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Suggest Treatment For Anxiety And Panic Attacks
Question: Hello Dr. Solanki -
I have recently, with no changes in medicine, lifestyle, or other triggering mechanism, gotten severe anxiety/panic attacks. The ER doctor gave me a 1mg dose of klonopin to be taken 2-3 times a day as needed, but I believe that the Effexor and Seroquel combination is not effective and would like to perhaps add something or change over to a sister product. I was on Zoloft (SSRI) for 8 years, and was changed to Effexor XR 8 months ago. I take 225mg in the AM, and 100mg Seroquel in the evenings. I notice severe sweats, changes in temperature, (fevers upwards of 100-101F), shaking, bouts of crying (1-2 hour bouts with no trigger). I've also gained close to 20 lbs yet these past 3 weeks have lost the desire to drink (water, juice, anything) or eat. On any given day, I may have 2 glasses of water and a small bite to eat (grilled chicken).
All psychiatrists here have at minimum a 3-4 month waiting period even if recommended by a specialist/
Side effects that I have noticed over the past 8 months include confusion, muscle twitching at night, additional anxiety, and inability to sit still. I've heard that Celexia and Ability as well as Buprofen may be helpful, but again 5 months in this condition is something I physically can not manage.
As for medical history, 5ft7in, 220lbs, no drug use, no smoking, no alcohol use, elevated BP due to the medicine.
Thank you,
XXXXXXX
I have recently, with no changes in medicine, lifestyle, or other triggering mechanism, gotten severe anxiety/panic attacks. The ER doctor gave me a 1mg dose of klonopin to be taken 2-3 times a day as needed, but I believe that the Effexor and Seroquel combination is not effective and would like to perhaps add something or change over to a sister product. I was on Zoloft (SSRI) for 8 years, and was changed to Effexor XR 8 months ago. I take 225mg in the AM, and 100mg Seroquel in the evenings. I notice severe sweats, changes in temperature, (fevers upwards of 100-101F), shaking, bouts of crying (1-2 hour bouts with no trigger). I've also gained close to 20 lbs yet these past 3 weeks have lost the desire to drink (water, juice, anything) or eat. On any given day, I may have 2 glasses of water and a small bite to eat (grilled chicken).
All psychiatrists here have at minimum a 3-4 month waiting period even if recommended by a specialist/
Side effects that I have noticed over the past 8 months include confusion, muscle twitching at night, additional anxiety, and inability to sit still. I've heard that Celexia and Ability as well as Buprofen may be helpful, but again 5 months in this condition is something I physically can not manage.
As for medical history, 5ft7in, 220lbs, no drug use, no smoking, no alcohol use, elevated BP due to the medicine.
Thank you,
XXXXXXX
Brief Answer:
Go for zoloft again or other alternatives as below
Detailed Answer:
Hello,
Thanks for detail reply.
Considering you have anxiety and depression, there are many alternatives.
First of all side effects:
Venlafaxine can cause high blood pressure, fever, sweating and 225 mg is good dose to cause such side effects.This is useful in depression but not so much in anxiety if not tolerated rather it worsen anxiety.
Quetiapine 100 mg is not at all indicated for anxiety. It is responsible for weight gain and may cause panic attack.It is useful in depression particularly in resistant cases and as add on therapy to primary anti depressant.
Your doctor changed zoloft,"I want to know the reason"
Zoloft-sertraline is very good medicine from SSRI group.It is useful and approved for depression as well as anxiety disorder.If you were better on that, as a general principle , zoloft should be started as before.
Knonopin 1 mg 2-3 times helpful to relieve the symptoms but not to treat the disorder itself ,it is like paracetomal in fever.
I think Effexor must be stopped as it is causing side effects particularly blood pressure. Quetiapine also should be stopped as I don't think it is useful.
Onther option is one molecule called Desvenlafaxine(Prestique) , a metabolite of Effexore, is good for treatment of for depression without significant side effects of effexor, even it dose not cause blood pressure elevation.
If I were your treating docotor, I prescribe you Paroxetine CR(Controlled Release) 12.5(also medicine from SSRI group) to start with daily once.If necessary can be increased up to 2-3 times a day. With that klonopin 0.25 to 0.5 mg two to three times a day initially.I would like to also use help of psychotherapy particularly CBT(Cognitive Behavior Therapy) to stop medicines in future.
It is good that you do not have any substance use.But your weight is too high as your BMI(Body Mass Index) is 34 which is suggestive of Obesity grade 1 and high risk of cardiac diseases. So you should try to loose by stopping Seroquine, controlling diet and regular daily exercises. This will also help in your anxiety.
Hope I have answered your query, happy to help further.
Regards,
Dr.Chintan Solanki.
Go for zoloft again or other alternatives as below
Detailed Answer:
Hello,
Thanks for detail reply.
Considering you have anxiety and depression, there are many alternatives.
First of all side effects:
Venlafaxine can cause high blood pressure, fever, sweating and 225 mg is good dose to cause such side effects.This is useful in depression but not so much in anxiety if not tolerated rather it worsen anxiety.
Quetiapine 100 mg is not at all indicated for anxiety. It is responsible for weight gain and may cause panic attack.It is useful in depression particularly in resistant cases and as add on therapy to primary anti depressant.
Your doctor changed zoloft,"I want to know the reason"
Zoloft-sertraline is very good medicine from SSRI group.It is useful and approved for depression as well as anxiety disorder.If you were better on that, as a general principle , zoloft should be started as before.
Knonopin 1 mg 2-3 times helpful to relieve the symptoms but not to treat the disorder itself ,it is like paracetomal in fever.
I think Effexor must be stopped as it is causing side effects particularly blood pressure. Quetiapine also should be stopped as I don't think it is useful.
Onther option is one molecule called Desvenlafaxine(Prestique) , a metabolite of Effexore, is good for treatment of for depression without significant side effects of effexor, even it dose not cause blood pressure elevation.
If I were your treating docotor, I prescribe you Paroxetine CR(Controlled Release) 12.5(also medicine from SSRI group) to start with daily once.If necessary can be increased up to 2-3 times a day. With that klonopin 0.25 to 0.5 mg two to three times a day initially.I would like to also use help of psychotherapy particularly CBT(Cognitive Behavior Therapy) to stop medicines in future.
It is good that you do not have any substance use.But your weight is too high as your BMI(Body Mass Index) is 34 which is suggestive of Obesity grade 1 and high risk of cardiac diseases. So you should try to loose by stopping Seroquine, controlling diet and regular daily exercises. This will also help in your anxiety.
Hope I have answered your query, happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Dr. Solanki -
I was taken from the Zoloft to the Effexor XR because it was believed that the Zoloft had stopped working. I was on 100mg for 8 years and had severe breakthrough depression and anxiety. For the first few months, the combination of Effexor XR and Seroquel did help with the depression but not the anxiety.
I'm not opposed to a medicinal switch or for an added medication - honestly I do not like the Klonopin as all it does is make me drowsy. It does not seem to help the anxiety.
My insurance will not cover CBT or any other psychological programs, and they only allow a psychologists' visit four times a year, but it takes upwards of 5 months just to get in to see a doctor.
I'm not sure how this site works, but would you be able to alter my prescription until I am able to get into another psychiatrist?
I agree with the dietary program - something I have been hoping to work on, but again, while on the Seroquel, that really contributed to weight gain.
I look forward to your thoughts.
XXXXXXX
I was taken from the Zoloft to the Effexor XR because it was believed that the Zoloft had stopped working. I was on 100mg for 8 years and had severe breakthrough depression and anxiety. For the first few months, the combination of Effexor XR and Seroquel did help with the depression but not the anxiety.
I'm not opposed to a medicinal switch or for an added medication - honestly I do not like the Klonopin as all it does is make me drowsy. It does not seem to help the anxiety.
My insurance will not cover CBT or any other psychological programs, and they only allow a psychologists' visit four times a year, but it takes upwards of 5 months just to get in to see a doctor.
I'm not sure how this site works, but would you be able to alter my prescription until I am able to get into another psychiatrist?
I agree with the dietary program - something I have been hoping to work on, but again, while on the Seroquel, that really contributed to weight gain.
I look forward to your thoughts.
XXXXXXX
Brief Answer:
See Detail Answer
Detailed Answer:
Hello XXXXXXX
Thanks for information.
Yes you are right klonopin can cause sedation and drowsiness but when you take it 0.25 mg or half of that , it does not cause drowsiness in most of the patients and works as anti anxiety medicine.
Zoloft should be used up to 200 mg.And when patient get episode when stable on it, some other medicine like klonopin or etizolam or buspirone should be added to that, it should not be totally stopped and replaced as it was effective since long.
For alteration on your medicines following are the option from which you can choose.It is not feasible to change your prescription through this site. But whatever we discussed, you can tell to your GP doctor and ask him to change the prescription.
You can start Zoloft again and increased 50 mg every week and reach up to 200 mg as it is the optimum dose.you can take it in 2 or 3 divided dosage.During this you can reduce effexor every week 75 mg after zoloft reach 100 mg and stop.Take klonopin 0.25 in the morning and afternoon.
Another option is Paroxetine controlled release(12.5) which you can start at night and increase after 15 days if you feel improvement is not satisfactory.You can add second dose in the morning.After more 20 days of adding second dose still you need more improvement you can add third dose in afternoon.You need not to take klonolpin regularly with this.You can take on required basis if you feel more anxiety specifically mouth dissolving preparation 0.25 mg. Effexor can be stopped same as above.
You should stop quetiapine after you stop effexor completely.completely. Seroquel you can stop gradually decreasing 25 mg per week.It will help in weight reduction also.
Hope, this information would help you.
Regards,
Dr.Chntan Soanki.
See Detail Answer
Detailed Answer:
Hello XXXXXXX
Thanks for information.
Yes you are right klonopin can cause sedation and drowsiness but when you take it 0.25 mg or half of that , it does not cause drowsiness in most of the patients and works as anti anxiety medicine.
Zoloft should be used up to 200 mg.And when patient get episode when stable on it, some other medicine like klonopin or etizolam or buspirone should be added to that, it should not be totally stopped and replaced as it was effective since long.
For alteration on your medicines following are the option from which you can choose.It is not feasible to change your prescription through this site. But whatever we discussed, you can tell to your GP doctor and ask him to change the prescription.
You can start Zoloft again and increased 50 mg every week and reach up to 200 mg as it is the optimum dose.you can take it in 2 or 3 divided dosage.During this you can reduce effexor every week 75 mg after zoloft reach 100 mg and stop.Take klonopin 0.25 in the morning and afternoon.
Another option is Paroxetine controlled release(12.5) which you can start at night and increase after 15 days if you feel improvement is not satisfactory.You can add second dose in the morning.After more 20 days of adding second dose still you need more improvement you can add third dose in afternoon.You need not to take klonolpin regularly with this.You can take on required basis if you feel more anxiety specifically mouth dissolving preparation 0.25 mg. Effexor can be stopped same as above.
You should stop quetiapine after you stop effexor completely.completely. Seroquel you can stop gradually decreasing 25 mg per week.It will help in weight reduction also.
Hope, this information would help you.
Regards,
Dr.Chntan Soanki.
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you Dr. Soanki -
I had thought that this site would allow a specialist to change my medication so I'm somewhat disappointed in the inability to do so. It's not a reflection of you, just something I'm disappointed about.
If you were to advise to one of the two options: Zoloft or Paxil, which would you feel is the safest and most effective option? Would it also be beneficial to combine it with something like Lexapro, Wellbutrin, or Cymbalta? Would it hurt if I were to add Lunesta as a night pill as one of the reasons for the Seroquil was to aid with sleep.
Thank you,
XXXXXXX
I had thought that this site would allow a specialist to change my medication so I'm somewhat disappointed in the inability to do so. It's not a reflection of you, just something I'm disappointed about.
If you were to advise to one of the two options: Zoloft or Paxil, which would you feel is the safest and most effective option? Would it also be beneficial to combine it with something like Lexapro, Wellbutrin, or Cymbalta? Would it hurt if I were to add Lunesta as a night pill as one of the reasons for the Seroquil was to aid with sleep.
Thank you,
XXXXXXX
Brief Answer:
Sorry for limitation of site, please see below
Detailed Answer:
Hi XXXXXXX
I can understand disappointment of yours.Actually without seeing and examination of the patient before, doctor can not change the prescription legally.I am sorry for your inconvenience.
Zoloft is very good in terms of tolerability as it does not cause significant side effects and you had taken before that is advantage.You should go for first choice.
Paxil is superb medicines for anxiety as per my experience. However sometime it causes headache,dizziness and sedation and in some lengthen the ejaculation time also.But most of the patients with anxiety tolerate it well and like you will also tolerate.But use it second choice.
No need to add lexapro as this is SSRIi like zoloft and paxil.
Wellbutrin can be combined with is as it is useful in depression without sexual side effects.
Cymbalata would be more useful only when you have pain like symptoms otherwise better choice is Desvenlafaxine(Prestique) as is is also SNRI like symbalta.
Yes you can add lunesta for sleep disturbance during or after stopping seroquel if you would suffer from sleep disturbance.
Hope I have answered your query,I will be happy to help further if still any doubt or clarification needed.
Regards,
Dr.Chintan Solanki.
Sorry for limitation of site, please see below
Detailed Answer:
Hi XXXXXXX
I can understand disappointment of yours.Actually without seeing and examination of the patient before, doctor can not change the prescription legally.I am sorry for your inconvenience.
Zoloft is very good in terms of tolerability as it does not cause significant side effects and you had taken before that is advantage.You should go for first choice.
Paxil is superb medicines for anxiety as per my experience. However sometime it causes headache,dizziness and sedation and in some lengthen the ejaculation time also.But most of the patients with anxiety tolerate it well and like you will also tolerate.But use it second choice.
No need to add lexapro as this is SSRIi like zoloft and paxil.
Wellbutrin can be combined with is as it is useful in depression without sexual side effects.
Cymbalata would be more useful only when you have pain like symptoms otherwise better choice is Desvenlafaxine(Prestique) as is is also SNRI like symbalta.
Yes you can add lunesta for sleep disturbance during or after stopping seroquel if you would suffer from sleep disturbance.
Hope I have answered your query,I will be happy to help further if still any doubt or clarification needed.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you so much!
If my most recent episode was indeed related to Seratonin Syndrome, wouldn't getting back on Zoloft produce an adverse effect? The symptoms that sent me to the ER were very similar to what which I could find about SSRI syndrome. I believe that's also why I was switched to an SNRI.
It is too bad that you do not to telepsychiatry via Skype or other product so that I could indeed get my medicine changed.
Best,
XXXXXXX
If my most recent episode was indeed related to Seratonin Syndrome, wouldn't getting back on Zoloft produce an adverse effect? The symptoms that sent me to the ER were very similar to what which I could find about SSRI syndrome. I believe that's also why I was switched to an SNRI.
It is too bad that you do not to telepsychiatry via Skype or other product so that I could indeed get my medicine changed.
Best,
XXXXXXX
Brief Answer:
No it is not serotoninsyndrome
Detailed Answer:
Hello XXXXXXX
Welcome back.
No 100 mg zoloft if you have taken for pretty 8 years, it does not cause serotonin syndrome.If it is so, it can occur with effexor also.So just relax.
You can restart zoloft without hesitation.
Again sorry for limitation of the site.Hope in future medical laws will improved and patient can get prescription for psychiatric problems online.
All the best XXXXXXX
Dr.Chintan Solanki.
No it is not serotoninsyndrome
Detailed Answer:
Hello XXXXXXX
Welcome back.
No 100 mg zoloft if you have taken for pretty 8 years, it does not cause serotonin syndrome.If it is so, it can occur with effexor also.So just relax.
You can restart zoloft without hesitation.
Again sorry for limitation of the site.Hope in future medical laws will improved and patient can get prescription for psychiatric problems online.
All the best XXXXXXX
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you -
I was able to speak with my GP who suggested switching directly from the Effexor XR 225mg to Paxil 20MG and to keep the Seroquel for the meantime. Do you feel that this would be an effective switch or just wasting my time?
Thanks,
XXXXXXX
I was able to speak with my GP who suggested switching directly from the Effexor XR 225mg to Paxil 20MG and to keep the Seroquel for the meantime. Do you feel that this would be an effective switch or just wasting my time?
Thanks,
XXXXXXX
Brief Answer:
yes it can be effective
Detailed Answer:
Hello XXXXXXX
You can switch directly. Initially for a week keep cover of klonopin round the clock.Use paxil controlled release formulation if possible, so you would have no side effects and can tolerate well.Dose matters on severity of your problem.
From my experience I can say paxil would be effective for you.
Have good health and Early stability,
Dr.Solanki
yes it can be effective
Detailed Answer:
Hello XXXXXXX
You can switch directly. Initially for a week keep cover of klonopin round the clock.Use paxil controlled release formulation if possible, so you would have no side effects and can tolerate well.Dose matters on severity of your problem.
From my experience I can say paxil would be effective for you.
Have good health and Early stability,
Dr.Solanki
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
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