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Suggest Treatment For Panic Disorder, Extreme Drowsiness And Weakness

Posted on Sat, 4 Jul 2015

Question: Hi im on holiday abroad just before leaving around 20th may i was prescribed 5mg diazepam and diagnosed with panic disorder. It helped calm symptoms down. For 2 weeks iv been fine.first week of holiday i was fine in thailand then i noticed the problems started in dubai. just the past three days iv been feeling ill again while taking medicine first it started woth extreme drowsiness then ilness i think i may be exerting too much pressure on my body ie going go waterparks and riding in fast bumpy car which i have stopped. Today i slept and woke up evening period took 2mg diazepam and went to the mall in crowded environment and started feeling sweaty faint weak and extremely incomfortable after taking medicine. before medicine, i was just feeling extremely weak. So i took another 2 mg and it made the symptoms more worser so i took the taxi back to the hotel. Now im resting in bed feeling ok. Im assuming it could be low blood pressure? But the discomfort was very extreme And i was considering going going to hospital. I would like to ask whether i should continue the dosage given to me by my psychiatrist of 5mg daily? Also the medicine may have been kept in hot temperatures but now i have put it in the fridge i dont know whether that had any effect on my symptoms. Can i also get more detail explanation as to what could have happened today and why those symptoms occurred and have been occuring past three days even on the medication.

Answered by Dr. Shubham Mehta (31 minutes later)

Brief Answer:
continue drug as directed.

Detailed Answer:
Hello
Welcome to healthcare magic.
I have read your question thoroughly and understand your concerns.

The symptoms which you experienced in mall must have been a panic attack.
Panic attack can cause dizziness.

I would suggest you to continue with 5mg dose.
The probable reason for not responding after drug may be that you have developed tolerance to 2mg dose.
Since when are you taking 2mg diazepam?

The factors which can precipitate these symptoms could be:
1. Low blood sugar levels or dehydration.
2. Fatigue and tiredness due to water parks and riding.
3. Alteration in blood pressure.

Take adequate food and fluids during your trip.

Take your drug as directed by your doctor.

Hope this helps.
Feel free to ask further.

Take care.
Thanks.

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

Follow up: Dr. Shubham Mehta (11 hours later)

No iv been taking 5mg daily not 2 as prescribed by doc. I didnt take diazepam the day before i had the panic attack that could be why it happened? As it was causing drowsiness and i was feeling ill. So i tried to stop taking it to see what would happen if id be able to get off the medicine but unfortunatey i was still feeling ill. I will continue to take the 5mg dosage until i get back and see the psychiatrist with further instructions. I am abit worried about getting of this drug now as iv seen how weak and ill i feel without it just after one day.

Answered by Dr. Shubham Mehta (24 minutes later)

Brief Answer:
continue with 5mg diazepam, SSRIs indicated.

Detailed Answer:
Thanks for the follow-up dear.

Well, the standard practice for treating a case of panic disorder is to start an SSRI like paroxetine alongwith a benzodiazepine (clonazepam or alprazolam).

Benzos are given for short-term, till the SSRIs start showing their effect.

You have been prescribed diazepam and it makes you drowsy.
In my opinion, you should be taking clonazepam or alprazolam.
Diazepam is a long acting drug and can cause drowsiness next day.
Whereas, clonazepam or alprazolam are short acting drugs and does not cause drowsiness next day.

May be, you missed the dose, thats why you suffered a panic attack.

Till you are out for holiday, continue with diazepam.

This drug has not to be stopped abruptly. A gradual tapering is necessary. You will be able to stop it but remission of panic disorder is must before that.

Also, practice relaxation exercises like deep breathing and meditation. This should also help.

Kindly discuss this with your doctor.

Hope this helps.

Thanks.

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

Follow up: Dr. Shubham Mehta (27 hours later)

Thanks doc going back home tomorow will make an appointment and discuss with doc. Last we spoke he gave me the option between diazepam and clonazepam but he advised me to take diazepam 5mg and stay on lowest dosage possible. He said 0.5mg clonazepam is equivalent to 10mg of diazepam which is alot hence he adviced me to take diazepam over clonazepam. Its been 3 weeks or more on diazepam now do you think i should try to switch to clonazepam and for how much longer? or do you think i am ready to try and get off the drugs as you suggested going through that period where i may suffer from panic disorder? Until it eventually goes

Answered by Dr. Shubham Mehta (4 hours later)

Brief Answer:
donot stop drugs straight away.

Detailed Answer:
You are most welcome.

Your physician is right about dose equivalence of diazepam and clonazepam.
But the main problem with diazepam is next-day drowsiness.

In my opinion, you can continue with diazepam.
But the important thing is to begin with SSRIs.
Till the SSRIs start showing their effect, you should continue with diazepam.

Donot stop the drugs straight away.

The decision of treating doctor should be final.

Hope this helps.

Take care.
Thanks.

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

Follow up: Dr. Shubham Mehta (5 days later)

Hi lastly i would like to know whether ejaculation/ sexual imtercourse is permitted while taking medications such as diazepam or ssri

Answered by Dr. Shubham Mehta (30 minutes later)

Brief Answer:
intercoursse is permitted with these drugs.

Detailed Answer:
Hi again.

Yes, sexual intercourse/ejaculation is absolutely permitted with these drugs.
These drugs would not cause problem while performing intercourse.
Donot worry.

I wish you well.
Kindly close the discussion if you have no more queries and give your valuable feedback.

Thanks.

Note: For further guidance on mental health, Click here.

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