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Suggest Treatment For Panic Attacks, Tremors And Poor Concentration While Having Depression

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Posted on Tue, 29 Nov 2016
Question: I have a long history of severe depression and major anxiety with PTSD. It is managed with 300mg bupropion, 20mg escitalopram, 300mg trazadone at bedtime & 100mg gabapentin 3 times a day as needed. We've had it controlled well for pretty much a year. Over the past 4-6 weeks I've slipped into high anxiety with panic attacks lately. I have an emergency appointment with my psychiatrist tomorrow and am seeing my psychologist tomorrow night. The recent PTSD symptoms are flashbacks, nightmares, seeing people who look like the abuser everywhere, feeling like I'm being followed. Symptoms of panic attacks are trembling, heart palpitations, feeling like I'm jumping out of my skin. Daily anxiety feelings of restless all day, difficult concentrating on one thing. My psychiatrist likes to keep my medications away from benzodiazepines. Can you offer your insight and suggestions.
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Answered by Dr. Seikhoo Bishnoi (1 hour later)
Brief Answer:
Propranolol or low dose benzodiazepines can be added.

Detailed Answer:
Hi, thanks for asking from HCM

I can understand your concern. You are on 20 mg Escitalopram, 300 mg Trazodone and 300 mg Gabapentin per day. But since last 4-6 weeks your anxiety has relapsed and you have panic attacks.

Escitalopram is a SSRI drug and you are taking sufficient dose to control PTSD and panic symptoms. I don't think increasing the dose of Escitaloprama and Trazodone would be a good idea. If your psychiatrist agrees then low dose benzodiazepines can be added to the prescription. Low dose Lorazepam or Clonazepam can be used on SOS basis for control of flashbacks, restlessness, nightmares and PTSD symptoms. If that is not accepted then other option is beta blockers. Propranolol can be added to your prescription. Propranolol can be used oN SOS basis and can help to control the symptoms of panic and anxiety. So you have option to discuss about these two drugs with your psychiatrist.

Thanks. Take care

Please forgive me for late reply. Don't hesitate to ask again for more doubts.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5193 Questions

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Suggest Treatment For Panic Attacks, Tremors And Poor Concentration While Having Depression

Brief Answer: Propranolol or low dose benzodiazepines can be added. Detailed Answer: Hi, thanks for asking from HCM I can understand your concern. You are on 20 mg Escitalopram, 300 mg Trazodone and 300 mg Gabapentin per day. But since last 4-6 weeks your anxiety has relapsed and you have panic attacks. Escitalopram is a SSRI drug and you are taking sufficient dose to control PTSD and panic symptoms. I don't think increasing the dose of Escitaloprama and Trazodone would be a good idea. If your psychiatrist agrees then low dose benzodiazepines can be added to the prescription. Low dose Lorazepam or Clonazepam can be used on SOS basis for control of flashbacks, restlessness, nightmares and PTSD symptoms. If that is not accepted then other option is beta blockers. Propranolol can be added to your prescription. Propranolol can be used oN SOS basis and can help to control the symptoms of panic and anxiety. So you have option to discuss about these two drugs with your psychiatrist. Thanks. Take care Please forgive me for late reply. Don't hesitate to ask again for more doubts.