[KG] Shannon’s story illustrates some notable points. First, he was fortunate in encountering a psychiatrist who apparently recognised the unique anti-anxiety effects of PLZ and initiated it immediately. Second, the addition of an antipsychotic, noted for promoting weight gain, is not usual, but it clearly worked in his case, since subsequent reducing/ceasing it produced resurgence of symptoms. Third, sudden onset of panic symptoms without premorbid anxiety in someone of that age is frequently associated with melancholic depressive illness. Monotherapy with an SSRI frequently makes patients like this worse — one might have used clomipramine, or possibly even gone straight to PLZ if presented with such a case. It is likely that there is a family history of depression [indeed, Shannon has since told me there is a definite family history of depression and anxiety].

Fourth, advice such as that given by people such as Claire Weeks has its value, but it must be appreciated that without appropriate pharmacological treatment it is inadequate. For those of us who understand MAOIs, and the unique benefits of PLZ, it is difficult to understand how there can be specialist psychiatrists who refuse to prescribe it, which is bordering on malpractice — it is a continuing reflection of the appalling education of psychiatrists in psychopharmacology (how many times have I said that). Shannon is willing to talk with any other sufferers if they wish. Contact me for details.

My story starts with a typical day. I was 30 years old and had a stable job and a 7-year stable relationship. Sitting down one night after work to eat dinner in 1999, I was struck by an all-encompassing dread and was convinced that I was dying — racing heartbeat, mind racing, intense fear and my eyesight looked strange, I was viewing the world in 2D. I later understood that I had suffered my first ever panic attack. I had never experienced this before, nor depression or an anxiety disorder. I somehow slept that night and awoke with the same vision problem and panic feeling. It had not gone away. That morning, I visited my local GP, but he was on leave, so I saw a locum. He prescribed me an SSRI, with little discussion of the side effects that are common and those that are severe. That was when my brain exploded. After the first dose of the SSRI, my symptoms worsened exponentially. I did not associate the ramping up of the symptoms with the SSRI and so kept taking it.

My symptoms now are hard to describe — even now I am reminded of the intense and all-encompassing terror that became permanent. My brain essentially was in hell, it felt like it was tearing itself apart, complete with moving sensations and electric shocks. Worse still was the evil dark place that I now found myself. If there was a hell, I was certainly in it. The feeling of terror is indescribable and was far removed from the panic attack that had taken me to the GP. All that I can say is that I felt like I was spiralling into a black hole, a dark void, accompanied by an evil at the centre that I would not wish on anyone. When later discussing this with my psychiatrist, he advised me that I would not be able to relate to other panic sufferers as I had fallen into the top 1% of severity. Lucky me.

My physical symptoms are relatable. I was a shivering mess, much akin to World War 1 soldiers who were afflicted by shell shock. I could not walk, and getting to a pathologist for a blood test was impossible. I could not sleep and had no respite from the symptoms that were more heightened as time went by. My skin was 1000 degrees, like someone was pressing a hit iron all over my body. Electric shock covered my body and brain. Somehow my mother managed to get me to a radiology practice where I had an MRI. He was praying for there not to be a tumour, I was praying for a tumour, anything that could explain my current predicament. Death was extremely attractive at this stage, not that I was in any fit state to take my life.

After days of this hell, we contacted my GP locum, who switched me from one SSRI, to another, offering no medication to dull the violent symptoms of the last SSRI. With hope that this tablet would free me, I started the second SSRI. The result was the same, time passed increasingly slowly. Minutes felt like hours, and hours felt like days. Finally, after 2 weeks of this torture, my mother took me to the Emergency department of the local hospital where we waited 3 hours — to me it was weeks. When I was seen by the mental health emergency team, they advised me to stop the SSRI immediately and to take 10mg of Valium and get some sleep. I did this and for the first time in weeks slept for 6 hours. Even though I stopped the SSRI, my symptoms only abated slightly. Underneath the above-described symptoms, I also felt what I would later learn was a major depressive episode, something that would be present for the next 3 months.

On contacting the GP again, I was referred to a psychiatrist. My waiting time was 4 weeks! The next 4 weeks seemed to stretch out like years. I began reading a book by the author Claire Weeks about living with anxiety and depression. I read this book repeatedly and probably had memorised every chapter. The book taught me to let time pass and that time was my friend. Every second apparently drew me closer to relief. Do not fight the symptoms he wrote but accept them as the current situation. Above all he was empathetic and sympathetic, and the book helped me focus on something, anything for the next 4 weeks. Finally, my appointment with the psychiatrist arrived. I must have been quite a sight, a twitching mess, with terror etched across my face. My psychiatrist immediately prescribed me an anti-depressant called Nardil. I asked him if this would help me and he responded by saying, “that’s the general idea”, hardly reassuring.

The next four weeks were torture. Petrified of taking another medication, I started on ¼ of a tablet, only increasing to ½ a tablet when I was convinced that this would not make matters worse, as if it could be worse. At the end of four weeks, nothing had changed. Unperturbed, my psychiatrist advised that sometimes he would need to add another medication, in my case Olanzapine. I was losing faith now but desperate to feel some relief, I started the Olanzapine. Weeks past and my weight ballooned. I went from 80 kg to over 120Kg (some months after starting the medications). One day while sitting on my balcony, something drastic happened. Suddenly my vision snapped into place. By this I mean that the two-dimensional world that I had been living in in an instant became 3D again. My extreme terror also disappeared, I felt like laughing; however, I was fearful that this was just temporary. Over the next week, the depression that my mind had sunk into, that complete lack of joy, the inability to feel anything but dread, lifted.

I had my life back!

Over the next 26 years, I have learned much about the medications that I was taking. Many GPs have never heard of Nardil, and other psychiatrists that I have visited would not prescribe it. I thank God that I happened upon my psychiatrist who had the experience to start me on Nardil [KG, the chances of encountering such a practitioner are certainly less than one and 100]. As he said on that first day, the SSRIs are like pistols, shooting a neurotransmiteer at your synapses, whereas Nardil is more akin to a shot gun. A simple explanation for complex processes. He had advised that my severe state required that level of medication. Some 26 years later, Nardil and Olanzapine are still working and have given me my life back [it would be worth considering stopping the olanzapine]. I have had a long career in IT Account Management, have married, have had two wonderful children and many happy memories. Taking me back to that night in 1999, I had resigned myself to my life ending — instead, I have had a rich and rewarding 26 years.

A note on the food and medicine restrictions with Nardil. First, I have had 3 operations requiring general anaesthetics. Each time I have worked with the anaesthetist to ensure that the appropriate anaesthetics were used. The surgeons were also able to use the right pain medication. The surgeries went smoothly and I had no issues. [The website of my international MAOI expert group will be helpful here, we have also published an authoritative review of MAOIs to help surgeons and anaesthetists.] Regarding food restrictions, at first I was paranoid. I strictly adhered to the food restrictions and was ever careful of any headaches. Over the years I have researched the more up to date food advice [see the information on PsychoTropical and my peer-reviewed publications about this]. The food restrictions are massively overstated. I eat yoghurt, drink commercially brewed beer, and eat cheese that is not aged. I do steer clear of red wine, vegemite, salami style meets and aged cheese. Other than I have never had an issue. I am careful to let pharmacists know what I am taking and have had no issues in taking a variety of medications [be aware that pharmacists may give incorrect advice because of false alerts in their computer systems]. So, after all these years, I have tried to understand what it was that caused that initial panic attack. I had never suffered from depression or panic/anxiety and did not lead a stressed lifestyle.

It has taken 26 years for me to come up with a theory. Clearly my reaction to the SSRIs was extreme. I happened upon a report several months ago that listed St John’s Wart as a mild SSRI. This was a light bulb moment. I had taken St John’s Wart leading up to the panic settling in. Could this be the catalyst for my misery? I will never know but will advise anybody to be careful with herbal extracts [KG, probably not].

Finally, a bit about weight gain. I grappled with this for 20 years. I visited several nutritionists, exercise-physiologists and several GPs. Nothing helped. I developed Type 2 diabetes, which Olanzapine is known to precipitate. Only after happening on an endocrinologist and sticking to a low sugar, low carb diet, did I shed all of the excess weight, returning to my weight of 30 years ago — six years later and I am still at a healthy weight. No need for Semaglutide or any other medications [good advice]. My Type 2 diabetes has been in remission for the last 6 years. My advice to anyone who is facing weight gain from medication is to research a low card diet and stick to it for 3 months, only then relaxing it although not returning to full sugars and carbs [agree].

What have I learned since 1999? Always be patient when seeking relief of symptoms. Question GPs and psychiatrists, understand what side effects may accompany medications, and what is a mild side effect vs an extreme reaction. Finally, if several antidepressants don’t work, or even before trying other classes of antidepressants, talk to your health professional about MAOIs. They can be lifesaving. I am a case in point.