ago. Your case is particularly difficult. Hope you are otherwise doing well. Lucy: I know you would. I was just wondering if a nervous system can be damaged from surgically induced meno. Dearest: Thanks, Dr. Shipko. Benjii, go ahead, please. benji: If you know you're beginning to have an anxiety/panic attack, is there anything you can do to inhibit its effects, knowing that it eventually will pass? Dr. Stuart Shipko: You can reduce anxiety by being psychologically prepared for it. Dearest: Because so many with panic disorder suffer with symptoms similar to heart disease, palpitations, chest pain/angina, arrhythmia, if the body is in a constant state of panic and anxiety, can this eventually result in heart disease? Dr. Stuart Shipko: As a matter of fact, yes it does. The incidence of stroke is 10 times higher, the incidence of heart attack is about 5 times higher in people with panic disorder. Arrhythmia tends to be benign in younger people but progresses to more serious arrhythmias in some people over time. Dearest: Amazing. Thanks, Dr. Shipko. Bette, go ahead with your question, please. Bette: In treating panic attacks, is CBT enough on its own, or must it be done in conjunction with talk therapy? Dr. Stuart Shipko: Good question. CBT is fairly shallow. It is often a part of deeper therapy, and I think that CBT is so popular and so studied because it is time limited and insurance companies like that. The deeper therapy that helps you to understand what makes you tick is always needed. Dearest: For those who don't know, CBT stands for cognitive behavioral therapy. Dr. Shipko, can you explain how CBT differs from "talk" therapy? Dr. Stuart Shipko: Cognitive therapy involves learning to tolerate discomfort. Catastrophic thinking is targeted and a person learns to spot it and change thought patterns. You can get this from a good book on the subject. charlie: Is weight gain a side effect of taking Effexor, too? Thank you. Dr. Stuart Shipko: Very much so. Not in everyone. Dearest: Does your reference to "catastrophic thinking" fit into Dr. Jon Kabat- Zinn's "Full Catastrophe Living" Dr. Stuart Shipko: I am not familiar with Kabat-Zinn. LibraDoll: Estrogen seems to give me so much energy I could go on forever. I also have anxiety. Is there a way to balance this out. Could this be BiPolar II? Total hysterectomy & I take Paxil. Dr. Stuart Shipko: I could only speculate on the answer to this. CGilley: Well, having had panic disorder since my late twenties (and having 2 babies) and a hysterectomy, I'm having difficulty working out with my healthcare people as to which came 1st-the chicken or the egg so to speak? Sorting out the HRT and the panic symptoms and which one to treat first? Dr. Stuart Shipko: Complicated. I guess you need to consider how bad the panic disorder is. If you are having frequent attacks or unbearable anxiety you must deal with the panic disorder first. If this seems hormonally driven, and the symptoms are tolerable, then measuring your hormones and making strategic changes is the long term solution. CGilley: Thank you....that helps Dearest: Dr. Shipko, thank you for a fascinating and informative chat and for so comprehensively fielding our questions about panic disorder, anxiety, depression, et. al. Dr. Shipko invites everyone to visit his Web site at http://www.algy.com/pdi. Dr. Stuart Shipko: It was a pleasure, as always. 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