Brief Answer:
Yes, it is possible for medication to be stopped.

Detailed Answer:
Hi XXXX,

It is nice to know that you are doing well on medication since 2010. It appears that you are disheartened after your attempts to reduce your medications were not successful. However, there is no need to feel discouraged. In my experience, there have been many patients not only of panic disorder, but also of more serious disorders like psychosis and bipolar disorder, who have been able to maintain well without medication.

Your efforts to reduce medications may not have been successful because of various reasons. Some unexpected stress might have come up and disturbed you. But that doesn't mean that your future attempts to reduce medicines would also be unsuccessful.

In my opinion, you can try to reduce your medicines under your doctor's supervision, keeping the following points in mind:
1) Choose a time when things are relatively stable in life, both personally and professionally. Do not attempt reducing medicines at a time when upheaval is expected.
2) Reduce only one medicine at a time. I would suggest that you start with Xanax as it has some dependence potential and half the battle will be won, once you can come off it.
3) Once you reduce a dose, continue on it for a few weeks at least. Do not be in a hurry to reduce further until you are sure that you are stable on the reduced dose. For example, try reducing Xanax by 0.125 mg (half of a 0.25 mg tablet) initially and stay on this dose for a minimum of three to four weeks. Once you have been successful in making even such minimal changes, you will gain in confidence and shall do even better.
4) Do not fear what will happen if you worsen on reducing the dose because there is nothing to lose. The worst possible thing that can happen will be that you will have to go back to your previous dose. So do not torture yourself with self-doubt.
5) Try to avoid worrying about little things and try to live a regular life. You have been off drugs of abuse and stay that way. Daily exercise and regular life style will help.
6) If possible, learn and practice relaxation exercises like deep breathing. They are very helpful in anxiety disorders.

Have faith in yourself. Others have done it and so can you.

Hope this answers your query. Feel free to ask if you want any clarifications.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

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Brief Answer:
Yes, you are on the right track.

Detailed Answer:
Hi XXXX,

Thanks for writing back.

I agree with you that the best thing would be start with Xanax, followed by Socian and then Cipralex at the end.

But with Xanax, you will have to be very slow and cautious as it is liable to cause withdrawal symptoms in the form of anxiety. So do not go from 1 mg to 0.5 mg at one go, as it may be difficult to handle. Just reduce by 0.125 mg (half of a 0.25 mg tablet) in just one dose initially and see how your body reacts. So if you are taking 1 mg thrice a day, take two of the doses as before and reduce one dose to 0.875 mg (1 tablet of 0.5 mg + 1 1/2 tablets of 0.25 mg). Keep reassuring yourself that if this doesn't work, you can go back to the previous dose. The key is to go slow and to allow your body plenty of time to adjust to the new dose.

Hope this works for you.

Please feel free to ask if there are any queries. However, if there are no further clarifications, you can close the discussion and rate it.

Best wishes.

Dr Preeti Parakh,
MD Psychiatry

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