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Have anxiety, GAD. Taking xanax. Taking Prozac and Cymbalta for depression. Having panic attack. Help?

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Practicing since : 2004
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I DESPERATELY need advice. I have severe anxiety, GAD. I also get intense anxiety attacks with the standard feelings of worry, despair, hopelessness. I have been taking 2mg of Xanax to control my attacks for years as well as Prozac and Cymbalta for depression and to help prevent the anxiety levels from areaching the attack phase. About 10 days ago, I had to go to the dentist to have a tooth pulled. I was starting to have a panic attack bec I have had a very bad experience with the dentist the previous two times I went. So on the way I took 2mgs of my Xanax. Now, I hadn't eaten nor slept in several days due to the pain from my tooth and infection in the gums. Only a few minutes after the Xanax started to work, it hit me way harder than usual. Not only was my speech slurred, but I was dozing off and my wife had to fill out all my paperwork. Afterward, I do not remember getting the tooth pulled, the ride home, during which we stopped at Dairy Queen and I ordered something totally out of character for me. I also don't remember the rest of the day or night. However, according to my wife, I continued to take more of my Xanax, either bec I couldn't remember or refused to believe that I had already had my daily dose. So in around 13 hours I had 11 bars of Xanax or 22mgs. I even drove my grandfather to work at 3:40 a.m. Luckily I wasn't killed. Nothing like this has ever happened before. But apparently, I DEMANDED that my wife give me all of HER medication despite having taken 25, 1mg Xanax in less than 24 hours.
After I returned from taking him to work, my wife and I got into an argument that quickly turned into a severe physical altercation, or so I'm told and the physical marks on both us corroborate this fully & completely. I strangled, dragged her, threw her, and tried to pull her wedding rings off (by bending her fingers back), slashed at her with something that cut her fingers, face, and body severely, etc. and even stabbed myself apparently with a knife then bleached & washed it (I assume I was setting up a self defense of some kind). As if that wasn't enough, when her Mother arrived to help her gather her things and leave, I pushed and shoved her Mother around and ultimately attacked her with a frying pan, my wife hit me in the back with a folding step stool to get my attention away from her ailing and disabled mother. When she did this I felt nothing, I can only tell you these things from what was told to me after my arrest and several days later, essentially I lost SEVERAL DAYS OF CONSCIOUSNESS (Three to be exact). The police were called and I spent the next 5 days in jail charged with Domestic Violence Assault, Simple Battery, & Aggravated Assault. Even after everything that I did to her during the two hours or so of assault, when I was bleeding, she applied a pressure dressing to stop the bleeding until paramedics arrived. Despite it all, she loves me with all her heart and couldn't stand to see me in pain. However, after she treated my wound, I assaulted her again...forcing her face down on the ground in a choke hold in an attempt to break her fingers to retrieve her wedding & engagement rings. Also, I must digress that she has SEVERE lumbar injuries from an on the job accident while lifting an emergent patient when no one came to help, despite her calling a CODE BLUE.
I have hurt her so deeply, and emotionally, mentally, and physically...I don't know why this transpired.
Despite all that has happened, she is still by my side pushing me, supporting me, and helping me in any way possible to conquer my addictions & bad habits.
My court date is set for the first part of December of this year, 2013. I'm going to discuss all the legal aspects of this with my lawyer. Since then, I have allowed my wife to control and dose out all my daily controlled substance medication including my pain meds that I take for complications due to Lupus. I have vowed to never take ANY Xanax again, due to the fact that besides the fact that it does help my anxiety, I do like it A LOT more than is healthy.
However, of course, my anxiety and panic attacks have not disappeared. I have tried over the past 8 years Klonopin, Ativan, Valium, Buspar, Cymbalta, Seroquel, Lithium, etc. Some of them helped minutely to prevent an attack, but whenever an attack ultimately did occur, it manifests itself in terms of severe chest tightness, hyperventilation, flushing, tics, stuttering, and even the sensation of my tongue rolling in on itself. The only options for relief are the Xanax, or a trip to the ER. The problems with the first is that although I'm rarely home alone, it does happen and I'm even more prone to attacks when I have no one to help me talk it through. And I vowed to my wife not to take Xanax ANYMORE in order to prevent the events that occurred that hurt both the love of my life and our relationship from happening again. The issue with the second option, a trip to the ER is that I am unable to drive, if I happen to be home alone. I can't afford to pay for Ambulance rides several times a month. And if my wife IS home, it is so impractical to go to the ER every time I have a panic attack, especially considering their answer is to give me a shot of Ativan and most likely a small script of the same and refer me to my PCP to follow up with basically the same treatment, a new script of Ativan.
I need advice. The only thing that seems to really help me, hurt my relationship that day. But if I keep going like this, it's gonna hurt more than just my marriage, but my mental and emotional health. Plus my children have no clue of what has been transpiring behind the scenes, nor would either me or their mother want them to.
I desperately need to go to in patient treatment that will allow me to take my Dr prescribed pain medications, I have state medical care but so far we've had no luck finding a program (even an outpatient program).
Please help me find an anxiety medication that I can speak to my Dr about....I am willing to try to ANYTHING that might help with my transition from who I was to someone my wife can once again trust and me proud of. Please help.
Sincerely, XXXXXXX
Posted Tue, 22 Oct 2013 in Sexual Problems
Answered by Dr. Ashish Mittal 2 hours later
Brief Answer:
Xanax use need to reduce in your case.

Detailed Answer:
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     28 year old male
•     Known case of GAD, Depression and Lupus.
•     Currently on Prozac, cymbalta and Xanax
•     Complaints of: Frequent panic attacks

From the history it appear that you are having primary problem of severe anxiety and panic attacks which is leading to depression in your case.

2 mg of xanax is very high dose. Usual dose range is 0.5 to 1.5mg for anxiety and panic patient. It is used for short term and on demand basis to prevent addiction of this drug which is very common in anxiety patients, which further increases anxiety in long term.

Prozac (fluoxetine) and cymbalta (duloxetine) are good medicine for long term control of anxiety and depression. But you are not responding them to well. There may be following reason for poor response which need to be addressed in your case:
-Addiction of xanax: You need de addiction from xanax gradually, as on chronic and high dose use, it can itself increase anxiety due to tolerance and withdrawal.
-Stress in life
-Concurrent medical illness
-Substance use like alcohol and excessive caffeine (tea, coffee and cold drinks)
-Vitamin deficiency: Start milk, eggs and multivitamins in diet
-Thyroid problem: get T3/T4 and TSH assay done.
-These medicine are not effective or not effective in current dose in your case

These medicines are prescription medicines. So, you can request your psychiatrist to focus on these issue.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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