Panic Disorder and GERD

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I am at my wit's end lately so decided to join this board and see if I can get some insight into what I can do to help myself get better. I have been researching on the net and I'm afraid I have not seen much in the way of hope when it comes to finding a cure for GERD. Many years ago I was diagnosed with a hiatus hernia, then later on GERD (and was taking Omeprazole for it until about a month ago.) I was lucky that I rarely had symptoms. The worse was that every now and again I would eat something that would set off my stomach for a couple of days, tops. I didn't realize how lucky I was until I began reading the accounts of people suffering from GERD and other stomach problems...it seems that so many continue struggling with pain. :(

In my case, a few months ago I had a huge glass of orange juice one night that precipitated a bout that has yet to leave me. Chocolate, caffeine and anything citrus killed me so I have cut those out (well, I still have one coffee a day but it doesn't bother me.) I began to think "ulcer" so asked my Dr. to send me for an upper GI series and to do a blood test for the H Plylori bacteria...I know it's standard to have an endoscopy but as I explained to my Dr. I have such a phobia about it I have terror about it and will do anything to avoid it. So we are at an impasse. She gave me a new prescription (Rabeprazole) to take twice daily but my symptoms aren't getting much better. I have also been taking 1-2 tbsp of apple cider vinegar daily, since I read that works wonders, and I do believe it soothes some of the symptoms. Yet with all this, I have bad days when I experience pain as if the medication isn't working, and the dietary changes are for naught. :(

I don't even know why I am typing this now, other than that this has been a bad day. I hope someone can give me some tips on what path I should take from here...
 
Hi Hollygirl, I hope your anxiety gets better. I found that fooRAB that contained gluten brought on a lot of anxiety and even palpitations. It used to be that only 1 in 5000 were thought to have Celiac Disease (a hypersensitivity/immunoallergic reaction to gluten, a protein found in wheat, barley, rye and cross-contaminated oats). Now the current thinking is that 1 in 133 Americans have Celiac Disease. I have been on a gluten-free diet since January 2007 and noticed my GERD decrease by at least 50%. Pepcid wouldn't have much effect on that GERD, but once I eliminated gluten from my diet (and checked all my medications for possible gluten content) the Pepcid started to work again.

I'm interested to hear your experience on AcipHex (rabeprazole.. I think it is generic now?). I have taken Prevacid and recently tried omeprazole in a low dose. Here's what happened to me with those medications:

. Soon after taking Prevacid I felt a "generally ill" feeling
. My food just never seemed to digest and would regurgitate it at night and almost choke on it (sorry to be graphic hehe)
. I began to develop pains in my bones and joints.. it hurt pretty badly
. I felt depressed during this time too
. 10 days into treatment with Prevacid I experienced a high fever and more bone pain, so I had to quit it

I tried Prevacid again a week or two later as a rechallenge and had bone pain and fever within 3 days. Pharmacist said that is a hypersensitivity reaction.

I tried omeprazole at a low, low dose and it gave me bone pains again. :-(

I think I must avoid all PPIs now. Is that what happened to you on AcipHex?

RegarRAB,
Paul
 
I also have panic disorder (have had it for 21 years).

The medications used to treat panic disorder can aggravate acid reflux, such as the benzodiazepines because they have myorelaxant (muscle relaxant) effects and this relaxes the LES (lower esophageal sphincter) allowing acid to reflux into the esophagus.

I take alprazolam (Xanax) 1mg qid (4x/day) and have been on that for a long time, yet it is very effective for my anxiety. I don't have any panic attacks while on this medication.

It is common for people with panic disorder to also be on SSRIs. I don't take those anymore, but I have read that they are harsh on the stomach and increase the risk of upper GI bleeding by 7 fold. (7x increase in risk of bleeding) In fact, it happened to me after taking a low dose of Prozac for 2 months and had to be hospitalized. Before my stomach began to bleed I felt a constant burning "lit match" feeling 24/7 in my stomach.

Are you taking any pain relievers such as NSAIRAB? (aspirin, ibuprofen, naproxen, etc)? Those can cause gastritis and ulcers by themselves. H. Pylori infection causes 80% of ulcers and NSAIRAB cause almost all of the rest.

I had an endoscopy and it isn't as bad as it sounRAB. I tried it without sedation event though the gastroenterologist didn't want to perform the procedure without me receiving IV sedation (he wanted to give me lorazepam/Ativan IV to cause sedation, but I refused).

Anyway, he sprayed Cetacaine, a local anesthetic, in the back of my throat and told me to swallow when he put the flexible tube in and I did that just fine. I felt like gagging a few times and he said men are more prone to the gag reflex than women.

The procedure only lasted a minute or two. It is really mind over matter with endoscopy. The prodecure is so short and you can get a shot of Ativan to help calm you down. It is very safe and effective and will reduce your recall of the endoscopy.

There is another way to look for H. Pylori without undergoing endoscopy. There is a breath test that can be done. You drink something (I forgot exactly what it was... urea perhaps?) and the doctor can check your breath for H. Pylori.

The good thing is that if it is H. Pylori, you'll only have to take some medications for 7 to 14 days to kill the bacteria. Then your stomach will begin to heal itself and you shouldn't have gastritis again unless you become reinfected (H. Pylori is contagious and can be caught via kissing or poor hygiene).

The irony here is that eradication of H. Pylori sometimes results in GERD.

Untreated, H. Pylori can result in ulcers or even stomach cancer. If you are on omeprazole for the rest of your life it probably won't give you an ulcer, but your risk of stomach cancer will always be there.

Have the breath test if your doctor can do that. I think it will be more comfortable than undergoing endoscopy, but if I had to undergo endoscopy again, I would surely do it. You only have to swallow at a specific time and it isn't painful. It just feels strange and makes you want to gag, but you can focus or meditate on other things to try to reduce gagging. It is such a short procedure though.

Good luck. I do know from a psychiatrist in Pasadena, CA that there is a strong correlation between GERD and panic disorder. He believes this to be due to bile reflux caused by improper CCK (cholecystokinin) release. Too much bile is released because of CCK and then, because bile is alkaline (opposite of acidic), the stomach overproduces acid in an attempt to bring the pH of the bile down.
This results in acid reflux. However, bile can reflux and although bile is not acidic, it is far too alkaline and can cause damage to your esophagus and also symptoms in your stomach, including diarrhea or IBS-like symptoms.

Xanax seems to inhibit CCK and reduce bile reflux.

If you take a proton pump inhibitor and it isn't reducing your symptoms, it is time to ask your gastroenterologist about bile reflux.

Sucralfate (Carafate) works well for bile reflux by coating it and thus preventing the stomach from overproducing acid against the bile. That's what the psychiatrist said (he's also a neurologist).

Good luck... sorry for the long post.
;-)

Paul
 
Hi Zoe. Clonazepam is a benzodiazepine with potent anticonvulsant activity and a lot of myorelaxant (muscle relaxant) action too. This will cause the LES to relax and allow reflux to occur. If you have obstructive sleep apnea (OSA) too, this drug can worsen it by relaxing the muscles and tissues in your throat so that you snore more and experience more apnea. There's a link between sleep apnea and GERD too.

Anxiety can cause GERD or stomach upset since anxiety increases gastric acid production. Your doctor was really trying to help with that, although I think Pepcid or another H2 blocker such as Zantac or Axid could help too. (Avoid Tagamet because it causes too many drug interactions and even hormone irabalances due to its anti-androgenic effects).

If you want to discontinue clonazepam, you can ask your doctor about switching to an equivalent dose of diazepam and then gradually tapering off. Diazepam (Valium) is the longest acting benzodiazepine so it leaves your body very slowly. A lot of folks say it is relatively easy to taper off diazepam..the easiest benzodiazepine to discontinue. :-)

You can take Carafate, but can't take it at the same time you take any medications as it will interfere with their absorption. It should be taken 2 hours after you take your medication or an hour before, but ask your doctor or pharmacist to be sure.

I hope you feel better. I am now on Pepcid 40mg bid (2x/day) and it keeps most of my reflux under control. It is more important to prevent nighttime reflux though since reflux while you are asleep is much more dangerous since it just sits there in your throat and esophagus causing damage during your 8 hours lying relatively still. When my acid reflux is under control, I know I feel much more calm. Pepcid (famotidine) is cheap too and there is a lot of room to increase the dose. The maximum dose is 160mg qid (4x/day) in the most severe cases of GERD or Zollinger-Ellison Syndrome.

An example of a benzodiazepine without many muscle relaxant or respiratory depressant effects is oxazepam (Serax). It is generic and has a wide therapeutic index. You could taper from clonazepam using diazepam and switch over to oxazepam later if you want. It is the only FDA-approved benzodiazepine that I know of that has the least amount of cognitive effects and drowsiness, etc. You can have relief of anxiety with it and at the same time not feel much in the way of sedation, which is good. It also has low abuse liability due to its very slow absorption (i.e. very unlikely to cause a "buzz".. drug seekers don't like it). I wish I could take that, but where I live it is not approved (Indonesia). When I go back to the US I'll try to get on that.

RegarRAB,
Paul
 
I really think you should get a endo, it the best way to get checked for any problems with the esophagus and such. I had my endo in April it took 15 min and I felt great afterwarRAB, no side effects at all, the medication I got was a wonderful drug, it was a twilight drug that only last a real short time so you wake up feeling great, I can't remeber name it starts with a V. Get the endo you won't regret it. Hope this helps. Take care
 
I've had panic disorder for 30yrs under control with xanax, GERD for13yrs. Nexium has worked the best but there are days of throat burn or sour stomach even when taking the Nex. I seem to go in cycles, something will set it off for weeks and then suddenly be gone over night, I do not even know what set it off or what sent it away. It drives me nuts because it is never the same thing. I really am so tired of this disease, it's always something, sore throat, sour stomach, chest pain, throat burn,no matter if there is heartburn or not.
 
I also wanted to let you know I too suffer extreme anxiety, Im afraid of any medical proceedure and I hate medicine, I think I'll die if I take anything but advil . I take prilosec now, but was on aciphex which I swore made me sick and left me feeling awful. Endo is really nothing, you can do it.
 
Hello guys. I also suffer from gerd, bile reflux, but also ocd. So my problems started when i came from great britain feeling very ill, with many symptoms, from muscle aches to lack of coordination. no doc knew what i had so theyh just sent me 2 the psychiatrist. my parents didnt believe me either. after months and months i found out i had lyme disease. my dad still doesnt believe me. in the meantime, i had a car accident and my grandpa died, whom i loved very much. right now, after treatment with abx, i developed bad episodes of gastritis and i took omeprazol, like an idiot. right after finishing omeprazol, the terrible bile reflux set in like crazy. so right now i cant take antidepressants for my ocd, bc of the stomach and another doc prescribed a diff kind of ppi, but i wonder if all of them r just plain idiots. bile reflux is alchaline isnt it? why do they prescribe stuff that reduces ur acid to 0, causing even more bile reflux?
My question is knightrider, do u think i should continue to take zoloft, even though it makes mys tomach crazy- it was the only thing that helped my constant ocd stress, together with clozapine. clozapine, the antypsychotic made me sleep very deep but kept me feeling so great and relaxed at daytime. Do u think clozapine would relax my sphincter even more? I know its some kind of dopamien antagonist right, kind of like motilium isnt it? so im thinking i just need my old treatment back and the physiological problems would resolve. Please a piece of advice anyone? Thnx
 
Hey Paul, do you think Clonazepam makes reflux worse or better? I was prescribed it along with my PPI. I want to ween off of it, but I'm scared it'll make my reflux worse, not to mention the withdrawal symptoms I'll have. I don't even know why I was prescribed it exactly, but my doc said to relax my stomach or something.

About carafate, can you take that while on a PPI at the same time? Or you have to do one at a time? I also heard Carafate makes you nauseous, and since that's my main symptom, I'm afraid to try that too. Thoughts?
 
I am withdrawing from xanax and lamictal (very slowly-for a year now) and am having horrible digestive disturbances since doing so. I have panic disorder and got to a point where the meRAB were making me feel worse after a few years. I thank these meRAB in the beginning but i hate them now, i feel like some muscle or something won't close and that they ONLY should have been prescribed to me short term. I am on the last .06 (1/4 of .25 mg) mg of xanax and it is by far the hardest part yet (physical). Does anyone know your les muscle, etc. can heal after a benzo withdrawl? This is hellishly awful and i have a sore in the back of my throat i can see and my throat is constantly swollen. Ppi's seem quite useless for me unfortuanately and i keep losing weight b/c i can only eat very small amounts of food at a time....5 months now, came on overnight. The dr. doesn't know what is causing it. He thinks its caused by stress but i have been feeling soooooooo much better mentally the more i get off of these.

If anyone has any ideas of what i can do to finish getting off of this or has ever heard of what is happening to me and if i will eventually heal. Thanks for your time and very interesting posts.
 
hi, how are you doing with your bile reflux?
i also have bile reflux and i'm suffering terribly from burning all over my stomach, abdomen and even my back. Please help me if you are getting well with yours. Thanks
 
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