Deep Brain Stimulation

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I didn’t know where to post this. If you take a look at clinicaltrials.gov, you can find deep brain stimulation trials for various mental disorders. Strangely absent is panic disorder. You can find people on YouTube who have had deep brain stimulation for depression or ocd, and they have gotten their lives back. Now I know not everyone who gets deep brain stimulation will respond so positively, but I think it’s ridiculous that no one is investigating it for panic disorder. I want nothing more than to have a life like I did before getting this horrible disorder, where I could pursue what I want to pursue in life. I don’t think I will get this without a drastic option like deep brain stimulation, or even vagus nerve stimulation, which no one is investigating either, even though there were a few people who got them before, apparently with good results. Why is no psychiatrist or scientist interested in DBS for panic disorder? They need to be pushed into investigating it.

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Why is no psychiatrist or scientist interested in DBS for panic disorder? They need to be pushed into investigating it.

It has been studied in the past. Deep brain stimulation seems to be fairly effective for depression, borderline for OCD and not worth the cost and potential risks for any of the anxiety disorders. This is also true of ECT, direct current transcranial stimulation, trigeminal nerve stimulation and vagal nerve stimulation. There is some evidence repetitive transcranial magnetic stimulation (rTMS) may be effective for GAD, but less so for the other anxiety disorders, including PD. A relatively high number of patients treated with DBS for depression and OCD have subsequently developed panic disorder.

Medication and therapy are better bets at this time. Therapy, although useful, wasn't the answer for me, but antidepressants have kept my PD well caged since 1987.

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A relatively high number of patients treated with DBS for depression and OCD have subsequently developed panic disorder.

Where is the evidence for this?


Medication and therapy are better bets at this time. Therapy, although useful, wasn't the answer for me, but antidepressants have kept my PD well caged since 1987.

You are lucky.

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Where is the evidence for this?

See, for example: New-onset panic attacks after deep brain stimulation of the nucleus accumbens in a patient with refractory obsessive-compulsive and bipolar disorders: a case report
(https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462015000200182&lng=en&nrm=iso&tlng=en)


You are lucky.

What have you tried?

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See, for example: New-onset panic attacks after deep brain stimulation of the nucleus accumbens in a patient with refractory obsessive-compulsive and bipolar disorders: a case report (https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462015000200182&lng=en&nrm=iso&tlng=en)
What have you tried?

The patient developed panic attacks after a setting adjustment on the DBS. It was reset to previous settings by patient request. Ultimately, it seems he is far better off with the DBS once they got the settings right. I think it’s worth the risk.

I have tried Zoloft, Paxil, lexapro, effexor, seroquel, and klonopin. I’ve seen your recommendations on the site. I may ask the psychiatrist for imipramine next time. I can’t imagine after SSRIs have done so little, that a TCA is going to magically work much better. Hopefully, I will be proven wrong.

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The patient developed panic attacks after a setting adjustment on the DBS. It was reset to previous settings by patient request. Ultimately, it seems he is far better off with the DBS once they got the settings right.

Yes, for OCD. I cited that study because of what it said about DBS being previously implicated in new-onset panic rather than the individual case. The problem with panic attacks is just one can trigger panic disorder which would continue even after the settings are changed.


I think it’s worth the risk.

As per my earlier post, DBS has not been shown to be effective for panic disorder (PD). None of the stimulus treatments have. If you wish to go down that route then try the non invasive rTMS first, not DBS. I doubt you'll find anyone willing to treat you with DBS anyway.


I have tried Zoloft, Paxil, lexapro, effexor, seroquel, and klonopin.

So 4 SSRIs (including Effexor/venlafaxine), an antipsychotic (which are not recommended (https://www.nice.org.uk/donotdo/sedating-antihistamines-or-antipsychotics-should-not-be-prescribed-for-the-treatment-of-panic-disorder) for panic disorder) and a benzodiazepine which may exacerbate anxiety/panic (also depression) by inhibiting hippocampal neurogenesis. For the SSRIs, what was the highest dose taken and how long were you on that dose?


I may ask the psychiatrist for imipramine next time. I can’t imagine after SSRIs have done so little, that a TCA is going to magically work much better. Hopefully, I will be proven wrong.

Imipramine was the gold standard PD med for 2 decades. It dropped out of favour when SSRIs and SNRIs became available not because they are more effective meds, they are arguably less so, but because SSRIs were perceived as being safer in overdose. Turns out that wasn't actually true of all of them with 2 of the ADs you were prescribed being no better in that regard. One of them is significantly worse.

BTW-while imipramine worked well for me,and another TCA continues to do so, the most effective AD I've taken was the MAOI phenelzine (Nardil). Unfortunately, the diet restrictions were an issue for me at the time, but modern food processing techniques have eliminated most of problems and should TCAs become problematic in older age I'll be switching to the MAOI tranylcypromine (Parnate).

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As per my earlier post, DBS has not been shown to be effective for panic disorder (PD). None of the stimulus treatments have.

Maybe it could be shown to be effective, if researchers were willing to look into it.

https://www.researchgate.net/publication/292190331_Immediate_effects_of_vagus_nerve_stimula tion_vns_for_the_treatment_of_panic_disorders

https://pubmed.ncbi.nlm.nih.gov/20633378/

https://www.sciencedirect.com/science/article/pii/S0166432816307069


I doubt you'll find anyone willing to treat you with DBS anyway.

True, hence my post complaining about it.


So 4 SSRIs (including Effexor/venlafaxine), an antipsychotic (which are not recommended (https://www.nice.org.uk/donotdo/sedating-antihistamines-or-antipsychotics-should-not-be-prescribed-for-the-treatment-of-panic-disorder) for panic disorder) and a benzodiazepine which may exacerbate anxiety/panic (also depression) by inhibiting hippocampal neurogenesis. For the SSRIs, what was the highest dose taken and how long were you on that dose?

I was on lexapro 20 mg for a number of years, and Effexor 150 mg maybe a year or two.

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I was on lexapro 20 mg for a number of years, and Effexor 150 mg maybe a year or two.

Which suggests they had some positive impact. So why did you stop? Because they ceased to work?

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Which suggests they had some positive impact. So why did you stop? Because they ceased to work?

I would get in such a desperate panic, I would go to my mom for help. She didn’t know what to do, so she would get me to go to the doctor. The doctor would give me antidepressants. This is basically why I used them. They probably helped a little. But never enough to give me a life.

Actually, I discovered the best way to reduce the panic is by alternating days of taking Effexor. This is what I do now. Doing this has the effect of making me not want to talk to people most of the time. It kind of screws me up socially, but I keep doing it because if I start taking an antidepressant regularly again, the anxiety starts to get stronger after several days. I hate being anxious as hell all day and getting in a state of desperate panic.

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I would get in such a desperate panic, I would go to my mom for help. She didn’t know what to do, so she would get me to go to the doctor. The doctor would give me antidepressants. This is basically why I used them. They probably helped a little. But never enough to give me a life.

So did you take the antidepressants (ADs) daily, or just when anxiety got bad?


Actually, I discovered the best way to reduce the panic is by alternating days of taking Effexor.

Which pretty much ensures venlafaxine won't work. Whatever benefits you're getting from it probably owe more to the placebo effect than the med.

Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

Venlafaxine has a very short half-life, around 15 hours for the XL extended release version. By taking it ever second day you are probably continually switching neurogenesis on and off and essentially training the brain to stop responding to the med. ADs need to be taken daily.


if I start taking an antidepressant regularly again, the anxiety starts to get stronger after several days. I hate being anxious as hell all day and getting in a state of desperate panic.

Unfortunately, that is a common initial reaction to ADs, especially the SSRIs and SNRIs. They can make anxiety/panic worse at the beginning because they initially increase serotonin activity. Despite the common myth, serotonin isn't a 'feel good' neurotransmitter. Just the opposite as you've discovered. However, after a week or two the brain and body respond by down-regulating serotonin synthesis and expression and the anxiety and other side-effects usually begin to diminish, although they may return for a while after dose increases.

Ask your doctor to prescribe a small dose of one of the benzodiazepines (BZDs) to help you get past that initial anxiety/panic surge. If s/he's reluctant to prescribe it then ask for *hydroxyzine instead. It is a prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough. Also, BZDs block the neurogenesis mechanism by which ADs work so take them only when anxious, not routinely just in case. That doesn't mean you should white-knuckle your way through a panic attack as that reinforces the disorder, just don't treat them as M&Ms.


*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.

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So did you take the antidepressants (ADs) daily, or just when anxiety got bad?

Yes, I took them every single day for years.


Which pretty much ensures venlafaxine won't work. Whatever benefits you're getting from it probably owe more to the placebo effect than the med.

Antidepressants have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

Venlafaxine has a very short half-life, around 15 hours for the XL extended release version. By taking it ever second day you are probably continually switching neurogenesis on and off and essentially training the brain to stop responding to the med. ADs need to be taken daily.

I know it’s strange, but I assure you that this does help for me. Believe me or not. I figured this out only because I forgot to take my effexor one day, and I got double vision and cried a lot. But I noticed I was able to do a bit more than I normally could. I experimented with this until I found the smallest dose I could do it with.

Yeah, I’ve had hydroxyzine. I feel nothing when I take it.

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I also get these strange physical sensations in three places: a sort of painful pressure-like feeling behind the eyes and maxillo region, tingling in my forehead, and another weird pressure-like sensation in my cheeks. I once mentioned this on a forum, and someone directed me to trigeminal neuralgia. This makes me think my panic disorder is somehow affecting my brain around where the trigeminal nerve enters the brainstem. I discovered trigeminal nerve stimulation is a thing. There is a device for this for when you sleep. It’s basically for ADHD and I think depression. It has been studied at least a little for PTSD and panic disorder, I think. I kind of want to try it.

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I know it’s strange, but I assure you that this does help for me. Believe me or not. I figured this out only because I forgot to take my effexor one day, and I got double vision and cried a lot. But I noticed I was able to do a bit more than I normally could. I experimented with this until I found the smallest dose I could do it with.

No, nothing strange at all. You're taking a sub therapeutic dose which isn't causing side-effects which has you thinking you're doing better. So why do you want deep-brain stimulation to get your life back?


I discovered trigeminal nerve stimulation is a thing. There is a device for this for when you sleep. It’s basically for ADHD and I think depression. It has been studied at least a little for PTSD and panic disorder, I think. I kind of want to try it.

I covered this in my original reply. It doesn't seem to work for anxiety disorders, but a team at the University of California LA is currently running a phase 1 trial for PTSD. Phase 1 trials are run to determine safety, not efficacy.

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No, nothing strange at all. You're taking a sub therapeutic dose which isn't causing side-effects which has you thinking you're doing better. So why do you want deep-brain stimulation to get your life back?



I covered this in my original reply. It doesn't seem to work for anxiety disorders, but a team at the University of California LA is currently running a phase 1 trial for PTSD. Phase 1 trials are run to determine safety, not efficacy.

I’ll be trying imipramine soon. Woopy.

And yes, I know. A full therapeutic dose every single day for at least 6 to 8 weeks before any determination can be made about its efficacy.

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I’ll be trying imipramine soon. Woopy.

Taking imipramine may not be as exciting as the electronic wizardry, but is more likely to work.