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Suggest treatment for anxiety disorder

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Posted on Tue, 22 Apr 2014
Question: Sir/Madam, 1. I have general anxiety/Panic disorder for past many year. I was occasionally taking clonazepam 0.5mg in morning as an SOS. It worked perfectly & I use to feel fresh & energetic. I try to regularly do physical exercise. My sexual drive have also been very satisfactory. 2. Last 6 month back I had very bad panic attack & clonazepam 0.5mg once a day also did not work out. I then consulted psychiatrist for same & he prescribed me Etilam 0.5mg twice a day & censopram 2.5mg at night. It worked perfectly fine for 5 months, the I had another panic attack & on consultation to my doc he changed the medicine to Depran 5 once at night & clonazepam 0.5mg in morning as SOS, which I am taking for past 20 days & feeling better. However the major side effect I am facing my lack of sexual drive, which is real cause of worry to me. 3. Can I revert back to earlier prescription of Etilam 0.5 twice a day & Censopram 2.5mg at night, since my anxiety is under control barring sexual drive. I am loosing confidence in performing sex. I am 45 yrs old male. Please advice. Regards, XXXXXXX
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Answered by Dr. Abhishek Kapoor (16 minutes later)
Brief Answer: You can stop or shift to another drug Detailed Answer: Hi Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. First i want to say that censpram and depran, both have same medicine that is escitalopram. It is antidepressant and some time, at higher dose, it decrease sexual desire. If you are facing same problem, then there is nothing harm in decreasing the dose. The effective dose of escitalopram is 5 to 20 mg and 2.5 mg is below therapeutic dose, so it would not control panic attacks. You can either stop it completely or shift to another antidepressant which does not have effect on sexual desire like bupropion or paroxetine. For them, you have to consult your psychiatrist. Mean time, you can carry on etilaam or clonazepam on sos basis. You can also do relaxation exercise, that would keep you calm and maintain without drugs In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Abhishek Kapoor (37 hours later)
Sir, 1. Thanks for answering my query. 2. I shall surely consult my doc as advised by you. I am taking second opinion of my problem. I just need your final advice on dosage & please clarify me following: (a) Since I was comfortable with Etilam 0.5 mg (1-0-1) & censopram 2.5mg (at night). Can I continue with this dose for some time & then reduce Etilam 0.5mg (morning only) & continue with censopram 2.5mg (at night). If ok, after when I need to gradually tapper it down so as to stop completely. (b) If not, can I reduce Diapram 5 to half tab at night & take clonazepam 0.5 mg also half tab in morning as SOS for some months & then stop completely. (c) Can you recommend any dosage for general anxiety/ panic attack on SOS basis only, as I don't want to depend or get addict to these antidepressants. 3. I am very active physically & also in my office & social front. I have another weakness of being workaholic & perfectionist, which may be causing lot of stress on me. Is that could be the cause of my general anxiety/ panic attacks? Please advice. Regards, XXXXXXX
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Answered by Dr. Abhishek Kapoor (36 minutes later)
Brief Answer: Better to take paroxetine, do relaxation exercise Detailed Answer: Hi As i have already told you that censpram and depran have same medicine, that is escitalopram and therapeutic effective dose of it is 10mg. Below this dose, it would give placebo effect. You can take censpram or depran at low dose, but it would not give you therapeutic benefit. Better to take escitalpram 10mg in a day which is the minimum effective dose or you can try another antidepressant like paroxetine. Paroxetine would lead to delayed ejaculation and help you get better sexual pleasure. This is best antidepressant to control anxiety symptoms and sexual dysfunction. Among etizolam or clonazepam, i would suggest etizolam due to less sedative and abuse potential. As you have mentioned that you are workaholic and perfectionist, that would go towards underline personality traits. That ccould be the reason for anxiety or panic attacks. Better to do relaxation exercise like yoga, meditation, JPMR etc that would keep you calm and relax. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Abhishek Kapoor (4 days later)
Dear Dr XXXXXXX 1. Thanks for answering my queries & for you advice. 2. I shall consult my doc for changing to paroxetine. However I have now changed to Etilam 0.5mg(1-0-1) & censopram 2.5mg(at night) so as to overcome my sexual drive probably due to earlier dose of Depran 5 once at night & clonazepam 0.5mg (in morning as SOS). 3. I need your final consultation on my following queries: (a) Can I go ahead with Etilam 0.5mg(1-0-1) & censopram 2.5mg(at night).Since I am taking under dose of censopram & in order to get therapeutic benefit as mentioned by you, is it ok to take censopram 5mg (at night). I don't want to take censopram beyond 5mg. Please advice. (b) Can I subsequently then reduce to Etilam 0.5mg (morning only) & continue with censopram 2.5mg (at night) and later stop the dose completely. Please advice in terms of dosage & periodicity. (c) Can you recommend any dosage for general anxiety/ panic attack on SOS basis only, as I don't want to depend or get addict to these antidepressants. (d) What will be the recommended dose of Paroxetine & its periodicity? Looking forward for your early advice please. Regards, XXXXXXX
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Answered by Dr. Abhishek Kapoor (1 hour later)
Brief Answer: You can take censpram 5mg Detailed Answer: Hi Duration of treatment depends upon the symptoms. There is no clear cut guideline for duration of treatment. If you remain asymptomatic for more than 9 months, then psychiatrist can think about to stop the drugs. Rest depend upon treating psychiatrist and symptoms. You can take censpram 5mg and etilaam 0.5mg twice a day. In case, you remain asymptomatic, you can gradually stop etilaam first. Reduce it to 0.25mg twice a day for one week and then stop it in case you have no symptoms. For anxiety, on sos basis, you can take clonazepam 0.5. Its mouth dissolving tablet is available and you can take that on sos basis. You can start Paroxetine CR 12.5mg and gradually increase upto 37.5mg. Increase the dose after every fortnight from 12.5 mg to 25mg to 37.5mg. Better to do all this under supervision of psychiatrist. You need cross tapering that mean stop one drug and mean time start another. In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Abhishek Kapoor

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Practicing since :2007

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Suggest treatment for anxiety disorder

Brief Answer: You can stop or shift to another drug Detailed Answer: Hi Thanks for using healthcare magic. I, Dr Abhishek Kapoor, would help you in this query. First i want to say that censpram and depran, both have same medicine that is escitalopram. It is antidepressant and some time, at higher dose, it decrease sexual desire. If you are facing same problem, then there is nothing harm in decreasing the dose. The effective dose of escitalopram is 5 to 20 mg and 2.5 mg is below therapeutic dose, so it would not control panic attacks. You can either stop it completely or shift to another antidepressant which does not have effect on sexual desire like bupropion or paroxetine. For them, you have to consult your psychiatrist. Mean time, you can carry on etilaam or clonazepam on sos basis. You can also do relaxation exercise, that would keep you calm and maintain without drugs In case, you need further help, you can ask. Regards Dr. Abhishek Kapoor Psychiatrist