Question

I'm 60 and I have severe panic attacks - I'm afraid to be alone or go anywhere alone, and I'm always afraid that I'm going to die. I have had therapy, biofeedback, and counseling, none of which seem to help. My husband is supportive. I'm taking 4 imipramine a day - 1 in the morning and 3 at night. Is there a medicine that would help me better?

Answer

What you describe is called 'panic disorder'. This can be very disabling and it's good to see that you have support from your husband. The fear of being alone may be a 'relative agoraphobia' if you get the panic attacks when going to places with a lot of people, such as a shopping mall. If not, then it is a phobia that may be related to some fear of abandonment. It's good that you have had psychotherapy experience. This should definitely continue in conjunction with your primary care doctor and a psychiatrist.

Imipramine is a tricyclic anti-depressant medication and will do little to help with the panic disorder itself. Many doctors use it for a calming effect and to help the patient sleep at night. Sleep deprivation can be the "gateway" to a depressive neurosis and should be aggressively treated. The primary medication used for panic disorder is paroxetine (Paxil), usually given at a dose of 10 mg in the morning and raised weekly to a working dose of 40mg in the morning. Other medications that are helpful are buspirone (Buspar), which will help with the anxiety (10 mg twice a day), and alprazolam (Xanax), to be taken in conjunction with the panic attacks.

It is extremely important that you discuss your medications thoroughly with your psychiatrist and your primary care physician. It is also very important that you have a complete medical check-up to make sure that you are healthy and all medical problems are well controlled. Endocrine problems, such as low thyroid activity and diabetes, can contribute to the problems and symptoms of any psychiatric disorder. Your primary care physician should check your thyroid function and do complete blood chemistry tests, depending on what is found on your check-up. You should, of course, have concurrent psychotherapy tailored to your needs.