Brief Answer:
Either increase dose or add SSRI

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

Alprazolam is potent anti anxiety benzodiazepine drug. Tolerance occurs in most of the patients after taking it for more than 3 months. It means drug will not be effective in same dose as before. In that case dose needs to be increased as 0.5 mg is low dose.
If I were your treating doctor I would like to add a drug from SSRI group like paroxetine or sertraline as anxiety problem is there since long. I do not prefer long term benzodiazepine use. And in among benzodiazepine my preference is clonazepam as it causes less Tolerance and dependence.

You can discuss my recommendation with your treating doctor and change treatment.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr. Chintan Solanki.

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Brief Answer:
yes clonazepam is better choice according to me

Detailed Answer:
Hi,

Thanks for information.

You are taking antidepressants - Viibryd and Trazodone. Trazodone 300 mg total is enough dose to make you sleep at night. Buspirone 15 mg twice a day is also acting on anxiety. Even after taking these medicines you have anxiety so I recommend following.

Add clonazepam instead of alprazolam.

Shifting to Mirtazapine or Paroxetine from trazodone will be better approach in my opinion.

For more specific comments please provide your brief history of illness & treatment and current symptoms with improvement in % according to you with current treatment.

All the best.

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