Brief Answer: change mirtazapine & escitalopram to paroxetine Detailed Answer: Hello Taking into consederation of your medical problems- hypertension, obesity etc., i am going to suggest some chnages in your medicines for good. I will also give reasons as to whay these changes should be made. First, mirtazapine- This is a good agent to control anxiety and also helpful in sleep BUT at the same time increases weight, increases cholesterol and so, also increases blood pressure. This need to be changed if possible. In long run this is not suitable for you. Second- escitalopram : this is a milder molecule compared to mirtazapine and serve the same purpose. So, there is no point in taking two medicines for one problem. suggestion- mirtazapine is harmful for.you and escitalopram is not needed. You should be shifted to paroxetine . This will not alter blood pressue and cholesterol and will control anxiety and depression effctively. You should continue lamotrigine and other drugs for time being. When the anxiety will reduce (with paroxetine), the need for clonazepam will also reduce and it might not be needd at all. Please increase salads and sprouts and yougurt in diet (if possible)- they are natural sources of boosting mind. Hope the reply is useful for you Please ask more queries if there is any doubt. Dr. Manisha Gopal MD Psychiatry

---