Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 34 year old female • Known case of severe panic, anxiety and depression for years • On Zoloft for 12 years • Complaints of: exacerbation of symptoms for some duration and worry of skin reaction with Lamictal. While treating psychological problems choice of treatment depends on severity of symptoms, personal preference, past treatment response history and availability of treatment. Considering this following steps will be helpful in your case: -Although chances of serious skin reaction with lamictal use are rare (around 1 in 1000 patients), but if you have worry, then you can request your psychiatrist to stop it or avoid use in your case. -Effective dose range of Zoloft is 50 and 200mg per day. As you have responded well to Zoloft in past then it is better to increase zoloft dose (if being given less than 200mg per day) gradually. Apart from this there is need to find out reason for exacerbation of anxiety and depressive symptoms, as concurrent treatment of these issues will bring fast relief. Following are common causes for exacerbation in previously stable patients: -Vitamin deficiency: specially b1, b6 and b12. Healthy balance diet is beneficial in such cases. -Thyroid imbalance: Specially in female. You can get your thyroid profile (T3/T4/TSH) to rule it out. -Excessive use of stimulants (amphetamines, cocaine, caffeine), so stop use if present. Reduce tea, coffee and cola drinks use as these contain caffeine. -Side effect of substance use: Stop smoking and alcohol use (if present). -Anemia (low hemoglobin level) 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. Regards,

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