Brief Answer:
Paroxetine will be better choice for you.

Detailed Answer:
Dear Mr. XXXXXXX,

I went through your query and can understand the dilemma that you are in.

Both Cipralex (Escitalopram) and Paxidep (Paroxetine) aroe selective serotonin reuptake inhibitors (SSRI) and are effective drugs for Agoraphobia and panic attacks. Actually both have been found to be equally effective. Some people respond better to paroxetine and others to escitalopram.

In your case, the choice is very simple. You have had good response to paroxetine in the past. In addition, you had side effect of insomnia with escitalopram. So, in your case, the best option will be to restart paroxetine.

You have to remember that the treatment for anxiety disorders is long term and may have to be continued even for few years depending upon individual cases. Early stopping of medicines leads to a higher chance of relapse. So, make sure that you continue to medications as per the advise of your psychiatrist and don't terminate the treatment prematurely again.

I do hope I was able to answer your query. Please let me know if you have nay further queries.

Best wishes,

Dr. Sunil Gupta

---

Brief Answer:
Please see details below.

Detailed Answer:
Dear Mr. XXXXXX,

Thanks for following up. Frankly, its difficult to comment on whether the drug will work again or not unless we try it. However, as a rule, it is advisable that we start with the same drug that had shown response in the past. Only if it fails, should we consider another drug. Most of the side effects of paroxetine do go off with time. In case, the sexual side effects occur again and are distressing, we would have to consider another medication.

Regarding the timing, I usually prescribe this mediation in the morning. Paroxetine can cause both insomnia as well as sedation, more chances being for insomnia. In case, you feel sleepy after taking the medication in the morning, you can shift in to night time.

I don't think that you need lorazepam or clonazepam if you are able to sleep adequately. It would be better if you take paroxetine alone. In case, you are having sleep difficulty, clonazepam can be taken for few weeks in the initial part of treatment.

Another thing is about the starting dose. You have mentioned 25 mg. I would recommend that you start with 12.5 mg and increase the dose to 25 mg in 4-5 days. This will help you minimize any adverse event and be able to tolerate the drug better.

I do hope that i was able to help you with your questions. Please let me know if you have any further questions. I will be glad to help. In case you don't have any further query, please to close the discussion and rate the answer.

Best wishes,

Dr. Sunil Gupta

---

Brief Answer:
Please see details below.

Detailed Answer:
Dear Mr. XXXXXXX,

Thanks for following up and for your appreciation.

Escitalopram and Paroxetine are both selective serotonin reuptake inhibitors (SSRI) and both are equally effective medicines. None is more superior than the other. It is true that Escitalopram has lesser side effects than paroxetine. However, both are safe and used quite frequently.

Personally, I prefer to use paroxetine in patients with anxiety disorders and escitalopram in patients with depression only or depression and anxiety both. Frankly, I would suggest that you should not worry about it. I have seen patients who have responded to paroxetine when they had no response on escitalopram and even the reverse is true. In your case, like I mentioned before, paroxetine is a simple choice as it has worked for you in past. So, just start with it and we do hope it works well for you.

Regarding the brand names that you have mentioned, all are paroxetine manufactired by different pharma companies. Paxidep cr has only paroxetine while other two has clonazepam with it. I personally will recommend you to use a drug with only paroxetine in it. So, you can go ahead with Paxidep CR.

I hope I. was able to make things clear for you. Please let me know if you have any further doubts. it will my privilege to help you with them.

Best wishes,

Dr. Sunil Gupta

---

Brief Answer:
Please see details below.

Detailed Answer:
Dear Mr. xxxXXXX,

Thanks for following up and considering me worthy enough to discuss your problems with me.

You have classical text book description of Agoraphobia with panic disorder. Agoraphobia is a condition in which a person is scared of being alone in places where escape is difficult like crowds, closed spaces, etc. It is mostly associated with the thought that if something wrong happens to him at such places, how will he escape/survive. Such thoughts are allayed if someone is with the person, as in that case the person feels comfortable that someone is there to take care of him in case any mis-happening occurs.

Usually, it starts with a minor incident in one of the places in which one feels uncomfortable. Later, he starts associating the places with similar feelings and starts avoiding or getting anxious in the same. This further escalates and develops into a disorder.

I do hope I was able to answer that in a language that you could easily understand. I ma sure with proper treatment, you will be able to overcome your symptoms and be back to being yourself again. Please feel free to ask any further queries that you may have.

Best wishes,

Dr. Sunil Gupta

---