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Old 05-13-09, 10:10 AM
BoldAsLove BoldAsLove is offline
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Question Adderall and Panic Disorder

Hi Everyone,

New here, but have been lurking for over a month. I've found so much great information here!

Here's the short version of my story. I'm a single mom of 2--a teenager and a toddler. Figured out I had adult ADD when my teenage son was diagnosed 2 years ago and I realized I had all the same symptoms as a child and still have several symptoms. I reluctantly put him on medication, and his grades improved. I didn't see meds for myself as an option b/c I liked myself the way I was--scatter-brained and spontaneous. But recently I've seen how adult ADD has taken a toll on my relationships and job performance, so I decided to give meds a go.

First, I tried Adderall XR 20mg. My son had an old bottle which he never finished, and being a clutter queen, I'd never thrown them out. Although they were 2 years old, they worked and I immediately noticed lots of positive changes--no irritability, less impulsive behavior, able to complete tasks, get things done, etc. I took all 5 pills in 5 consecutive days. Then I rushed out to a pdoc (first time ever) and got a script for Adderall XR. He Rx'd 30 mg the following week and started those. I had about 5 days lapse between the last 20mg and the first 30 mg XR.

Starting the XR 30mg was great. I experienced typical side effects like appetite loss and trouble sleeping...hated the crash so I started taking 5htp, which my pdoc said was fine. Then around day 6-7, I noticed the meds didn't seem to be working as well. From reading these boards, I know Adderall has some better days, works differently depending on estrogen levels in women, etc, so I wasn't concerned. Day 8 was the day that changed everything...

On day 8 of Adderall XR, I had a dr. appt with my ob/gyn for a routine exam. The appt was at 9AM so I took my Adderall shortly before the start of the exam. She listened to my heart and said she heard an "extra beat", and suggested I see an internal medicine specialist. Because I am already paranoid about the sudden death reports in people with heart problems, this random comment ignited that paranoia on some unconscious level. I told myself it was fine and went to the office to make an appt with a specialist. I already knew I had an irregular heartbeat--I'd noticed it since I was a child. I also was told during my 1st pregnancy that I had a heart murmur. But this was the first time a doctor had ever confirmed the irregular heartbeat.

Once back at the office, I started feeling lightheaded. I went down to get breakfast but had no appetite. Started feeling more dizzy and "not like myself." Went to get a Vitamin Water and felt with each step that I might pass out. Deep breathing wasn't helping. I rememberd that aspirin can stop a heart attack/stroke, so I swallowed one, then chewed the second. This probably only made things worse. The symptoms kept multiplying and getting worse...heart palpitations, chest pain, tingling in my left arm, upper jaw pain, weird sensations in my head, tingling in the nerves going up the back of my neck to my skull, shortness of breath, dizziness, and a sense that I was on the verge of a heart attack, stroke or an aneurysm. I was in the throes of the mother of all panic attacks, but I was convinced it was death at my door and ended up in ER. I stayed there for 9 hours while they ran tests, hooked me up to fluids on an IV, did 2 EKG's, bloodwork to check cardiac enzymes (to check for heart damage), a chest x-ray, all while monitoring my heart rate and blood pressure. My blood pressure had been normal that morning at my regular dr. appt, but by the time I got to ER it was high. It eventually came down. I arrived at ER at 1:00 and wasn't seen by a doctor until 6:00 PM!!! I immediately told them about the Adderall upon arrival, so I guess they didn't put me at the top of the list, which was adding to the panic. Because I was so dizzy, they wouldn't even let me go to the bathroom--instead I had to change into a hospital gown and pee in a bedpan. It also didn't help when a lady in a suit came in to ask me for 2 names to contact in case of emergency (like if I keel over) as well as my religion and if I had a designated power of attorney. I was hyperventilating and couldn't calm down. Finally by about 4:00 PM, I started to calm down and didn't need the oxygen anymore...my oxygen level was 100% without the mask, so I stopped using it. It took forever to get the test results, but the final analysis was that my EKG's were normal--they just showed an irregular heartbeat, which the doctor said is normal for many people. He also said I still have a heart murmur, and should see a specialist to rule out any heart problems, but my chest x-ray and cardiac enzymes all were very normal...no damage to my heart.

He said to call my pdoc and let him know what happened, but stopped short of saying the Adderall had caused the episode. He also never called it a panic attack, even though I have a history of them, but have not had one in about 8 years.

Long story, I know...hang in there!

That was 2 weeks ago today--Wed April 29. So I wasn't able to see my pdoc until Monday May 4. He said it all sounded like a panic attack, which I'm convinced now it was. I am under a lot of stress right now with a 15-yr-old typical teenage son who contantly tries my patience. Also a clingy 2-yr-old who is my sunshine but sometimes I need a break! I'm glad her dad keeps her on the weekends! Also I work 2 jobs--a fulltime corporate job 40 hrs a week, then a cocktail waitress on weekends to bring in extra cash. I recently got fired from the weekend job for not complying with an unreasonable request from the owner. This caused additonal stress. On top of all this, there's the ongoing drama of the passive-aggressive behavior of my ex-fiance who called off our wedding last year and one minute says he has feelings for me, but runs away because he fears commitment. This all lends to me having anxiety and also small bouts of depression, so my pdoc prescible Lexapro 10mg. My first antidepressant ever. He said it would help with the anxiety and also wrote a script for .5 mg Xanax to be taken only if a panic attack starts. Wow, I had no idea there was such a magic pill! Of course, I've read all over these boards that it's very addictive, so I only take the Xanax if I start to feel stress/tension that is making me feel on edge and unable to relax. The bottle says to take 2 a day (there are 60 in the bottle), but so far I've only taken about 5 total.

He told me to take the Lexapro and Adderall at the same time in the morning, unless the Lexapro made me sleepy (which it doesn't)

So today is day 9 of Lexapro, and I love it. The pdoc also advised me to keep taking the Adderall, since it seemed to be helping with the ADHD, but since I was TERRIFIED of another panic attack, I wouldn't take it. The mere thought of another panic attack causes anxiety.

Oh, in the meantime I saw an internal specialist who also did an EKG, confirmed the irregular heartbeat and said it did not disqualify me form taking the Adderall. He took blood to check my thyroid and my THS level is .62, well within the normal range.

So today I decided to be brave. After quitting Adderall cold turkey 2 weeks ago, I took my Lexapro 10mg and Adderall XR 30 mg together with a little food about 45 minutes ago. I feel like I did when I first started the Adderall. GREAT! So far, no issues. And I have the generic Xanax, just in case a panic attack starts.

So my question is to anyone out there with panic disorder. I Googled like crazy yesterday but can't seem to find a lot of people managing panic while on Adderall.

I think I'm still going to see a cardiologist, just to be sure there is absolutely nothing wrong with my heart. I feel calm now, but I wonder if I should have made sure the Lexapro had the anxiety completely under control before starting the Adderall again. The pdoc wanted me to keep taking the Adderall, but it's been my decision to be off of it the last two weeks.

I know this is a novel...this is my introduction to the boards as well as an invitation for help and advice. Thanks for reading!!

BoldAsLove
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Old 05-13-09, 10:23 AM
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ndnbutterfly ndnbutterfly is offline
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Re: Adderall and Panic Disorder

Hi! Welcome to the forums!

Sounds like you've been through a lot lately!

Glad you're here!
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Old 05-13-09, 10:29 AM
BoldAsLove BoldAsLove is offline
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Thanks, Nikki

This post is ridiculously long...I really had no idea until I looked at it after posting it. Thanks for the welcome!
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Old 05-16-09, 04:21 AM
Yellow Yellow is offline
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Re: Adderall and Panic Disorder

i posted this with a similar thread regaurding anxiety/panic and adderall, so take whatever you can from this, i thought it might help:


The answer you are looking for is to get on an ssri/snri that is great for anxiety:

SSRIs in my order of anxiolytic strength
#1 zoloft -can be activating with SLIGHT Dopamine reuptake
#2 paxil -slight Norepinephire reuptake which can acutally increase dopamine in freontal cortex but also sedating because of anticholinergic effect, so its like a very weak SNRI
#3 luvox -if zoloft doesnt work and u dont want slight sedation from paxil, id try this
#4 prozac -it can also slightly release Dopamine and norepinpehrine, but if your taking adderall, its negligble probably
(lexapro and celexa arent for anxiety, just depression)

SNRI = Pristiq. after all my research (including reading Stahl's Essential Pscyhopharmacology) and my own trials with a few of the ssri's, i think this is the best antidepressant/anti anxiety (anxiolytic) available. i would try this first before anything else seriously. one dose, 50mg, no titration. it worked for me within 3 days, i was amazed as SSRI's didnt too much for me after a whole month.

now, you can also ASK to add klonopin on as an adjunct as needed when anxiety can become overwhelming. drs usually start at .5mg, but i say start with .25mg instead, or even .1mg (a quarter of a .5mg tab). a dosage as low as .5mg (even .25mg) can lower anxiety all day long. klonopin is the single best anti anxiety drug there is. (xanax might be more powerful in onset as far as stopping a sudden panic attack, but aside from that, stay away)

finally, you might want to ask about tenex, and definitely ask if he doesnt approve of klonopin, as some psychs dont like the mix. it can lower norepinephrine and side effects of adderall. i dont know how it compares to klonopin, but im guessin klonopin would be stronger. still try...

Also, get on generic barr 5mg dextroamphetamine, itll take away half your adderrall related anxiety simply by itself.

SUMMARY: I would try to ask for Pristiq (50mg/day) and Klonopin (.25-0.5mg/day as needed). If Klonopin is denied ask for tenex (.5 mg/1-3x daily). Most importantly, drop adderall and switch to dextroamphetamine (but do not take barr 10mg, get the 5mg pills) and that might solve your anxiety stuff period without adding anything else. if you dont want instant release, get dextroamphetamine/dexedrine spansules which are XR. i was in the same boat as you and this is what finally worked perfect. good luck
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Old 05-18-09, 11:43 AM
BoldAsLove BoldAsLove is offline
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Thanks, Yellow!

You seem to be very knowledgeable abou this, so thank you for sharing what has worked for you.

So far, the Lexapro is working well for me. My mood is improved and I don't experience the rebound effect to any noticeable extent when my Adderall wears off in the evening. Not to mention, I cleaned my bedroom this weekend for the first time in 2 years, and converted my daughter's crib into a daybed (had been procrastinating for months), which I was not able to do w/the Adderall alone! I still can't believe my room is clean. That alone makes me feel such an enormous sense of accomplishment and has improved my outlook on life. Living in a messy, cluttered room for 2 years isn't good for anyone's outlook!

Also, the .5 Xanax (generic) is very useful for times when I seem to be on edge or if I feel as though panic is setting in. As I've only been on the Lexapro for 2 weeks, I am hoping to not need it at all once the Lexapro has had 2-3 more weeks to reach maximum benefit.

If my anxiety isn't decreasing, I will definitely take your advice to drop the Adderall and try the dextroamphetamine XR. Why do you suggest 5 mg instead of the 10 mg? I'm currently on 30 mg Adderall XR. Is the 5 mg dex equivalent to that?
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Old 01-18-10, 04:04 PM
beatrice22 beatrice22 is offline
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Re: Adderall and Panic Disorder

hi everyone,

started taking adderall 8 months ago 20mg slow release and in the past couple months have began to notice higher than usual anxiety. i have had history of what i like to call "light" depression and anxiety, meaning i do not feel at this point in my life that i need anti-depressants and i have had years of therapy and have already tried a number of anti depressants over a very long period of time.
i notice that when the meds starts to wear off i began having heart palpitations a little heavier breathing than usual. at first i was convinced that there must be something wrong with my heart i even took a trip to the hospital because i thought maybe i was having asthma attack. but now i am thinking it is more like a panic attack because i am conviced in the moment i might die and then it goes away and will start hyperventilating the more i think of what might be wrong. i should also mention that i am a hypocondriac and look up medical diseases in my spare time which doesn't help with my panic. i am 26 years old and have had only 2 panic attacks in my life. this adderall is definitely taking my anxiety up a notch and making me more socially anxious. anyway i am surprised there is only a few posts on panic attacks and thought it would help to share.

thanks
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Old 01-18-10, 06:03 PM
kiosk kiosk is offline
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Re: Adderall and Panic Disorder

Quote:
Originally Posted by Yellow View Post
[B
(lexapro and celexa arent for anxiety, just depression)
huh? where u get that from? Lex is like one of best and most selective serotonin SSRIs and top rated for GAD
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Old 02-08-10, 07:51 PM
Mzack212 Mzack212 is offline
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Re: Adderall and Panic Disorder

I have ADD and have been taking Adderall for awhile now. I also suffer from anxiety and panic attacks, brought on by situations where I feel the potential to get "stuck" (meetings, the subway, long dinners out with friends - name a situation where you are at the mercy of others and I've probably had a panic attack because of it). Strangely enough, when I began taking Adderall the anxiety went way down. In my case, on a psychological level, I'm beginning to suspect the ADD had something to do with why I started having them in the first place. My brain was constantly wanting stimulation - to 'go, go, go!' and it wouldn't take no for an answer. Whenever I was in a situation where I had to sit still, pay attention and act like a grown up (I'm 38, lol) the panic attack would begin. I think that because the Adderall helps me concentrate and observe the reality of the situation (I've yet to hear of anybody stuck in a meeting so long that they died of old age) it keeps the aggravating ADD voices at bay.

I also go to therapy twice a week on top of the medication which helps me try to make sense of my life now that I know I have ADD. It's a big help. Everybody's different, both psychologically and physiologically so there really is no right or wrong answer as to why we suffer from anxiety and whether or not ADD medication helps you or makes it worse.

It really is a trial and error process. I had been misdiagnosed with depression and put on so many different types of anti-depressants, none of which worked for me, that I had all but given in to the fact that I would suffer from anxiety and confusion for the rest of my life. The day I found out I had ADD was like a complete rebirth with all the pieces falling into place. It all finally made sense.

Regardless of the Adderall working for me and the benefits of therapy, I still always have my Klonopin in my purse in case it ever comes back because there is absolutely nothing worse than a panic attack. I've yet to take it but knowing I have an "emergency kit" handy makes my life a lot easier.

Just thought I'd chime in on the topic because it hits pretty close to home.
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Old 02-08-10, 11:58 PM
surferdude123 surferdude123 is offline
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Re: Adderall and Panic Disorder

I am taking Adderall XR and Lexapro as well. I have ADD,OCD/GAD


I find Lexapro 10mg qAM with the Adderall seems to work well for Anxiety and obsessive thinking. In fact it's one of the few antidepressants approved for OCD/GAD.

It is a good combination with the Adderall, and I hope it continues working for you (and me for that matter)


I recently posted a post about the difficulty sleeping I experience with Adderall, and what to do about it.

Dex is decent, but as you know Adderall is mixed, and some people preferentially respond to Adderall, over Dex.

I'd recommend taking 1-2 days per week drug holidays as well, that seems to be common theme with any stimulant.
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Old 02-09-10, 12:00 AM
surferdude123 surferdude123 is offline
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Re: Adderall and Panic Disorder

Quote:
Originally Posted by kiosk View Post
huh? where u get that from? Lex is like one of best and most selective serotonin SSRIs and top rated for GAD
yah I would check your sources as well...


Lexapro is FDA approved for GAD/Panic Attacks, and my medical school student affairs coordinator (MD) recommends Lex to most of her "depressed and anxious" medical students.
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Old 02-13-10, 07:26 PM
wmazz wmazz is offline
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Re: Adderall and Panic Disorder

I have tried many ssri's, lexapro and celexia always worked the best. But I still required xanax to get me through the day. After I started taking Adderall, the xanax was no longer necessary. I have never been so calm in my life!, and my BP is great.
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