Question: I have history of anxiety spectrum disorders: PTSD, Illness anxiety, Panic w/agoraphobia, and MDD. Son has been Diagnosed with ADHD and so has my mother. Screening tools indicate me as well. I am an LPC and familiar with adult ADD. I have never taken medication for it however. Panic attacks began in college following symptoms of IBS I perceived to be heart related. Symptom recurred in late 20's in conjunction with first job high stress. Panic disorder led to MDD. Prescribed Elavil and Xanax 3pd @ .5mg. until chronic panic attack subside. Then as needed for anticipatory anxiety. Total course of PD/MDD on Elavil about 1.5 yrs. Learned to manage stress, anxiety, and panic. 3 years ago PD recurs and MDD symptoms begin following work stress. Started Celexa 20 mg with Xanax .5mg as needed for panic attack. I'm reluctant to use Xanax unless coping requires too much effort. Mood stabilized quickly within a month. Although first week on citalopram was quite difficult with increased anxiety. Within 6 months begin to experience weight gain and emotional blunting. I began to taper citalopram on my own and varied between 25-26 hr intervals and when reached evening would skip evening dose and restart taking dose in the am. Began to experience what I believe now to be discontinuation syndrome symptoms. This triggered illness anxieties. This past year work stress significant plus ongoing discontinuation symptoms resulted in continual anxiety and symptoms of MDD. I began to return to 20 mg of citalopram. Two weeks in, experience extreme agitation and fear of "going out of control." GP switches me to Lexipro. First week sedative effect but fear of agitation and of thoughts of "going out of control" persist. Second week apathy increase, emotional blunting, loss of interest and motivation. Mood scores
indicate movement from mild to moderate depression. Agitation / Anxiety spikes requires .5 mg of Xanax. I read that escitalopram is a good SSRI and takes a couple to three weeks to get through intensification of anxiety / depressed effects. But I'm really
scared of the agitation and fear of the thought of "going out of control." Do I press on with 10 mg per day? Do I split dose 1/2 in am 1/2 in pm? Should I stop all together? Primary symptom that really upsets me is the thought that I might "go out of control" and "what if I give in to it." The Xanax does ease this struggle but I know I cannot nor would I want to use this long term. By the way I'm 53 year old male. I exercise regularly. Recent physical and blood test all in normal range.

I am so thankful for your quick and understanding response. I know that we anxious patients can seem skeptical and untrusting. Your response understands this and I am grateful.

I notice that my mind doesn't seem to want to work on problems. If I do some research or reading for my job--I can--but when I stop the mental work--I can't seem to focus on anything. It's like my mind doesn't keep idling. The engine driving thought seems to shut off. This worries me because as a therapist I do a lot of mental work. I'm wondering if this is within the normal range of side effects for Lexapro?

Hello, mood has improved a bit. Mornings are very difficult. It's hard to tell if it's depression or fear of getting out of bed and going to work. I had developed a pattern of taking .25 Xanax in the morning. Then the other 1/2 pill (.25) in about three hours. By afternoon around 3 I noticed mood improve--able to exercise. If needed I'd take .25 around 7 pm and another if needed within 1/2 hour. This routine really seemed to help. Problem with initial dose of the Xanax it would be a bit sedating and this didn't help the dysphoric mood. My doc had given me a prescription for Klonopin .5 3per day. However, Yesterday best day yet--sedated by Xanax but not as dysphoric--didn't need any after the first two .25's. Felt normal! This morning instead of Xanax I decided to try the Klonopin since I had read it sets in slowly...it did and my mood was OK. But after 5 hrs when it would be 1 hour before next dose--mood really dropped--agitated, anxious, fearful--I did not like that effect at all! Did not have this effect as Xanax wore off. I haven't taken the next .5 mg Klonopin yet. Question: Should I stick with the Xanax routine-Or keep trying with the Klonopin? If I continue with the Klonopin and feel panicked on the Klonopin--can I take .25 Xanax? Also this will be 20th day on Lexapro.

Thank you. Should or could I split the klonopin in 1/2 and try .25 ?

Thank you for your encouragement! I took .25 Klonopin this morning and it helped. I thought I'd get through the day not needing a second dose. Had a mild panic attack--should have taken the .25 xanax as you recommended. Instead i took .25 Klonopin. Its been an hour and I can tell its calming me. But there is still some agitation and restlessness. Would it better to continue to wait or would it be OK to take a .25 mg Xanax?

It did eventually calm me last night. Its 4:12 pm. I took .25 K at 8:30 i felt sedated and emotionally blunted. Im feeling a bit more normal now. But had a very stressful social confrontation. I'm concerned about when to take the next dose.