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At 43 I Was Diagnosed With Panic And Anxiety Disorder.
Question: At 43 I was diagnosed with Panic and Anxiety Disorder. I had overcome two bouts of shingles on my face and post herpetic neuralgia. A month later I began having 'mini panic attacks. I knew this because my mom, grandmother, cousin also had panic attacks..although mine more severe. Tried everything hypnotherapy to a $400 video. Finally saw a XXXXXXX Psychiatrist-she put me on Paxil and Clonazepam. Therapeutic Level came to 60mg Paxil 1.5mg Clonazepam. After a while I was down to 1 mg of Clonazepam with my 60mg axil-Then as low as .5 mg of Clonazepam for at least 4+ years .
Fast forward 13 years later. XXXXXXX 2018 I fell in XXXXXXX broke my shoulder. One month later Paxil stopped working. I met with 3 different drs. (we had relocated to Sioux Falls SD) first I was put on Zoloft-6+ weeks then Prozac 6 weeks-then Cymbalta-two days swollen lips and horrific side affects. Put back on Paxil 10 days nightmare. See another Dr. Puts me on Venlavaxine Immediate Release (I had 1/2 stomach removed at 32 so I can't take extended release)....Finally in December after now being on Venlavaxine 350 mg and 3 mg clonazepam, I have my life back.
We just relocated to XXXXXXX TX, two months ago. I noticed 3+ weeks ago more anxiety mild-moderate+. I needed a Psychiatrist regardless to continue treatment-Issue, I have found it hard to set an apt because I am on 3 Mg of Clonazepam. (Which I didn't choose the Dr did in South Dakota), I know something now is not going well-it Venlavaxine not working as well? I want to lower Clonazepam....I finally have an apt with one Dr., who will see me yet made it clear clonazepam is something that he wants me off. I am open. This panic and anxiety disorder is genetic. I am happily married, one son 17, great family...I don't drink, smoke, do drugs. Only other Med I am on is repenerol for restless legs. What are my choices if you were to look at me as a patient? I know I am slipping-RX is not working like before. Clonazepam has most likely run its course and drs put fear in me when they telll me how awful it will be to get off of it. What other RX would you put a patient like me on...just looking for a person who is an expert with a person who suffers from this disorder, and did go through therapy, learn coping skills etc. It's about the right medication now.
Fast forward 13 years later. XXXXXXX 2018 I fell in XXXXXXX broke my shoulder. One month later Paxil stopped working. I met with 3 different drs. (we had relocated to Sioux Falls SD) first I was put on Zoloft-6+ weeks then Prozac 6 weeks-then Cymbalta-two days swollen lips and horrific side affects. Put back on Paxil 10 days nightmare. See another Dr. Puts me on Venlavaxine Immediate Release (I had 1/2 stomach removed at 32 so I can't take extended release)....Finally in December after now being on Venlavaxine 350 mg and 3 mg clonazepam, I have my life back.
We just relocated to XXXXXXX TX, two months ago. I noticed 3+ weeks ago more anxiety mild-moderate+. I needed a Psychiatrist regardless to continue treatment-Issue, I have found it hard to set an apt because I am on 3 Mg of Clonazepam. (Which I didn't choose the Dr did in South Dakota), I know something now is not going well-it Venlavaxine not working as well? I want to lower Clonazepam....I finally have an apt with one Dr., who will see me yet made it clear clonazepam is something that he wants me off. I am open. This panic and anxiety disorder is genetic. I am happily married, one son 17, great family...I don't drink, smoke, do drugs. Only other Med I am on is repenerol for restless legs. What are my choices if you were to look at me as a patient? I know I am slipping-RX is not working like before. Clonazepam has most likely run its course and drs put fear in me when they telll me how awful it will be to get off of it. What other RX would you put a patient like me on...just looking for a person who is an expert with a person who suffers from this disorder, and did go through therapy, learn coping skills etc. It's about the right medication now.
Brief Answer:
ANXIETY DISORDER
Detailed Answer:
Hi.
Welcome to Ask a Doctor service.
I am Dr Ajeet XXXXXXX
I have gone through your query and here is my opinion.
Commonly benzodiazepines are used to treat anxiety and panic disorder.They include alprazolam,diazepam and lorazepam.
They reduce the intensity of panic attacks and anxiety.
They affect on GABA receptors of the brain and reduce brain discharges thus reliving anxiety.
Lorazepam is a benzodiazepine which is quick-acting and relieve symptoms in a short amount of time but is not usually considered the first course of treatment for anxiety.
The reason is because of development of tolerance,addiction potential and development of withdrawal symptoms on discontinuation.
As benzodiazepines are not meant to be taken for the long-term so I would advise you to discontinue it.This might be difficult but should be done under a competent medical practitioner.
It may be replaced by short acting agents like Etizolam which has very short half life and gradually tapered off.
You may need a service of rehabilitation center and multiple counseling sessions.
You can be on multiple drugs which are safe and non habit forming.
1.SSRI Group
Examples include citalopram, escitalopram, fluoxetine, paroxetine, and sertraline.
2SNRI Group
Examples include desvenlafaxine, duloxetine, and venlafaxine.
3.Others-
A) Buspirone hydro chloride is an anti anxiety agent that is not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs.
b)Gabapentin is a seizure medication that works quickly and is often preferred over benzodiazepines.
c)Hydroxyzine is also prescribed to treat anxiety because it works quickly and is non-habit forming.
Your psychiatrist would be in the best position to tailor your treatment protocol according to detailed history and clinical examination.
Hope that you are doing meditation,yoga,other relaxation techniques,taking regular sun exposure and taking multivitamin supplements.Procure your thyroid levels too.
Hope that I have answered your query.
Regards.
ANXIETY DISORDER
Detailed Answer:
Hi.
Welcome to Ask a Doctor service.
I am Dr Ajeet XXXXXXX
I have gone through your query and here is my opinion.
Commonly benzodiazepines are used to treat anxiety and panic disorder.They include alprazolam,diazepam and lorazepam.
They reduce the intensity of panic attacks and anxiety.
They affect on GABA receptors of the brain and reduce brain discharges thus reliving anxiety.
Lorazepam is a benzodiazepine which is quick-acting and relieve symptoms in a short amount of time but is not usually considered the first course of treatment for anxiety.
The reason is because of development of tolerance,addiction potential and development of withdrawal symptoms on discontinuation.
As benzodiazepines are not meant to be taken for the long-term so I would advise you to discontinue it.This might be difficult but should be done under a competent medical practitioner.
It may be replaced by short acting agents like Etizolam which has very short half life and gradually tapered off.
You may need a service of rehabilitation center and multiple counseling sessions.
You can be on multiple drugs which are safe and non habit forming.
1.SSRI Group
Examples include citalopram, escitalopram, fluoxetine, paroxetine, and sertraline.
2SNRI Group
Examples include desvenlafaxine, duloxetine, and venlafaxine.
3.Others-
A) Buspirone hydro chloride is an anti anxiety agent that is not chemically or pharmacologically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs.
b)Gabapentin is a seizure medication that works quickly and is often preferred over benzodiazepines.
c)Hydroxyzine is also prescribed to treat anxiety because it works quickly and is non-habit forming.
Your psychiatrist would be in the best position to tailor your treatment protocol according to detailed history and clinical examination.
Hope that you are doing meditation,yoga,other relaxation techniques,taking regular sun exposure and taking multivitamin supplements.Procure your thyroid levels too.
Hope that I have answered your query.
Regards.
Above answer was peer-reviewed by :
Dr. Kampana
Thank you for your response. I was surprised you listed the SSRI's that I wrote I tried and had no luck with. Also, Buspar did nothing and Hydroxine gave me the jitters. I can't take any kind of antihistamine or OTC cough RX. My main question really is-if I am on 350mg of Venlavaxine and the goal is to lower the clonazepam what scenario would we look at to replace the clonazepam if venlavaxine doesn't block panic attacks. What other SNRI is showing good results in 'challenging panic/and anxiety disorders? What is frustrating is-a those in the industry want society not to frown on mental illness. Those who suffer from it, go to a Dr. and trust this Dr. who yes , has to try different RX's since they are not 100% sure...then when they choose to put you on something like clonazepam...you are then put through the ringer by others in the profession as though 'you chose this RX'. When prescribed I knew nothing about treatment for my disorder. When it was raised from .5mg to 2mg then to 3mg, it gave relief....so in end, although I will meet with a qualified specialist next week-those who I have seen over the years know mine is a situation that medication will most likely always be part of me handling this disorder, aside from coping skills, exercise, etc..again I had it at 43 was great for 13 years then BAM....and professionals are pretty fast to put everyone in the same box when you enter a clinic. Which is something I hope more professional who are good can change the mindset.
Also I ask respectfully- why was my question put in your hands?
I specifically signed up for this to be sent to a Psychiatrist. You are a General Practitioner....I truly was expecting an answer directly from a Psychiatrist...thanks you
I specifically signed up for this to be sent to a Psychiatrist. You are a General Practitioner....I truly was expecting an answer directly from a Psychiatrist...thanks you
Brief Answer:
ANXIETY DISORDER
Detailed Answer:
Yes Sir.....You are right.
Mental health is thought of a taboo subject and a social stigma but it is not.
It's the demon most of the people in the world are fighting with every day.
It's something that needs so much more attention, care and time.
It is something that needs to be spoken about and it needs to be spoken about now.
The World Health Organization (WHO) states: “There is no health without mental health.”
Accordingly, the third Sustainable Development Goal (SDG) about health and well being explicitly includes mental health.
Achieving it will require much more work on emerging health priorities such as mental health.
I totally agree with you that many of professionals are pretty fast to put everyone in the same box as soon as you enter their clinic.
That's why I wanted you to see a psychiatrist.
Each patient has a different history,stressors,symptomatology,family history,DNA make up,ability to cope with stress,co morbidity and response rate.
Treatment is individualized and fortunately a "cafeteria's choice" is available as far as treatment of Anxiety and panic disorders are concerned.
If Paxil,cymbalta,Buspar and Hydroxine have already been used and Venlavaxine is not working,I would recommend escitalopram for such patients of mine.
It is a wide spectrum anti anxiety drug,safe for elderly,well tolerated and has fewer side effects as compared to other drugs.
It is a drug that goes through the body more quickly.
A dose of 20 mg is started initially and as the symptoms wean off ,doses are sequentially reduced by 2.5 mg.
They are never stopped abruptly,otherwise rebound phenomenon occurs.
God bless you.
Warm regards.
ANXIETY DISORDER
Detailed Answer:
Yes Sir.....You are right.
Mental health is thought of a taboo subject and a social stigma but it is not.
It's the demon most of the people in the world are fighting with every day.
It's something that needs so much more attention, care and time.
It is something that needs to be spoken about and it needs to be spoken about now.
The World Health Organization (WHO) states: “There is no health without mental health.”
Accordingly, the third Sustainable Development Goal (SDG) about health and well being explicitly includes mental health.
Achieving it will require much more work on emerging health priorities such as mental health.
I totally agree with you that many of professionals are pretty fast to put everyone in the same box as soon as you enter their clinic.
That's why I wanted you to see a psychiatrist.
Each patient has a different history,stressors,symptomatology,family history,DNA make up,ability to cope with stress,co morbidity and response rate.
Treatment is individualized and fortunately a "cafeteria's choice" is available as far as treatment of Anxiety and panic disorders are concerned.
If Paxil,cymbalta,Buspar and Hydroxine have already been used and Venlavaxine is not working,I would recommend escitalopram for such patients of mine.
It is a wide spectrum anti anxiety drug,safe for elderly,well tolerated and has fewer side effects as compared to other drugs.
It is a drug that goes through the body more quickly.
A dose of 20 mg is started initially and as the symptoms wean off ,doses are sequentially reduced by 2.5 mg.
They are never stopped abruptly,otherwise rebound phenomenon occurs.
God bless you.
Warm regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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