Brief Answer:
Sertraline and ativan are the best choices.

Detailed Answer:
Hello Dear
Glad to see you again.

I hope you are following my suggestions to control the anxiety attacks and palpitations as we discussed earlier.

To my patients of panic disorder with cardiac issues, I usually prescribe ativan upto 6mg in divided doses, depending upon the response. I start with 1mg twice a day and then gradually increase the dose till my patients start to feel better. (max dose I usually give is 6mg).

As suggested earlier, I would have started sertraline 25mg (initial dose) if I had a case similar to yours, in my OPD. The dose can then be increased by 25 mg every week. Majority of the patients respond with 75-100mg of setraline. I must tell you that sertraline is a prescription drug.

I would suggest you to consult a nearby psychiatrist and discuss these doses. Please donot start/increase the dose of any of the drugs on your own. Your psychiatrist would be the best judge to observe your progress and make any dose changes.

Feel free to ask further.

If you wish, you can ask a direct query at your convenience.

Hope this helps.

Thanks.

Dr. Shubham Mehta, MD (Psychiatry)

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Brief Answer:
it is ok to take ativan at 2pm in afternoon.

Detailed Answer:
Thanks for the follow-up query here.

Its absolutely ok to take ativan 1mg at 2pm.

Dear,
My advice for my similar clients is:
1. To take tablet ativan 1mg between 8-9am, 1mg between 2-3 pm and 1mg between 8-9 pm.
and
2. To take tablet sertraline 25mg at 9am and 25mg at 9pm. (I usually prefer to start with total 50mg of sertraline).

I also make them learn and practice relaxation exercises regularly (at their own).

I call them for follow-up after 7 days to observe the effect of therapy. Most of the clients usually do well with this dose. If needed, i gradually increase the dose at subsequent follow-ups at every 7days.

May I please tell you that this platform does not allow us to write a prescription. Secondly these drugs are prescription drugs and to be taken under a psychiatrist's supervision.

Hope this addresses your concerns satisfactorily.

Further queries are welcome.

Wish you good health.

Thanks.

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Brief Answer:
both drugs can be taken together; quit alcohol.

Detailed Answer:
Welcome again.

The drugs, sertraline and ativan can be taken together.

I would not advise you to take alcohol as alcohol can easily precipitate panic attacks.

Also, avoid tea, coffee and chocolates as they can also cause anxiety.

If you can tell me your office timings and what kind of work you mostly do, I can advise the timings accordingly.

Please note that this platform does not allow us to write prescriptions. A supervision of your nearest psychiatrist is must before starting any drugs.

Hope to hear from you soon.

Thanks.

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Brief Answer:
Breathing exercises are ok for you.

Detailed Answer:
Best time to take sertraline (prescription drug) would be 1pm and 9pm, both times after meals.

Best time to take ativan (Prescription drug) would be 1mg at 1pm and 2mg at 9pm, both after meals.
Ativan can cause sleepiness. So its not advised to carry out work with heavy machinery and driving should be avoided, as far as possible.

Keeping in mind your cardiac issues, breathing exercises are ok in your cases.

Do keep a regular follow-up with your cardiologist to monitor your cardiovascular status.

Hope this answers your query satisfactorily.

If you wish, you can also ask a direct query at your convenience.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Thanks.

Take care.

Dr. Shubham Mehta, MD (Psychiatry).

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