The People's Perspective on Medicine

Hydrocodone for Panic is NOT a Good Idea!

Q. I’m writing to ask your advice about my condition and perhaps get a second perspective on the situation. I’m 28 yrs old and ever since I was 18 I’ve been on anti-depressants, mainly for anxiety and panic attacks.

I’ve tried citalopram (Celexa), escitalopram (Lexapro), sertraline (Zoloft), paroxetine (Paxil), desvenlafaxine (Pristiq) and am currently on venlafaxine (Effexor XR) and bupropion (Wellbutrin XL, which was just added recently). I have also been prescribed alprazolam (Xanax) and clonazepam (Klonopin) to take as needed.

Needless to say, the attacks keep coming and seem to increase around times of gastrointestinal distress. The Xanax makes me loopy and unable to function at work (I have a technical job) and the Klonopin is too subtle to bring me down from a full-blown panic attack.

I have a friend that has chronic back pain and uses hydrocodone regularly. I’ve found that if I take just half of one of her pills it pulls me right out of the panic attack.

I’ve told my doctor this and she is wary about prescribing hydrocodone because of its addictive properties. My question is, has hydrocodone ever been prescribed for panic attacks and are doctors even allowed to (I know there’s govt regulations about this stuff)? Or, can you suggest anything else I might try?

I fear that my doctor is running out of ideas on how to treat this. She has suggested that I see a psychiatrist, which I am, but the first appointment he has available is a long way’s off and a lot can happen between now and then. I thank you for your time and compassion.

A. We are so sorry that you have had to struggle for so long with anxiety and panic. The antidepressants you have taken help some people, but not everyone. And when you stop taking any of them there is always the possibility of withdrawal symptoms, which can mimic your condition, ie, irritability, anxiety and panic.

Alprazolam (Xanax) is fairly short acting, so it too can trigger anxiety or panic as the effect wears off. That means you could be caught in a vicious cycle. Whenever you try to stop any of these medications the symptoms you have been trying to overcome could come roaring back with a vengeance.

We agree with your physician that hydrocodone (Lorcet, Lortab, Norco, Vicodin, Zamicet, Zydone, etc) could be too big a risk. This is a powerful narcotic pain reliever. Here are some of the side effects you need to be aware of even at a relatively low dose:

Hydrocodone Side Effects:

  • Dizziness, fatigue, drowsiness, lightheadedness
  • Nausea, vomiting, digestive tract distress
  • Constipation
  • Impaired motor coordination (technical work or driving affected)
  • Itching, rash
  • Blood disorders
  • Addiction, dependency, drug withdrawal upon stopping
  • Liver toxicity

Getting off hydrocodone can be even more difficult than stopping benzodiazepines like alprazolam or clonazepam or the antidepressants you have been taking. Withdrawal from narcotics like hydrocodone or oxycodone can be challenging.

We strongly recommend that you consider cognitive behavioral therapy (CBT). This form of treatment can be very successful for anxiety and panic. We encourage you to check out a book by Reid Wilson, PhD, titled Don’t Panic: Taking Control of Anxiety Attacks. Then try to find a cognitive behavioral therapist. You may discover that you can eventually control your symptoms without medication.

In the meantime, do NOT stop taking ANY of your medications suddenly! Virtually all the drugs you have taken can precipitate a withdrawal phenomenon. You can learn much more about these issues in our FREE guide, Psychological Side Effects. We have included a list of symptoms and also some strategies for working with your doctor to get off some of these medications. Here is a link to the store where you can find our guides, books and other products.

We wish you the best and hope you can eventually find a way to overcome both the anxiety and panic attacks without a narcotic pain reliever.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I have had panic attacks daily for almost 5 years. I started taking tramadol two years ago, just one in the morning and one and night, and klonopin when needed. My panic disorder has gone down so much!! I don’t have panic attacks daily or anything. Just sometimes. Still working on it but the tramadol saved me.

The only thing that stops my panic attacks is half a hydrocodone which is prescribed for pain from my polymyaglia rheumatica. It works even though my Doctor says it can’t. I think every body responds to meds differently and some times Doctors can’t see beyond the labels. I know hydro is a dangerous drug but after 8 years I am still on the same dose and it is still working. Not for every one, I guess, but it works for me.

Joe, I am in the same situation. I have extreme depression, anxiety and other mental health issues. After being on different meds; doses; cocktails of meds – nothing helps significantly for me to get better.

However, when I take a piece of someone’s foxy, the depression and anxiety subsides more than anything else I have taken and I can actually function for the day??? I don’t get it? Have you found anything new that has helped with your anxiety?

I say this especially because you mention the gastrointestinal problems that correlate with your anxiety.. get thoroughly tested for celiac disease. I say thoroughly tested because they have not perfected the process, and there are different levels of tests. Often celiacs show up negative for the basic tests.

On a final note, I do in fact have major anxiety problems that turn out to have been caused by celiac disease my entire life.
Best of luck.
-Kay

I have taken a low dosage of Inderal and Xanax for panic attacks for years. I discovered this combo when I was diagnosed with
essential tremor. It has really worked for me. I also have general anxiety disorder. Hope this helps someone.

I had a stroke in 2008 at age 50. Prior to that I had taken Lortab for headaches and Klonopin for anxiety. After the stroke I had no problems with headaches or anxiety. I was told that a stroke can “detach” you from reality for a while. After several almost a year later, I started having anxiety and depression symptoms which is common for stroke victims. I also had problems with my head which I call “mental fatigue”. It’s likes my brain has had too much stimulus and I crash mentally and physically.
I found out that when this happens, taking a whole Klonopin and a whole Hydrocodone together relieves that fatigues feeling. I had been seeing 3 doctors for the stroke and told then about it. I starting taking half of a .5mg Klonopin and half of a 5mg/500 Lortab (hydocodone). It relieved the problems with my head at this dose and I still use it as needed. 60 tablets of each will last me 3 months.
My doctors are not really sure why the 2 drugs worked together to help me as well as it does but they all say that as low as a dose and no more than I am taking that its ok to continue. Sometimes I have morning anxiety. My doctor also gave me valium that I take a bedtime. That helps with the morning anxiety about 75% of the time. When I do have morning anxiety, I also have the fatigue problems with my head. When I take the half doses of Klonopin and Lortab, that relieves the feeling. I don’t take any higher dose. I don’t have problems with euphoria, dizziness, sleepiness, or any of the common side effects. Its just works. I take it only when I need it and I have no problems with dependency.

I just underwent cancer surgery and was given hydrocodone for pain. I was on it for about two weeks. I have been suffering an anxiety attack for days; the previous commentators lead me to believe they ‘get’ it. I feel afraid of everything, and everything is a struggle.

Is anyone else having a problem with substitution of a yellow oblong pill with ‘3601’ on it in place of a slightly larger white oblong pill, (both with a ‘v’ on them), for Norco? Just had it refilled, and it is just not working. (For pain, mfr: Qualitest.)

I would recommend hypnosis. I tried it after giving up on everything else, found a VERY good hypnotherapist (you really need to do your research on this), and it did the trick. During regression hypnosis we discovered the beginning of my anxiety as a result of my parents fighting when I was a little kid, along with bad experiences in school. She explained that this “fills the cup” and eventually during adulthood the cup overflows, resulting in anxiety disorder.
Over five sessions she subconsciously “emptied” the cup and removed the source of unjustified anxiety. It also did wonders to help with my procrastination problem.

I was diagnosed with IBS and GERD. I was given two medications (one was Lexipro) after being told that the panic attacks I had just started having were causing the IBS. My quality of life decline dramatically while taking the medications. I could barely leave the house because of debilitating fatigue and mind fog even though my dose was very low. I began to keep a food diary and be more aware of what triggered my gastro problems. I realized that the panic attacks were always associated with the episodes of IBS and not at any other time. As I learned to control what I was eating, (no red meat or caffine, for example) the IBS was less of a problem and so were the panic attacks.
When I quit taking the medicine my doctor was unconvinced I could do without it or that it was a major problem. I found that it was also causing the panic attacks. Don’t let the medical profession convince you that panic attacks are always the trigger. For me they are a symptom. I got the same attitude when I had problems with ulcers (drink milk and relax). After one treatment for H-pylori five years ago I am ulcer free. It wasn’t all in my head at all. Now that I realize that my brain is getting the wrong signal from my stomach, I watch my diet, do something active during an attack (which is much milder and shorter now) and try to control my breathing.
Find what works for you and tell your doctor what you learned. I have a friend who gets panic attacks without any obvious cause. We both agree – her treatment should be different from mine. My advice is to explore the cause of the gastro problems you mentioned. I did and after two years of observing and experimenting, I finally got my life back!

What did help my son with panic attacks is vigorous physical exercise – running and Bikram yoga. However, he still has bouts of panic and has to be reminded that THIS IS A PANIC ATTACK. It is going to pass. Talking to a Cognitive Behavioral Therapist has also been helpful. Panic attacks are very hard for others to understand and deal with. Thanks for the reading recommendations.

My son has suffered from symptoms similar to yours for years. He was given oxycodone for pain at the ER. It made him feel great and over a years time began obtaining it illegally. He became addicted and life became a nightmare. Had to have him arrested for stealing. Court ordered treatment followed, then several months later treatment at a very costly treatment center. He is clean now but battling this powerful narcotic has become a lifelong challenge. I hope you don’t choose to take oxycodone.

While waiting to see the psychiatrist, check out the website eftuniverse.com for very effective free self help for anxiety using tapping on acupressure points. Noninvasive and free of side effects! I have seen many people get excellent results.

PS, fibro fog, forgot to mention this: hydrocodone can make you high and that change in your brain is enough to melt away the panic attack. Not a good idea, all you are doing is covering up what may be a real problem. Plus it is highly addictive. Save it for later in life when you may need it for pain. Taking it now will reduce its ability to overcome pain later.

Years ago I used the paper bag trick and it always worked to stop not only the hyperventilating, but all those generalized feelings of anxiety that came out of nowhere. Just sticking my head in that bag and thinking about what it looked like from the outside, was enough to make me pause and then gain control. It is a matter of building up mind strength so you can be in better control of your body, and of that irrational baby who lives inside your head. Now I still find anxiety building in my head, out of nowhere, but I push my attention away from it, and it has no power over me.
The trick with the exercise is good too, you release adrenaline and breathe faster with an actual physical reason. I used to take a fast walk whenever my heart suddenly started beating a mile a minute. When the exertion caught up with the heartbeats, after a bit I was able to reduce intensity and my heartbeat would drop normally. Aiii, the tricks your mind and body can play on your psyche.
I use xanax for sleep only. I have fibro and sometimes my mind is like a squirrel in one of those wheels, my body tenses up as I long for sleep that does not come and the xanax knocks me out in minutes. Placebo? I’ll take it! But I keep the usage down to no more than once or twice a week, with zolpidem taking over if I am having a really bad week. Staying up all night, in my experience, and having to go to work the next day, can be done too.
I have weaned off several anti-depressants, diabetes medication and neurontin. The trick is to do is slowly, cutting those pills until the amount becomes so small, the next jump is nothing. It could take as long as a few months, to many months, well over a year. You have to keep pushing. However, if long term use of the medication has rewired your brain, no weaning off process may work.
Even if you cannot see a CBT therapist, any therapist that uses talk therapy can be helpful. Since they cannot prescribe medication their entire focus is on talking it out. I personally think that is better, but be prepared for tears as you examine parts of your life you never thought had to do with the panic attacks.
Lastly remember it took 28 years to get to where you are, it is not going to change overnight. And only you can change it. But once done, you will feel so much better!!!

Being somewhat high-strung (bipolar traits but not full blown bipolar), I have long used Wellbutrin, 100 mg q/day, occasionally on bad days. It works in about 4 hours, I swear, even though my Dr. insists this is impossible; “it has to be the placebo effect.” Well, it isn’t. Anyway, due to some severe life stressors in the last few months, I’m finding I now take it almost every day.
In the last few weeks I’m noticing some rather intense anxiety upon arising. It’s like being hit in the solar plexus. Never experienced anxiety like this. Could this be caused by getting more used to the Wellbutrin, i.e., my body is now “asking” for it? If so, this is very irritating. I definitely don’t need to add more anxiety to the picture!

Your doctor is already giving you drugs that are just as addictive as hydrocodone. I have had PTSD since the 60s and have been on just about everything. Xanax is in your system approx 24 hrs and if you have been on it for a while not taking it, trying to stop taking it will cause you to have anxiety attacks, as will hangovers so stop any alcohol, and stay away from caffeine as well.
One of the best ways to deal with this is to get into some very physical activities that does seem to help. I get by now on 10mg of xanax once a day at about 8 pm, that gives the drug time to get into your system and to get to sleep. A panic attack is bad and people who have never had one are lucky and will never know how debilitating they are, but basically it is your brain telling your body that you are in danger and the adrenaline starts to flow you start breathing fast, feeling like you are fainting and end up getting too much oxygen in your bloodstream, you can try breathing in and out of a paper bag to stabilize your oxygen levels.
Once you realize that your brain is playing tricks on your body and that regardless of how you feel you ARE NOT DYING!!! Your brain may come up with some new ways to try and torment you but when you can fully grasp that it is just your brain playing tricks you will be able to cope with this much better, now getting off benzos is a trick I have yet to completely master. Seems like the brain somehow changes it’s wiring and produces more adrenaline and doesn’t know how to turn it off, now don’t waste 40 years making mistakes you can beat this, or at least gain control over it!!! Some days will always be better than others!

I take clonazepam several times a day when I get nervous or anxious– so far it seems to be working.

I had panic/anxiety attacks for years. Seems stress, asthma and even going through menopause made them worse. I was fortunate that Xanax would stop the attack. I didn’t use the Xanax otherwise. Thankfully now they are few and seldom occur. I read a book by Robert Handy and Pauline Neff called “Panic Attacks, their cause and cure.” It helped me a lot when I used the guided imagery relaxation technique they recommended. Thanks for giving the name/author of another book that may help me and others. I appreciate your advice and receiving the newsletter.

I too suffered panic attacks with gastrointestinal issues. What helped me was: regular yoga and exercise (so you break a sweat), learning Mindfulness, being food allergy tested (what causes the gi issues) and probiotics. It is a work in progress, but it is all coming together and I suffer less attacks.

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