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Suggest Treatment For Anxiety And Panic Attacks
Question: My husband had massive stroke and he is having anxiety and panic attacks. He was given Alprazolalm .25. He was taken off this and given Mirtazapine 45. This is not working. We can give him alprazolam for panic attacks but it takes over an hour to work and we will deal with thx for an hour. We are 78 years old and it wears me out. After Ned's begin working, things are better. Out Internist is handling his car. I need help and suggestions
Brief Answer:
Antidepressants like Mirtazapine take time for effect.
Detailed Answer:
I read your question carefully and I understand your concern.
Mood disorders like anxiety are common after stroke. The available options for its management include benzodiazepines like Alprazolam or antidepresants. Alprazolam as you say may handle the symptoms but it is not a long term solution. In time though it develops tolerance (same previously effective dosage is not effective anymore) and dependence, so it is not suitable for long term use.
Antidepressants are the preferred choice long term. They have the problem that they do not achieve complete efficacy right away, it takes some time, may take up to 6 weeks. So their effect is not noted in the initial period of therapy. That is why often they are started together with the benzodiazepine which is later interrupted once the effect of benzodiazepines has started. Usually the preferred option is not Mirtazapine, but SSRI antidepressants like Citalopram, Escitalopram, I would have started with those. However since Mirtazapine has been started it should be given a full trial if not already done so. It should be continued for at least 6 weeks before deciding it is not effective. If it has already been used for that long without effect then perhaps a switch to Citalopram should be considered.
I remain at your disposal for other questions.
Antidepressants like Mirtazapine take time for effect.
Detailed Answer:
I read your question carefully and I understand your concern.
Mood disorders like anxiety are common after stroke. The available options for its management include benzodiazepines like Alprazolam or antidepresants. Alprazolam as you say may handle the symptoms but it is not a long term solution. In time though it develops tolerance (same previously effective dosage is not effective anymore) and dependence, so it is not suitable for long term use.
Antidepressants are the preferred choice long term. They have the problem that they do not achieve complete efficacy right away, it takes some time, may take up to 6 weeks. So their effect is not noted in the initial period of therapy. That is why often they are started together with the benzodiazepine which is later interrupted once the effect of benzodiazepines has started. Usually the preferred option is not Mirtazapine, but SSRI antidepressants like Citalopram, Escitalopram, I would have started with those. However since Mirtazapine has been started it should be given a full trial if not already done so. It should be continued for at least 6 weeks before deciding it is not effective. If it has already been used for that long without effect then perhaps a switch to Citalopram should be considered.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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