Question: I have recently developed panic attacks / anxiety. I see a therapist and am working on it that way. However, it doesn't seem to be getting better very quickly, so I am considering medication solutions and I want to see a psychiatrist.

Ironically, the anxiety seems to be primarily triggered by doctors or medical facilities and pretty much anything related to them. I'm sure it was caused by a recent trauma, but just knowing that and knowing that my fears aren't really logical doesn't make the panic go away.

I am currently on Effexor 150mg, but this was prescribed years ago for depression. My family doctor also gave me .25mg xanax tablets which I can take when I have a panic attack.

The xanax scares me a little bit. I don't know how safe it is, and I have really tried not to take it. I don't want to become addicted. I have to admit that it absolutely does work to break that panic cycle. I don't know how long my family doctor will be willing to give that to me. I'm sure that I have not overused it yet.

What I have noticed is that I tend to get very anxious the week or so before I have to go to the doctor. Then when I'm there my anxiety is horrible. My blood pressure is always high when I am at the doctor (but not when I'm not) and my pulse often goes up to 115-120 when I'm there. After I am done and don't have to go for awhile, my anxiety subsides unless I have some even minor medical problem. Then I get very anxious, not because I'm afraid I'm going to die, but because I'm afraid I'm going to have to go to the doctor.

So what medication would you suggest? Is the xanax safe to take? I will need one maybe every couple of days before an appointment, and then probably not more often than once per week or two between times. Will taking it that frequently lead to tolerance or addiction? Since my anxiety is episodic, is it better to take the medication as needed or would it be better to take something regularly to prevent it?

I'm afraid to go up on the Effexor because it absolutely does raise my diastolic blood pressure. I noticed about an 8-10 point increase when I went from 75 to 150 mg and that was before I developed these panic attacks. It's not an especially common side effect, but it is a known one. Besides, I don't have anxiety all the time, and I think it does absolutely nothing for the panic attacks.

Thanks for the information about xanax.

Propranolol is a beta blocker, correct? Would that be taken on an as needed basis? Or regularly? How horrible are the side effects? Particularly if it is taken regularly?

If I were your patient would you be more likely to keep me on the xanax as needed (usually only once a week or less--and then only .25mg) or put me on the propranolol either as needed or regularly?