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Suggest Medication For Severe Anxiety

Posted on Thu, 26 Nov 2015

Question: Dear doc - thank you for your prompt answer. I have following clarifications:
since my chemist is asking for the prescription for libraX. Is it possible for you to email me the precription? When should I take it, morning or evening?
How long should I take it and what dose? Is it habit forming? Will it give me a discontinuation syndrome once I leave it?
Should I continue with etizolam along with libraX or it needs to be tapered off since both are for anxiety?

Answered by Dr. Seikhoo Bishnoi (43 minutes later)

Brief Answer:
Take the drug till your symptoms decrease.

Detailed Answer:
Hello again, thanks for asking again

- I am sorry but it is not possible to provide prescription online on this platform because it will not be accepted by chemists. Please visit any GP and ask for prescription.

- Start taking one tab in morning and if needed use it in evening on SOS basis.

- Since it is a fixed dose combination so no specific doses are there. 1-3 tabs per day will be sufficient for control of symptoms.

- It is not habit forming but as the drug also consists of Chlordiazepoxide which is a benzodiazepine like drug so ths might cause some mild form of dependence.

- Tapering over a week will not cause withdrawal. Try to discontinue the use once you become stabilised on Fluoxetine.

- You can take it with your existing drugs without any worries. Continue to take Etizolam because I am advising Librax use for short term only.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (11 minutes later)

Thank you so very much. Have got the prescription. Was wondering if I can do a Skype/video consultation with you today evening. Look forward to hearing from you!!!

Answered by Dr. Seikhoo Bishnoi (3 minutes later)

Brief Answer:
Will be available tomorrow most probably

Detailed Answer:
Hello again

I am sorry but I am not available today. Will be available tomorrow most probably. Busy with some appointments.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (6 minutes later)

I have an important presentation with some XXXXXXX officials on Friday. Think about it is making me nervous whether I'll be able to conduct it well, what if i feel breathless, what if I choke? Don't know how to handle myself between today till Friday and also during the presentation on Friday!
Also what time tomorrow we can Skype/have a video consultation and how to go about it!!!
Also I am feeling more sedated than yesterday and day before....don't know its coz of what!

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
Will be available tomorrow

Detailed Answer:
Hello again

Please don't anticipate anything, you are a good orator so no need to worry. Just try to relax yourself and don't analyse things. Take 20 mg Propranolol before the presentation and this will control the anxiety. This will reduce the chocking.

I might be available for consultation tomorrow, will inform you before. Out of station so couldn't give you time today.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (34 minutes later)

If you can keep it sometime in the afternoon as I have holiday tomorrow and waking up late. Around 1 o'clock should be OK.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
I will try my best for that.

Detailed Answer:
Hello again

I will try my best for that. Afternoon preferably or evening. You will be informed.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (15 hours later)

Dear Doc - Was wondering how and when do v connect?

Answered by Dr. Seikhoo Bishnoi (2 hours later)

Brief Answer:
I will be available tomorrow.

Detailed Answer:
Hello again

I am sorry but haven't reached yet due to some appointments. Will be available tomorrow. I hope you are doing good and symptoms improved after taking Librax.

Thanks.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Seikhoo Bishnoi (8 minutes later)

Didn't start librax. Stomach is lil better. But nervous about tomorrow presentation. Don't why? What would you advice?

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Brief Answer:
Try to relax yourself.

Detailed Answer:
Hello again and thanks for asking a follow up

This is good. As the stomach is relatively better so now reassure yourself that there is nothing wrong. The initial side effects of Fluoxetine usually pass spontaneously in a week. So no need to worry. As you have presentation tomorrow so try to remain calm. Don't think much about presentation and just remain confident. As you have mentioned earlier that you are a good speaker so there is not much need to fear from presentation skills.

Just ask yourself that why are you having anxiety? There is nothing that can precipitate anxiety. You have anticipatory fear that what would happen? or fear of panic. But since you are on good medicines so this will not repeat. Take 20 mg Propranolol about one hour before presentation (as per prescription) and this will control the autonomic symptoms. Keep Etizolam along with you which can be taken if needed. Avoid excess tea, coffee or even carbonated drinks in morning. Have a glass of cold water and drink it slowly over 1-2 minutes and this will help in relaxation. Deep breathing exercise and distraction will help to remain calm.

All these things will make you calm. Try not to anticipate things. Don't have any fear that what others will think or remove any fear of judgement by others. Just keep one thing in mind that you have a fight in ring with anxiety and you have to beat this.

Thanks, Still have doubts please ask again at any time.

Take care

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Seikhoo Bishnoi (19 hours later)

Thank you doc. The presentation went off very well. Am going to dubai on Monday for work. Will be back on 4th Nov. Wanted to check with you the following:
Can I increase fluoxetine to 20 from tomorrow since its a week end? Will I go through the stomach problem with the increased dose or should I wait till Monday?
Wanted to discuss about other medicines . How to go about the mirtaz 7.5 and oleanz 3.75 with the increased dose of fluoxetine.
At what time today we can have video consultation and what is the procedure to fix it.
Do you get fluoxetine 15? If not can I make it 10 and 20 for a week on alternate days and then increase it to 20 or straight I make it 20?

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Brief Answer:
Increase the dose on Sunday. No need to worry.

Detailed Answer:
Hello again and thanks for asking a follow up

No please don't increase the dose to 20 mg tomorrow. You can increase the dose on Sunday. This will help you in better tolerance. Slight restlessness might occur but that will be self limited.

No need to change to doses of Mirtazapine 7.5 and Oleanz 3.75 for some time. Continue to take the same doses till you get stabilised on Fluoxetine. Once you will be on 20 mg dose without any side effect then we will start reducing the dose of Mirtaz. Slow progression will prevent any side effect.

I am sorry I was late today so couldn't see the message. You can fix it tomorrow after 4.00 pm or I will communicate this to you.

No Fluoxetine is not available in 15 mg doses. It is available in capsule form 20 mg. One can increase the dose to 20 from 10 mg without any fear. The drug will be tolerated easily. Don't remain anxious.

Thanks, Still have doubts please ask again. Take care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (57 minutes later)

Would wait to hear from you for tomorrow's consultation.

Answered by Dr. Seikhoo Bishnoi (2 hours later)

Brief Answer:
Sure you will be informed.

Detailed Answer:
Hello
Sure will inform you tomorrow by 3.00 pm.

Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (15 hours later)

Dear Doc, am waiting to hear from you about video consultation. Since i am off to Dubai on monday, will appreciate if we can have it today. Look forward to hear from you. just wanted to know if i have to fix up the timing online and pay online or you will manage it. Awaiting revert!!!

Answered by Dr. Seikhoo Bishnoi (2 hours later)

Brief Answer:
You can fix today.

Detailed Answer:
Hello

You can fix the consultation at 6 pm today.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (3 days later)

Dear Doc, I increased my dose of fluoxetine to 20 mg since Sunday and doing fine in terms of my stomach issues. Also I have reduced olimelt to 2.5 from 3.75 mg in the night since Sunday. The evening Etizolam I have made 1/4 of 0.5 mg since Monday. Mirtaz 7.5 in the night and Etizolam 0.5 in the morning continues. Am more or less fine with anxiety hitting me off and on. I wanted to check if I can increase Fluoxetine to 30 (20+10) as I am carrying strips of 10mg and 20mg fluoxetine for a week and then make it 40. Also should I stop Betacap tr 20 as I reduced it from 40mg a week back.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Please don' increase or decrease the doses by yourself.

Detailed Answer:
Hello again and thanks for asking a follow up

Please don't adjust doses by yourself because this might increase the risk of relapse. Though reducing the dose of Olanzapine to 2.5 mg is a good step. Try to take the same dose for at least 2 more weeks and then you can think of stopping the dose.

Etizolam doses you can adjust as per your needs. If needed in anxiety you can increase the dose of this drug also.

No don't increase the dose of Fluoxetine at this time. Wait for at least one more week and then the dose can be increased.

Yes you can stop the drug. Keep few tabs with you as they can be used in anxiety provoking situations.

Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Seikhoo Bishnoi (55 minutes later)

I am on holiday from 30th till 4th Nov. Was just thinking if I can use this time to increase/decrease dosage of my medication so that I get used to it by time I resume work on 5th Nov.

Answered by Dr. Seikhoo Bishnoi (3 hours later)

Brief Answer:
WAIT TILL SUNDAY

Detailed Answer:
Hello again

Yes you can but wait till SUNDAY. From Sunday increase the dose without any worries. This would not cause any side effects. Don't reduce the dose of Olanzapine from 2.5 mg, continue with the same dose for at least 2 more weeks.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (55 minutes later)

thank you doc for your reply. Where am coming from the fact is that i think i am feeling little better with fluoxetine. You had told me to increase the dose of fluoxetine to 40mg after taking 20 mg for a week. Since i have been taking 20mg for the last four days, i thought of increasing it to 30mg (20+10) from tomorrow and be on it for a week before making it 40mg. Today while attending conference in dubai, when i had to speak (make a short presentation), i started off well but felt breathless towards the end. It happened twice through out the day though i had to speak at many occasions as a participant, therefore, i thought may be increasing fluoxetine to 30 will help me as i can see it helping at 20 but not fully. I had not taken morning betacap tr 20 in the morning, dono this breathlessness happened because of that or something else. i am right now on the following medication:
mirtaz 7.5 +olimelt 2.5 in the night
Fluoxetine 20 in the morning
Betacap tr 20 in the morning (had skipped morning dose just to see how i feel without it, dono whethere i did the right thing)
Etilaam 0.5 in the morning + 1/4 of 0.5 in the evening (i was on 1/2 of 0.5 in the evening, since monday i have made it 1/4 of 0.5, I am consciously trying to taper off etilaam as during our video consultation, you said its not good to be on etilaam for a long time and i have been taking it for more than 45 days now)
since am ok with 1/4 of 0.5 in the evening, wanting to check with you if i can take evening dose for a week and stop it and continue with morning etilaam. Though would like to know what should be the tapering process of morning 0.5
About olimelt you said to take 2.5 for two weeks and then stop it, i have tapered 3.75 t0 2.5 since sunday (its been four days), should i taper it further after a week and continue with tapered dose for a week before stopping it or i can stop 2.5 altogether after two weeks
I personally feel fluoxetine can set me right, therefore, i am keen to make it 30 so that gradually i can come off olimelt and etilaam
sorry for posting a long question, its just that i want my bindaas self back and i think fluoxetine can help me to get that back.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
Increase the dose from tomorrow.

Detailed Answer:
Hello again

Ok you can increase the dose of drug to 30 mg. You might have slight restlessness (though chances are rare) and this will be tolerated because you are on holidays.

Etilaam can be reduced by dividing the dose to half for morning dose once you stop the quarter of tablet of Eitlaam in evening. Then for next one to two weeks Eilaam can be reduced further to 0.125 mg dose and then can be stopped.

Olanzapine can be stopped altogether after two weeks. 2.5 mg dose is minimal dose so no need to worry.

Try to take Betacap 20 on SOS basis especially when you have to attend some meeting or have to present something. The drug is safe and will control the issues related to social anxiety.

Fluoxetine is a SSRI drug and with time the drug will help in better symptom control. No need to worry.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (7 days later)

Good evening Doc - I am back from from my holiday. I am on the following medication as of now:
Fluoxetine (20+10) 30mg in the morning, have increased it from monday from 20 to 30 (its been third day), there is slight stomach problem (slight burning and burping), it has started after i have made it 30mg, hope it will settle down with time and if not, it will start worrying me again
Etizolam 0.5mg in the morning, have stopped evening 1/4 of 0.5mg etizolam since saturday
Olimelt 2.5 + mirtaz 7.5 in the eve
Since i have made fluoxetine 30mg, it takes me long time to fall asleep and i keep on moving my legs while going to sleep (was wondering if fluoxetine causes it, if yes, will it settle with time)?
Is 20+10 mg fluoxetine equal to 30mg or little more than that?
I have been feeling better than before but the feeling of nervousness and anxiety is still there (especially when i wake up in the morning, intensity is more, with the passage of time during the day, intensity goes down). Was wanting to check when would it settle down
Have gained about 2kgs in the last 10 days while i was on vacation, though i was lenient with the diet, was wanting to check if its because of my lenient diet or medication has also added to it, i was weighing about 72kg, now am close to
74kg.
how much weight can increase because of mirtaz 7.5 + olimelt 2.5mg? does fluoxetine also cause weight gain and is it safe for liver since i drink (vodka) over the weekends
What should be the course of action now? I was seeing a doc in XXXXXXX (Dr. Shamsah Soonawala) and have an appointment with her tomorrow, was wondering if i should consult here, she has not added much value though, I am on the medication advised by you
Also, when can we have video chat
Look forward to hearing from you soon!
Regards, XXXXXXX

Answered by Dr. Seikhoo Bishnoi (12 hours later)

Brief Answer:
With time the symptoms will decrease

Detailed Answer:
Hello again, thanks for asking a follow up

Yes the mild symptoms of gastric upset with 30 mg dose will reduce with time. No need to worry. With in a week the symptoms will decrease. Fluoxetine causes mild insomnia in some individuals but most of individuals develop tolerance to this side effect in some days. 20+10 is 30 mg because most of reputed companies make 20 mg and 40 mg only.

The anxiety will settle down with time. No need to worry. The drug is making its concentration in brain and will start controlling anxiety.

The medicine is not implicated in causing much weight gain. No need to worry. If we consider weight gain the risk is not very high. The drug is relatively safe no need to worry. Yes Mirtazapine and Olanzapine are drugs that cause weight gain but the risk can't be predicted.

Yes you can discuss the management with her.

I will be available on Sat or Sun.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (30 minutes later)

I had a terrible night. Didn't sleep at all. And major stomach upset. Don't know what to do!If this continues, I don't think I can take it. Was wanting to check with you if not ssri then what else can help me with my symptoms. Does clofranil help with ocd, anxiety and phobias and does it help with Ibs? Does it have stomach problems and insomnia as side effects? I am actually feeling helpless. Need your sincere advice! I am miserable today, the worst day I would say!Also can I reduce prozac to 20 and add another medicine? How about adding clofranil to fluoxetine 20. At 20 fluoxetine, I was better in terms of my sleep and stomach problem. Sorry if I am asking too many questions, it is just that I am getting worried. Don't know what will set me right! Pls help

Answered by Dr. Seikhoo Bishnoi (2 hours later)

Brief Answer:
The drug side effects will reduce with time

Detailed Answer:
Hello again, thanks for asking a follow up

First of all I'd like to tell you that though Fluoxetine causes reduction in sleep but since you are taking the drug in morning so the risk of side effects reduces significantly. I don't think insomnia in your case is due to Fluoxetine.

Your holidays have just ended and post holidays a lot of individuals see worsening of symptoms. So don't remain worried, with in a week symptoms will decrease. The sleep will improve in a day or two. You can take Etizolam in evening apart from your regular doses.

We have other options of drugs but I will not suggest you to change the drug at this time. In some days symptoms will be controlled.

Don't feel hopeless, you are absolutely normal. There is nothing that is serious. Just try to remain relaxed. Please don't reduce the dose of the drug. Wait for some more days, the symptoms will reduce.

Thanks. Still have doubts please ask again.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar