Question: Major Panic Attack or Seritonin Syndrome.. I started Effexor xr 75 mg on Thursday May 17th. By Monday morning I noticed I was weighing in a few pounds light, thought it was great at the time. Abs were cracking more than usual so I was happy. I felt great, happy and clear until about 4pm I took 3 hits of strong marijuana and had a massive panic attack that put me in an ambulance. The attack lasted nearly an hour. The syncopy started as I stood up and I just couldn't gain my ground. I took Xanax the night before if that matters. Im ok now, but don't know how to proceed. I stopped taking the Effexor. I guess my question is, would I have had this attack if I had waited for my body to adjust to the Effexor, or is this a sign that this medicine isn't for me.

Dr. Stuart Shipko Says...:

Although drugs such as Effexor are prescribed for anxiety, it is not uncommon for the serotonin based antidepressants to precipitate serious panic attacks when they are first started.  The marijuana probably also played a role in this panic attack, as both the marijuana and the Effexor affect the autonomic nervous system.  Many people are able to use marijuana and antidepressants, but it was probably worse for you since you had just started the Effexor.  Often the serotonin based antidepressants are initiated along with a benzodiazepine such as Klonopin or Ativan to prevent the initial anxiety/panic that may occur.  It was probably a good idea for you to stop the Effexor, as you likely would have had more panic attacks.  This is a pretty common side effect.  You can still take this category of medicine.  One strategy to prevent initial anxiety/panic is to start off at a very low dose.  Another strategy is to start the medication with a benzodiazepine.  You should avoid marijuana at least until you are stable on the medication. 

Question: I am at a loss . No one really wants to help me and everyone said it's my fault because I let my kid get a license, which gave him freedom to leave small town. Now he's in the throes of loving to smoke weed. I can't reason with him, and he tells me he smokes it, and now that I know what it smells like, He has not hit the other drugs, as far as I can tell. I can tell. He's so close to 18 and I just am not sure what to do to not lose him forever. He listens to underground rap and well, he wants to look like them and well, I am not a millionaire

Jim LaPierre Says...:

Thank you for connecting with us. I totally understand the feeling of being concerned about your son as he is on the cusp of becoming an adult. I certainly would not fault you for allowing him to get a license as this is an important life skill. I would say the best you can do is express your concerns to your son and I urge you to do so without being overly critical of his those he looks up to. Relating to our children as adults is a huge transition. Share concerns without judgment and be patient. As a father who has been a young man and raised a young man I can tell you that at 18 we know everything and as Mark Twain noted, "By the time I was 21, my father (or mother) was the smartest person I knew. It's amazing how much he learned in three years!"

Question: Have a son, 17, who thinks smoking weed is fine. I didn't notice it at first, so it seemed like I condoned it. I am now seeing that he won't eat my food,(so skinny) talk to me, be home. He still has good grades, but all his friends are leaving him. He is beginning to lie to look good. I have tried talking. I haven't really taken any thing for I guess I don't want him to runaway or go into deeper drugs?? He's not skipping school. Just being late and becoming truant late... (2 to 7 minutes)

Jim LaPierre Says...:

Hi there and thank you for writing to me! I would encourage you to talk openly and honestly with your son about marijuana. For many adolecents, marijuana use can be a sign that something is amiss - but perhaps not in the way you might think. Many folks use marijuana to medicate anxiety, Attention Deficit Disorder, and depression. I would encourage you to talk with him about the benefits he experiences from use and discuss different ioptions for getting his needs met.

A lot of what you're describing is what most would call normative teenage behavior. I do not excuse or condone your son breaking your rules for the family. I do want to share with you that what you've described does not set off red flags for me as an addictions counselor nor as a father of two healthy adults.

I love that you're concerned - it shows how much you care. Please share that with your son and see what's possible. Please write to me if I can answer questions or be helpful.

Question: I quit marijuana 2 weeks ago and my tinnitus is through the roof. When will it go away?

Dr. Stuart Shipko Says...:

This is a pretty uncommon symptom, and I don't think that the phenomenon has ever been studied.  It is so uncommon that I went online to see if anyone was posting their experiences on marijuana withdrawal tinnitus.  People have reported withdrawal related tinnitus.  From what I could learn from the posts, it looks like it takes a few months for the tinnitus to resolve.  Tinnitus is an extremely common symptom and can result from a variety of medical conditions and medications.  It would probably be a good idea to see your doctor to make sure that the tinnitus is not due to an unrelated medical condition.

Question: I plan on doing a very gradual Suboxone taper. I tried a fast one before and it was HELL so I am going to do it smarter this time. I keep reading about people using Imodium and that it takes away a lot of the withdrawals because it is an opiate but here is where I am confused. For example, if I was taking 8 and I went down to 7 and then to reduce the withdrawal symptoms I used loperimide for 2 or 3 days once I stopped using loperimide wouldn’t I feel just like I had when I went down originally from 8 to 7. What I mean by this is isn’t using loperimide just keeping my opiate receptors from returning to normal while I use it and thus defeating the purpose of the taper in the first place? My plan is to do small drops every week to 10 days and to use loperimide for the first 2 or 3 days after each drop. What do you think about this?

Jim LaPierre Says...:

Hi there and thanks for reaching out. I applaud your efforts at tapering and your goal of being free of the substance. To be perfectly candid with you, going down 1mg every seven to ten days is totally manageable. Adding loperimide seems unnecessary to me. I get your thinking here and I agree that keeping your opiate receptors from returning to normal is counter productive. We always want a little something to take the edge off and we always seem to come up with a back up plan. Keep it simple - 1mg a week is manageable. I get that it's scary and rough but you can do this! Good luck to you!

Question: Can you get addicted to steroids? How can you get addicted to a drug that does not make you feel high?

Jim LaPierre Says...:

Hi there and thanks for your question. Unfortunately, yes - we can say that people become addicted to steroids because they continue to use despite negative consequences. The high of steroids is not the euphoria that it is with other drugs - it is more about achieving the desired outcome. I encourage you to reach out to your primary care physician and discuss your concerns. I would predict that your recovery process would be relatively pain free in terms of withdrawals, but it's always best to err on the side of caution and ensure that we do things in the safest way possible. Good luck to you!

Question: I am new to cocaine I only tried for the first time 2 weeks ago. It was unbelievable. Since then already I have already been snorting it 2 or 3 times a day. I am already needing bigger amounts to get as high. This feels so good but already I am scared about addiction. Can it happen this fast in only a couple of weeks?

Zelik Mintz Says...:

With cocaine, becoming psychologically addicted is more the issue than physical addiction.  Cocaine's effect is very seductive because the high produces strong elation and illusions of power.  Because the high is so short lived, the user tends to need to use often in order to sustain those feelings.  And resistance can build very quickly with one needing more and more to reach the initial high.  If you have been using for 2 weeks and it makes you feel "unbelievable" and already you are using throughout the day and need more and more, it is best to stop as soon as possible.  The escalation you describe suggests that there is likely some degree of self-medicating that is motivating your cocaine use.  Although physical addiction is secondary, physical side effects of cocaine is substantial irritability when the high wears off and, with long term use, a physical deterioration.  It may be useful to go to an NA (Narcotics Anonymous) meeting to experience the destruction that cocaine addiction can cause.  

Question: I am a heroin user. I dose every 12 hours or I start getting sick. In the last 3 weeks I noticed that by about 10 hours I start getting a lot of hives and then after I dose these hives disappear. Is this normal or am I allergic to not being high (haha). I realize this is a help site but with school and work I just can’t deal with withdrawal now.

Jim LaPierre Says...:

Hey there, thanks for your question. I'm intrigued by your use of the word, "dosing." I have no interest in judging you. I point to this word because it feels like a gross rationalization. You're self medicating? I get that. Heroin for you is medicine - cheap opiates take the edge off anxiety and pain. That you can function (I assume pretty well) in school and work is rare with using at your level and frequency.

Are you allergic to being not high? Hardly. Your body is starting withdrawals at the ten hour mark and your addiction is demanding to be fed. I'm wondering if you've been through withdrawal before - guessing you have. The first 72 hours are hell and it's progressively better from there. Take a week off and do a medically supervised detox. You'll do better work, get better grades, and avoid going further into hives and hell. Wishing you the very best.

Question: How do you look at dealing with the Addiction of Alcohol compared to other drugs? I know some say A drug is a drug. Although I agree to some extent, there are different components that one drug carries from another..

Jim LaPierre Says...:

Hi there and thanks for your question. Yes, as they say, "addiction is addiction, is addiction" and yet there are differences and some of them need to be acknowledged and addressed. In my experience 95% of what we have to deal with is ourselves and in order to do that we have to be clean and sober. The other 5% can be dealt with bit by bit. Food addiction is unique in that it's the one addiction that I HAVE to continue using in a healthy way. Alcohol is unique in that no matter how hard I try, I can't stay away from it - (it's in every store I go into). I think focusing on what divides us and what the distinctions are drives us away from each other. My choice is to focus on what unites us, connect to others (even after all my healthy years I'm still no good alone other than brief period of solitude) and choose what I'm moving toward and not just what I want to get away from.

I'm not sure what your journey looks like but I hope that it includes amazing people and the recognition that you're one too (most of the best people I know are in recovery). Good luck and blessed be!

Question: I can’t stop marijuana I am dependent in that I need it many times every day or I start to feel quite anxious and ill. I have tried stopping many times but I can’t make it for more than 2 or 3 days before it gets to be too much. It’s weird. Even though I knew that I could not stop I never considered it that I was addicted and dependent on marijuana because I did not really think of the herb as that kind of substance. Last night I went to my first NA meeting. I was really nervous before going in and then honestly the whole time I was there I felt like a poseur who was just smoking herb next to these guys with hardcore heroin habits. I am never going to feel comfortable in that scene but I do not know what to do to stop?

Jim LaPierre Says...:

Hi there - thanks for your question. Everything you're saying suggests to me that you've been using marijuana to self medicate anxiety. My guess is that you struggled with feelings of nervousness or worry before you started smoking and now those same feelings are returning but with greater intensity. The key to your recovery would be to find strategies to cope with emotions other than using marijuana.

We never really just eliminate something from our lives - we replace it. I strongly recommend talking with your doctor about a non addictive medication for anxiety - something like Lexipro or Celexa. I urge you not to make comparisons between yourself and others in NA. If something makes our life unmanageable than comparing it to stronger substances is just going to make us feel bad. I would urge you to get the NA workbook and complete it - it will challenge you and help you to consider how you can get what you need and feel okay without herb.

I also urge you to share your goals and hardships with friends and family. The change you're seeking is too hard to do alone! I wish you the best of luck and please write again if I can be helpful.