Question: It's been a couple of weeks since I've last consulted you. I believe I'm still making steady improvement even after 3-1/2 months of being on Lexapro. Sleep is very regular, 7-8 hours nightly. I'm increasingly able to sustain longer stretches of work and stress without feeling like "grabbing a shot to calm down".

What I've noticed that while my anxiety levels still continue to diminish, the strange "stupor" that I have (i.e., the feeling of "not being present") is not diminishing at the same rate, even though I believe that is still diminishing as well. I am definitely feeling more and more like my old self, more calm overall and now even able to take a short afternoon nap after watching some TV. I used to be incapable of doing that in the bad previous months.

I have heard that too much serotonin can cause anxiety, and drugs like SSRIs and anti-depressive, such as Lexapro and Trazodone, can boost serotonin levels high enough to create problems instead of reducing them. I plan on staying with the current dosages, but I'd like your explanation about that? I am not taking anything else such as herbals or supplements or drugs other than as prescribed, as I think they only "confuse the brain" and keep it from finding its balance.

Should I plan on taking the current medications for probably at least the rest of the year? I'll probably taper down Trazodone first, when the time seems right.

Are there any health and mental consequences from long term use of Lexapro, such as accelerated cognitive decline? If I was able to return to baseline being on Lexapro, I'd consider it, but unfortunately, as much as I've improved, I'm still a long ways from baseline. My general mood and functioning isn't back to the way things were a year ago.

I'm not getting much help from Dr Cho in deciding what I should do. She says nothing about how long I should or probably be on Lexapro or Trazodone.

There have been so many negative reports or articles about long term use of SSRIs that obviously now I worry about it. But I did have a brother-in-law that used Paxil for years, until he died of unrelated causes.

Can you explain why I "may need it indefinitely", and how long term use of it can continue to help? I've been using the same combination of Losartan and Norvasc for hypertension for years, and I feel that it's safe for me to do so, considering the protection they give me. Now that I know that anxiety is another serious disorder, I need to be serious about managing my anxiety, especially as i get older.

But my fear is that I'll never be able to return to how I used to feel, where going for a walk outdoors or up in the mountains was fun and relaxing, and that the longer I use Lexapro, the harder it could be for me to return to that. I just don't know, answers are very hard to come by, and I have trouble deciding what I should do. Am I causing irreverisble changes in my brain as I am trying to revervse things back to the way things were before?