Brief Answer:
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Detailed Answer:
Dear Mr. XXXXX,

I read your query and can understand your concern regarding taking two anti-depressants together.

You have mentioned that you have been diagnosed with panic disorder. It would been better had you provided details regarding your symptoms too. Panic disorder is a condition where a person suffers from sudden exacerbation of anxiety which lasts for variable period of time and can be associated with feeling of dying or impending doom. In between the episodes, a preoccupation regarding developing further episodes remain.

Panic disorder is treated effectively with medication like selective serotonin reuptake inhibitors (SSRI). Nexito is Escitalopram and paxidep is Paroxetine, both being SSRIs. Generally it is preferable to use one drug at a time for adequate duration and adequate and tolerable dose.

I am not sure whether you felt any relief while you were on Escitalopram (Nexito). The maximum recommended dose of escitalopram is 20 mg. It might be possible that your psychiatrist considered that escitalopram was not effective for you and hence decided to use paroxetine. When we start another drug and stop another, generally cross tapering is done. I fell your psychiatrist must be tapering the dose of escitalopram before stopping it. That is why, the dose has been brought down to 5 mg/day from 10 mg/day. Sudden stoppage of escitalopram could lead to discontinuation symptoms and increase in anxiety.

So, most probably, escitalopram will be stopped in due time and you will remain on single anti-depressant. Usually, more than one anti-depressant is recommended only if trial of at least two anti-depressants for adequate time and adequate dose is not be found effective.

I think you should talk to your psychiatrist regarding your prescription. I am sure he will clear your doubts and explain what he was intending to do.

I hope I was able to answer your query. If you have any further questions, please feel free to ask.

Regards and best wishes for a speedy recovery,

Dr. Sunil Gupta

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Brief Answer:
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Detailed Answer:
Dear Mr.XXXXX,

Thank you for following up. I am glad to hear that you are doing fine with the treatment and you haven't had any further panic attacks for last two years.

I do understand your concern regarding medications and their safety. However, the medications that you have mentioned are very safe as well as effective. Generally, it is difficult to say exactly how long the medications has to continue. It all depends on how a patient responds and whether he remains completely off symptoms while taking medications.

Generally, if someone is symptoms free for 1-2 years, tapering of medication very slowly can be tried under close supervision. If the symptoms don't appear again, the medications can be stopped, but if they do, the medications will have to be continues. you can rest assured that the medications don't cause any damage to your brain, rather they are beneficial.

In order to decrease the need for medications and allow easy tapering later on (which has to be done only after your treating psychiatrist decides), you should start exercising on a daily basis. That will help you relax.

Hope this information was helpful. If you have any further queries, please feel free to ask. If not, you can close the discussion and rate the answer.

Best wishes.

Dr. Sunil Gupta

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