Hello and thank you for your excellent question. It's a good one. Panic disorder, along with all the other anxiety disorders like generalized anxiety and medication management along with psychotherapy. Most of my patients once they are so-called controlled by the medication, are desirous to try to get off the medication after a length of time on the medication. There's no problem in attempting this, however what tends to occur is that once the patient goes off the medication, the symptoms of anxiety generally return. The anxiety symptoms may not recur right away, which lulls the patient into thinking that they are Cured of their disorder. The inevitable fact is that anxiety is an incurable disease that will almost always recur after treatment has been withdrawn. The question then begs to be asked, after what length Of time off the medication and out of treatment, does the anxiety return? The answer to that question is simple, we do not know. Every patient is different. In some patients the anxiety returns very rapidly, not long after the stoppage of the medication. In other patients, there may be a big lapse of time prior to symptoms of anxiety returning. There are no good studies that can give you a statistic as to the likelihood of anxiety returning after cessation of treatment. A reasonable clinical estimate would be that about 80% of the time, anxiety symptoms will recur when
A patient stops his/her medication. Because of this fact, I usually counsel my
Patients not to be so hasty in desiring to stop the medication, particularly if it is working well. One compelling reason not to stop medicine while it's doing well for you is the following: once you stop medication and then your symptoms recur, you may not respond as well the second time around to the same medication regimen as you took the first time. Every medication trial is a new trial, as if you had never taken it before. Therefore there's no guarantee that it'll work as well the second time or subsequent time around. So I hope this answered your question adequately. My best advice to you is to continue to take the medication on an ongoing basis, as long as the benefits outweigh the adverse effects or side effects of the medicine. Of course, if the medication you're taking is not helping you adequately with your symptoms, you must tell your psychiatrist about this and have your psychiatrist Adjust the medication in order to give you or at least attempt to give you a better response. Thanks for your interesting question. Don't hesitate to contact us again if you need further follow up on this question or for any other questions you may have. Thanks.

J. Clive Spiegel MD

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Thanks so much for your follow up question. The medication you are currently taking is an EXCELLENT regimen! If these medications are treating your anxiety symptoms to your satisfaction, then you should continue the medications as prescribed. There is no reason to stop them at this point if you are benefitting from them, because you've only been on them for a short while and your anxiety will surely worsen if you go off the medications now. As for your liver, cholesterol, sugar, etc., there is NO DANGER to you from these medications as I see it. You are a young and healthy man an so while you are on these medications, your blood and urine can be checked once a year by your regular primary care doctor. Your bloodwork on an annual basis
Should always include a fasting lipid profile, thyroid function tests and the basic
Blood count, electrolytes, liver and kidney profile and hemoglobin A1C to check for diabetes. Apart from that, you should have no other concerns or worries. Keep doing what you're doing. I hope this addresses your additional concerns. Don't hesitate to follow up with me further if you feel the need. Again thanks for
Your excellent questions.

J. Clive Spiegel MD

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