Brief Answer: Hi XXXX Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 26 year old male • Known case of anxiety and depression • Took treatment for 4 years, stopped 3 months back • Complaints of: sudden onset anxiety, depression and lack of energy for 2 weeks. Anxiety and depression occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter. Treatment with antidepressants corrects this imbalance which lead to improvement in symptoms. These (Anxiety and depression) are chronic illness like diabetes and hypertension. In presence of severe or recurrent anxiety and depression treatment may be required for years or life long (like needed for other chronic illness) like in your case. According to guidelines mild to moderate anxiety and depression can be treated with lifestyle modification, sleep hygiene and cognitive behavior therapy (CBT) in majority of cases. In cognitive behavior therapy, in-person counseling sessions conducted several times a month, by trained therapist. So you can search for CBT therapist in your area and can take their help to recover. If you are not interested in medical management then you go for this treatment. But if symptoms are severe or you do not respond in 1 month, then it is better to switch for drug or combined (drug+CBT) treatment. If you choose drug treatment, then opt for medicines on which you have responded in past. 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,

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Brief Answer: Do not taper medicines early. Detailed Answer: Hello again, Thanks for follow up. It is true that medication should be tapered slowly to prevent recurrence and withdrawal. In sudden stoppage of treatment, symptoms usually recur in 2-3 weeks. But your case is different. You have already stopped treatment 3 months back and remained well for almost 10 weeks. Currently starting treatment and then tapering medication slowly will not help you. Considering duration of symptoms and past treatment history, in my view, you need treatment for years. At-least do not stop treatment before 9 months after relief and without treating psychiatrist supervision. Same time start CBT which will help you to remain without medications. While planning tapering, it is better to reduce 10-20% medicines dose every week. So tapering usually take 1-2 months. But tapering should be stopped and medication should be given in previous doses, if there is recurrence of symptoms. Please accept my answer and give feedback in case there is no further query and you found reply helpful. In case of doubt, I am here to help you. Wish you good health. Regards

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