Hi,

I'm currently taking dexedrine (not solid on the dose yet) and celexa for my ADHD, depression and panic disorder. The dexedrine is working. I also have clonazepam as needed for emergencies.

The rest is not. My panic attacks have morphed into depersonalization/derealization experiences with chest tightness, shortness of breath, etc. and they are absolutely terrifying. I have had to take clonazepam every day for a few days because of how bad it's become.

I'm at 60mg of celexa and I've been on it since August (started at 20, then went to 40, now at 60). It's clearly not working.

The panic isn't exacerbated by the dexedrine, I got these periods of daily panic attacks every so often before I went on dex as well. The stimulants help me so much that I'm not even going to consider going off them.

Does anybody have any suggestions as to what I could change? I'm hesitant to try another SSRI since this one didn't work, and don't want to take a benzo for a long-term period because the withdrawals are hell. Is there anything else I can do, medication-wise?

Well I've heard that when Celexa (citalopram) starts to fail you can move to Lexapro (escitalopram) and Lexapro may still provide some benefit. Now I know you said no to SSRIs but Lexapro is an excellent medication in my eyes. I take it on a daily basis. I'm on 20mg/day for panic attacks and depression and it works very well. However I was never on Celexa first so I can't say if it would work for that transition. However I was on Zoloft (sertraline) and Pexeva (paroxatine) before Lexapro and was still able to get benefit from Lexapro after moving from those 2 SSRIs. I had to quit Zoloft and Pexeva because they were causing mania, Pexeva worse than Zoloft. Lexapro doesn't do that for me so that's at least of benefit to me.

Another move you could take is moving to the SNRIs. Two that have FDA approval for anxiety are Effexor XR and Cymbalta. I was on Cymbalta and it made me confused and daydream all the time. Not a great medication for me. Effexor XR, I've never taken so I can't say anything about this medication except watch your blood pressure if you take higher doses.

Well whatever you decide to do I wish you the best of luck,
Andy...

Beta Blockers like Inderal can help with some of the physical symptoms that come with anxiety/panic (like heart palps).

I'm glad you are aware of the benzo risk. That stuff can really get it's claws into you pretty quickly if you take it every day--please be careful. I just finished a valium taper that took me close to 2 years, and it was definitely not fun.

Also, have you tried non-drug treatments for anxiety/panic? There are good "talk therapists" who can help with this, and there are plenty of good books on the subject. Techniques such as CBT (cognitive behavioral therapy) can be quite useful. Learning and practicing meditation also helps, as does regular aerobic exercise.

Good luck,
-tom

I just bought a book called "The Cognitive Behavioural Workbook for Anxiety" and my partner said he would help me through it.

I also have an appointment with a Learning Disabilities/ADHD specialist psychologist, but she only does learning/organizational/studying behaviour modification, though she gave me two names of psychologists she knows who do Cognitive Behavioural Therapy. The problem for me is the cost.

FWIW my similar problems are helped with lexapro, yet i have never been on Celexa they are similar 'cept lexapro only has the S enantiomer, and not both the R and S in celexa.

i have more GAD than depression, yet in therapy, he thinks that depression is more my culprit. i was always thinking the anxiety came first, yet we are exploring the depression aspect as primary...i also take 150mg wellbrutin which i don't think it does much.

good luck

to add...i think you can do well with CBT, but i think the best results are with meds and CBT.