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Why Am I Feeling Panic And Having Heavy Feeling In My Chest Despite Taking Xanax For Anxiety?

Posted on Sat, 25 Jan 2014

Question: I did not use citalopram as I was concerned it raises prolactin levels in blood. I am now on xanax 3 times a day, but actually i only take two morning and night. It did help 70% in controlling the anxiety but it did not take the fear away. I start feeling panic once i take it and after half an hour the symptoms go away. yet i feel unease, strange heavy feeling on my chest, as if unable to breath. I feel heavy, dizzy, and unable to concentrate. the dr said i need to use it regularly until it shows its effect

Answered by Dr. Ashish Mittal (22 hours later)

Brief Answer: Citalopram or Mirtazapine is better option Detailed Answer: Hello, Thanks for your query. Xanax is used only for short term control of anxiety symptoms. In long term patient develops tolerance and dependance on it with exacerbation of anxiety. In long term and better control of anxiety SSRIs are better. Citalopram is not linked to a significant increase in prolactin levels. Highest incidence of SSRI-associated hyperprolactinemia is for sertraline, followed by fluoxetine, paroxetine, and fluvoxamine. Other option in your treatment is Mirtazapine which do not not associated with increase prolactine level in several clinical trials. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards, http://bit.ly/Dr-Ashish-Mittal

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ashish Mittal (2 days later)

Thanks for your response. Xanax is .25 mg it is almost 10 days since I start using it, sometimes half a pill sometimes a full pill but not exceeding twice a day. I really as mentioned don't think it controls the anxiety 100%. I saw a psychiatrist and prescribed Venlift XR (am not sure of its chemical name). I told him am considered about possible interaction with Tamoxifen and he said only on higher doses (he gave me 75 mg). My questions are: 1. Should I go for Venlift and is it true it does not interact only on higher does, or should I go for Citalopram. 2. The problem is I saw 3 psychiatrists till now and each one is giving me a different medication and tells me about the bad side effects of the medication prescribed by the other doctor!!! 3. What about stopping Xanax do I stop immediately? What about withdrawal symptoms. 4. My psychologist advised that I use Xanax as the only available option with less side effects specially that it does not interact with Tamoxifen, and that I should use the does as prescribed 3 times a day, but I am concerned that it is not showing effect and I think my panic and anxiety are sever. Recently I have been experiencing muscle tension, rapid heart beat, dry mouth, great fear, loosing control, feeling as if going crazy, want to scream, cry allot, loosing hope, feeling restless. So would cognitive therapy help ? 5. I am a very smart person and like to rationalize things, can I use positive thinking and would it help in my case or it is a must to take SSRI. Just forgot to add: 6. Why is the anxiety always at its peak during the morning. This is what I had observed that my anxiety is at its peak during the morning and in the afternoon it goes away. 7. Are there any home remedies or things (apart from Johns Wart) that I could take. Is coffee, and tea increase anxiety or help reduce them. 8. What about exercise in my case, does it work or it should only be medications. Is Yoga or walking good. 9. My symptoms mimic heart disease, I saw a Dr who explained this to me, but those symptoms are very bothersome.

Answered by Dr. Ashish Mittal (19 hours later)

Brief Answer: Hi Detailed Answer: Hello again, Thanks for follow up. 1. Should I go for Venlift and is it true it does not interact only on higher does, or should I go for Citalopram. 2. The problem is I saw 3 psychiatrists till now and each one is giving me a different medication and tells me about the bad side effects of the medication prescribed by the other doctor!!! Answer: That I already answered. You can choose citalopram or mirtazapine in my opinion. Treatment choice differ doctor to doctor. Try to follow one psychiatrist advise only otherwise you will become more confuse. 3. What about stopping Xanax do I stop immediately? What about withdrawal symptoms. Answer: As you are already having anxiety it is better to continue it for 2-3 more weeks then taper it slowly to avoid withdrawal. Same time start citalopram or mirtazapine. 4. My psychologist advised that I use Xanax as the only available option with less side effects specially that it does not interact with Tamoxifen, and that I should use the does as prescribed 3 times a day, but I am concerned that it is not showing effect and I think my panic and anxiety are sever. Recently I have been experiencing muscle tension, rapid heart beat, dry mouth, great fear, loosing control, feeling as if going crazy, want to scream, cry allot, loosing hope, feeling restless. So would cognitive therapy help ? Answer: You are having severe symptoms of anxiety. There is need for long term treatment. You can start cognitive therapy along with medical treatment which will improve treatment response. 5. I am a very smart person and like to rationalize things, can I use positive thinking and would it help in my case or it is a must to take SSRI. Answer: Hope you are already using positive thinking approach. Considering severity of symptoms it is better to start medical treatment along with use of positive thinking. 6. Why is the anxiety always at its peak during the morning. This is what I had observed that my anxiety is at its peak during the morning and in the afternoon it goes away. Answer: Morning worsening of anxiety can occur due to: poor sleep quality and weaning of effect of evening dose of xanax. 7. Are there any home remedies or things (apart from Johns Wart) that I could take. Is coffee, and tea increase anxiety or help reduce them. 8. What about exercise in my case, does it work or it should only be medications. Is Yoga or walking good. Answer: Following simple measures will help you to some extent: -Healthy diet: Milk and fruits in diet. -Daily morning brisk walk atleast for 30 minutes. -Do not use caffeine (tea, coffee and cold drink) -Stop substance use like alcohol (If present in your case) -Breathing exercise, yoga and meditation (which you can learn from some nearby expert) 9. My symptoms mimic heart disease, I saw a Dr who explained this to me, but those symptoms are very bothersome. Answer: Many anxiety symptoms mimic symptoms of cardiac illness. Although cardiac illness less likely but you can consult cardiologist to rule it out. Please accept my answer in case there are no further queries and recommend our services to your friends too if you have found it helpful. Wish you good health. Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar