Brief Answer: As below. Detailed Answer: Hi XXXX Thanks! It is common for anxiety (manifested by rapid breathing and palpitations) and low mood to flare up in times of stress. Please do not worry. These ups and downs are part of life. Next time you have rapid heart beat, try this. Take a deep breath very slowly, taking almost double the time to exhale than to inhale. Repeat this for a few minutes and you will notice an almost magical response in your anxiety and palpitations. It works faster than Inderal and has no side effects. It can be practiced any time and anywhere, even when you are at work and seated at your desk. Practicing this at bedtime will improve your sleep. The other thing you can do is to hike up Rivotril in times of stress. For example, taking half of 0.25 mg in the morning as well for a few days, when things are not going well, will help control the anxiety in the daytime. The night dose of 0.25 mg can also be hiked up occasionally if you are having sleep problems. Xanax 20 mg would be a toxic dose. I guess you meant a far lower dose, perhaps 0.25 mg or 0.5 mg. It is short acting but has rapid action. Probably you did not notice much benefit because of its short half life. Xanax will not be needed if you hike up Rivotril which is longer acting. I do not feel there is any need for a change in either bupropion or escitalopram at present. Continue with them as before. Let me know if things do not settle down. Take care. Best wishes. Dr Preeti Parakh MD Psychiatry

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