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

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
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 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).