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Suggest Treatment For Severe Anxiety And Stress
Question: I suffer from anxiety and anxiety attacks. Also I have developed phobia of attending meetings. The very thought of meeting gives me jitters. Have tried various medicines like bupropion ( gives me headaches), dveniz ( was OK on it and then it started giving me upset stomach). I also suffer from IBS on and off and some medicines especially SSRIs give me upset stomach and insomnia. Have tried paroxetine also, it gave me constipation and upset stomach. After various permutations and combinations, doctor put me on mirtaz 7.5 and oleanz 2.5, but I observed that at times I was becoming breathless. Have tried quetiepen along with dveniz in the past and that time realised that quetiepen made me calmer. Discussed this with my doc and he prescribed quetiepen 25 along with mirtaz 7.5, have started this combination about a week back but I have following issues:
- I started it last Thursday
- Friday, Sat and sun were not that great in the sense that I felt tired, nervous and really not up to it
- Monday I was up and about, Tuesday again woke up with a lot of nervousness and tiredness
- Wed was OK
- today I.e. Thursday was terrible, didn't sleep well last night. Woke up with a lot of irritation, nervousness and was feeling very nervous in the meeting
I also take etizolam 0.5 mg in the morning along with betacap tr 40 and half of 0.5 etizolam in the eve. Yesterday I forgot to take evening dose of half etizolam. Also with mirtaz and quetiepen combo, I have been getting slight but irritating headache and a lot of sedation in the morning but sometimes it continues through out the day.
Is it that I have switched from oleanz to quetiepen about a week back and these medicines are taking time to adjust or I need to change this combo with some other combo. I have three holidays and was wondering if I you can suggest some combo and I can start from tonight so that I have three days to adjust.
- I started it last Thursday
- Friday, Sat and sun were not that great in the sense that I felt tired, nervous and really not up to it
- Monday I was up and about, Tuesday again woke up with a lot of nervousness and tiredness
- Wed was OK
- today I.e. Thursday was terrible, didn't sleep well last night. Woke up with a lot of irritation, nervousness and was feeling very nervous in the meeting
I also take etizolam 0.5 mg in the morning along with betacap tr 40 and half of 0.5 etizolam in the eve. Yesterday I forgot to take evening dose of half etizolam. Also with mirtaz and quetiepen combo, I have been getting slight but irritating headache and a lot of sedation in the morning but sometimes it continues through out the day.
Is it that I have switched from oleanz to quetiepen about a week back and these medicines are taking time to adjust or I need to change this combo with some other combo. I have three holidays and was wondering if I you can suggest some combo and I can start from tonight so that I have three days to adjust.
Brief Answer:
The dose of a Quetiapine should be increased
Detailed Answer:
Hello, Welcome to Health Care Magic
I can understand your concern. Your symptoms suggest clearly social anxiety disorder and other symptoms like bowel symptoms are also getting aggravated due to anxiety. Most of medicines caused side effects and were not tolerated. This happened most likely due to side effects but to some extent the anxiety is also a cause of these symptoms.
If we consider your current medicines then in my opinion the combination is correct. No need to change to some new medicines because you are on current therapy since last one week only. But as you are not feeling good and sleep is poor so doses of Quetiapine should be increased. Increase in dose of drug to 50 mg would help in sleep and also reduce the anxiety symptoms. The drug will increase the effectiveness of Mirtazapine also. Continue with changed doses for about 4 weeks and you will see good improvement.
Please don't remain distressed, the symptoms will surely decrease with medicines.
The symptoms you are having are not due to switch of drugs. Oleanz and Quetiapine are same group drugs and the switch in such low doses doesn't cause such symptoms. Most likely these are due to the persisting anxiety. The sleep will improve with increased doses of Quetiapine. Continue to take Etizolam and Betacap as per your doses.
Thanks, Hope this helps you, if you have more doubts please don't hesitate to ask again.
The dose of a Quetiapine should be increased
Detailed Answer:
Hello, Welcome to Health Care Magic
I can understand your concern. Your symptoms suggest clearly social anxiety disorder and other symptoms like bowel symptoms are also getting aggravated due to anxiety. Most of medicines caused side effects and were not tolerated. This happened most likely due to side effects but to some extent the anxiety is also a cause of these symptoms.
If we consider your current medicines then in my opinion the combination is correct. No need to change to some new medicines because you are on current therapy since last one week only. But as you are not feeling good and sleep is poor so doses of Quetiapine should be increased. Increase in dose of drug to 50 mg would help in sleep and also reduce the anxiety symptoms. The drug will increase the effectiveness of Mirtazapine also. Continue with changed doses for about 4 weeks and you will see good improvement.
Please don't remain distressed, the symptoms will surely decrease with medicines.
The symptoms you are having are not due to switch of drugs. Oleanz and Quetiapine are same group drugs and the switch in such low doses doesn't cause such symptoms. Most likely these are due to the persisting anxiety. The sleep will improve with increased doses of Quetiapine. Continue to take Etizolam and Betacap as per your doses.
Thanks, Hope this helps you, if you have more doubts please don't hesitate to ask again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Since I have started quetiapine, I have been getting hunger pangs early morning and late evening. Do you think switching back to oleanz is an option if yes, what dose of oleanz should I be on, 2.5 or 5? And how the switch from quetiapine to oleanz should be, instant or gradual? With quetiapine, my sedation has gone from bad to worse. Also, if at all I have to be on quetiapine, how long do you think it will take to settle down ( in terms of my sedation, headache and hunger pangs). I am really confused, one half of my brain is wanting to stay with quetiapine and the other half is keen on going back to oleanz. Today I am very depressed and feel like crying. Also, do you think staying with quetiapine and changing dose of mirtaz is another option, mirtaz keeps my stomach calm though......
Brief Answer:
Remain on this therapy only
Detailed Answer:
Hello again
Quetiapine is known to cause much sedation than Olanzapine but in most individuals at low doses tolerance usually develop with in 4 weeks. You have just changed to Quetiapine so in my opinion changing back to Olanzapine again is not a good idea. Wait for some more time and you will start seeing improvement. In my opinion no need to change the doses of Mirtazapine. If possible increase the dose of Quetiapine to 50 mg per day, this will cause significant sedation but you can skip the evening doses of Etizolam, which should compensate. For symptoms of irritable bowel, anxiety medicines like Clinidium bromide and Chlordiazepoxide combination can be used. This will cause less sedation and will settle abdominal complaints also.
Remain on your current therapy and wait for some days, your symptoms will reduce.
Thanks, still have doubts please don't hesitate to ask again.
Take care
Remain on this therapy only
Detailed Answer:
Hello again
Quetiapine is known to cause much sedation than Olanzapine but in most individuals at low doses tolerance usually develop with in 4 weeks. You have just changed to Quetiapine so in my opinion changing back to Olanzapine again is not a good idea. Wait for some more time and you will start seeing improvement. In my opinion no need to change the doses of Mirtazapine. If possible increase the dose of Quetiapine to 50 mg per day, this will cause significant sedation but you can skip the evening doses of Etizolam, which should compensate. For symptoms of irritable bowel, anxiety medicines like Clinidium bromide and Chlordiazepoxide combination can be used. This will cause less sedation and will settle abdominal complaints also.
Remain on your current therapy and wait for some days, your symptoms will reduce.
Thanks, still have doubts please don't hesitate to ask again.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Was waiting for your second reply, since it was delayed a bit, have started oleanz 2.5 along with mirtaz 7.5 last night. Now since I have started oleanz 2.5 instead of quetiapine 25, what would you advise regarding the dosage of oleanz? Should I stick to oleanz 2.5 or increase it to 5mg gradually. And does it work better for anxiety than quetiapine and if yes, at what dosage is good for anxiety, 2.5 or 5 mg of oleanz. Sorry bothering you with my questios. Somewhere I was not happy with quetiapine bcoz of its sedativeness, hunger pangs and headache. Also whether it's safety profile is better than quetiapine in terms of weight gain and raised sugar levels and lipids? Since I have three days holiday, took a chance to start oleanz hoping it will settle down by Sunday. Just one more thing, a doctor friend of mine said to take Librium 10 in the morning instead oetilaam, what would you advise? Read that Librium is more habit forming than etilaam. Just wanted to check if I can consult you over phone after transferring your consultation fee electronically!!!
Brief Answer:
Increase the dose of Olanzapine to 5 mg per day
Detailed Answer:
Hello again, thanks for asking a follow up
I am sorry for delay because I am but busy with some personal work, replying from cell phone.
If you have started taking Oleanz then increase the dose to 5 mg per day. The 5 mg dose will help to reduce anxiety and will surely supplement the action of Mirtazapine. Both Olanzapine and Quetiapine have almost same efficacy. If we consider side effects like weight gain then both drugs are known to cause weight gain but with Olanzapine it would be less as compared to Quetiapine.
Librium is Chlordiazepoxide and is more habit forming than Etizolam. But for bowel symptoms the drug is better in efficacy. The drug will relieve anxiety earlier. If taken under proper regular supervision of a doctor then the drug is totally safe.
Yes you can contact with me on phone through Health Care Magic, but please if possible fix appointment on or after 5th October because busy with some conference.
Thanks, still have more doubts please don't hesitate to ask again.
Take care
Increase the dose of Olanzapine to 5 mg per day
Detailed Answer:
Hello again, thanks for asking a follow up
I am sorry for delay because I am but busy with some personal work, replying from cell phone.
If you have started taking Oleanz then increase the dose to 5 mg per day. The 5 mg dose will help to reduce anxiety and will surely supplement the action of Mirtazapine. Both Olanzapine and Quetiapine have almost same efficacy. If we consider side effects like weight gain then both drugs are known to cause weight gain but with Olanzapine it would be less as compared to Quetiapine.
Librium is Chlordiazepoxide and is more habit forming than Etizolam. But for bowel symptoms the drug is better in efficacy. The drug will relieve anxiety earlier. If taken under proper regular supervision of a doctor then the drug is totally safe.
Yes you can contact with me on phone through Health Care Magic, but please if possible fix appointment on or after 5th October because busy with some conference.
Thanks, still have more doubts please don't hesitate to ask again.
Take care
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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