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Suggest Treatment For Severe Anxiety When I Am Alone With No Work
Question: Hi Doctor, Myself XXXX XXXXXXX Male of 41 yr. old. Now i'm suffering from morning anxiety and fearness and mid of the day i really become fine. Some thoughts that come to my mind in the morning is related to my businesss and i fear of how i cop up the current recession. i'm doing the sanitary business out here. Also i'm supersttious regarding my clothes, that nightwear is lucky for me, regarding shoes i wear, regarding brush i use. I visited our GP and he advised me to take escitalopram 5 mg and clonazepam .5 mg in the night for 3 months. I took escitalopram 5 mg and clonazepam .25 mg instead as my sleep is ok and i take a good sound sleep of 5.5 hours. it has become 3 months and i'm fearing of dependency on clonazepam so I left it from last 4 days but escitalopram 5 mg is going on. There is not much withdrawl symptoms appeared in except only one thing that i've left the medicine and i won't be ok but I searched the internet and this make me fearful that withdrawl symptoms could last for years also. In my case I've taken the same combination of med. in 2012 also that time my wife has gone through swollen lymph node biopsy test and i feared a lot but by the god grace everything fine and this time in july 2014 my daughter of 12 yrs. old has pain in her left leg and no doctor even find out the reason. it make me feared a lot but again by god grace she is fine in november 2014. it disturbed me a lot. I have phobia of going to doctor for some kind of consultation and become more anxious by the name of consulting a doctor. recently I have started to take the medicine on march 12 for 3 months. otherwise I'm a healthy male with all the test regarding blood sugar, kidney, lever, ecg etc. has done and all is ok. Now Pl. advice me How much time with this type of thoughts would disturbed me and have i done the right thing? One thing i want to mention that my anxiety increase when I'm alone with no work in hand. What should I do kindly advice.
Brief Answer:
In anxiety treatment should be continued for at least 6 months
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I can understand your concern. After reading the history you have mention it is clear that you have anxiety disorder. The anxiety occurs more while you are doing nothing and remain alone and these are features of generalised anxiety disorder. The ideas like ideas related to superstition are to some extend related to obsessive thoughts. The anxiety disorders are difficult to treat disorders and medicines in high doses are used for anxiety disorder. The doses of Escitalopram you have been prescribed are lower doses and in my opinion considering your age these are low doses and would not cause improvement. Coming to your questions-
- The withdrawal of clonazepam or any other benzodiazepines may persist longer than six months and this is called as protracted withdrawal. But that occurs commonly in individuals who abuse the drug and who take the drug regularly for prolonged periods of time. You have taken very doses that is .25-.5 mg per day. I don't think the withdrawal would persist in your case, in fact you will not have any withdrawal because you were on low dose of the drug.
- Please discuss with your doctor and ask to increase the dose of Escitalopram and with proper doses your symptoms will start reducing. In normal cases in most individuals with proper dose symptomatic improvement starts in about 4 weeks and completel remission occurs in about 2 months. After finishing acute phase of treatment maintenance treatment is advised for 4-6 months. So please finish your treatment with consultation of your doctor.
- You have anxiety, take proper treatment and you have done right thing to seek treatment. Your all investigations are normal so there is no need to worry. Remain relaxed and complete your treatment.
Thanks, I hope this help you. Please don't hesitate to ask again for more doubts.
Take care
In anxiety treatment should be continued for at least 6 months
Detailed Answer:
Hello thanks for asking from HCM for your health related queries
I can understand your concern. After reading the history you have mention it is clear that you have anxiety disorder. The anxiety occurs more while you are doing nothing and remain alone and these are features of generalised anxiety disorder. The ideas like ideas related to superstition are to some extend related to obsessive thoughts. The anxiety disorders are difficult to treat disorders and medicines in high doses are used for anxiety disorder. The doses of Escitalopram you have been prescribed are lower doses and in my opinion considering your age these are low doses and would not cause improvement. Coming to your questions-
- The withdrawal of clonazepam or any other benzodiazepines may persist longer than six months and this is called as protracted withdrawal. But that occurs commonly in individuals who abuse the drug and who take the drug regularly for prolonged periods of time. You have taken very doses that is .25-.5 mg per day. I don't think the withdrawal would persist in your case, in fact you will not have any withdrawal because you were on low dose of the drug.
- Please discuss with your doctor and ask to increase the dose of Escitalopram and with proper doses your symptoms will start reducing. In normal cases in most individuals with proper dose symptomatic improvement starts in about 4 weeks and completel remission occurs in about 2 months. After finishing acute phase of treatment maintenance treatment is advised for 4-6 months. So please finish your treatment with consultation of your doctor.
- You have anxiety, take proper treatment and you have done right thing to seek treatment. Your all investigations are normal so there is no need to worry. Remain relaxed and complete your treatment.
Thanks, I hope this help you. Please don't hesitate to ask again for more doubts.
Take care
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor for your kind opinion. In my case Its psychologically I'm feeling that i haven't take the medicine and its stuck in my mind for the whole day that make me feel uncomfortable. Also another thought that make me uncomfortable is i heard and that anxiety disorder can never be treated and one have to take medicine for the whole life. Also i heard that medicines are highly dependancy. This kind of thought further increase my anxiety. Also one thing i want to share with you is i feel better when i heard someone has bigger disease than me with the thought that when he can fight why i can't fight myself. Is there any natural ways to fight with the anxiety like eating habits, some suppliments, morning walk or yoga etc. I went on walk forcefully 4-5 times a week and do pranayam 1-2 times a week. I'm not a smoker and occassionally drinker that too 1-2 peg atmost that too once in a month or so. Also as per your opinion according to my age and weight (74 kgs.) what dose should one take and whether the escitalopram is better or stretalyn is better. kindly advice.
Brief Answer:
Behaviour therapy can help to reduce the anxiety
Detailed Answer:
Hello again and thanks for asking a follow up question
The symptoms like inability to remove repetitive thoughts from mind which make you uncomfortable are also occurring due to anxiety. The belief that psychological disorders or anxiety disorders can't be treated is wrong. With proper medicines and psychological therapy most of individuals function normally. No need to worry, you will not have to take medicines for life.
The medicines don't cause dependency. Just keep one thing in mind that it is not advisable to discontinue the medicines abruptly because this might result in withdrawal effects. Medicines if taken with proper prescription and with proper regular follow up of a psychiatrist result in early and best results. So be assured the medicines are safe and can treat anxiety easily.
Yes natural supplements help to reduce anxiety. Flex seeds which are rich in Omega-3-Fatty Acids are found to be useful in anxiety. Even green tea have anti anxiety effects and results in relaxation. Start taking supplement containing Omega-3-Fatty Acids, Vitamin B12 and you will see improvement in your anxiety.
Behaviour therapy by a good psychologist and relaxation exercises have efficacy comparable to medicines. Relaxation exercises include Progressive Muscle Relaxation Exercises (PMR) and Breathing Exercises. You can learn these methods with help of a psychologist or youtube.
In my opinion doses of Escitalopram considering your weight and age should be at least 10 mg per day and this can be increased depending upon response.
Escitalopram and Sertraline both are anti-anxiety drugs of SSRI class. Both have comparable efficacy. Sertraline is considered as safe for elderly and in individuals with liver or kidney impairment. Otherwise both drugs are good.
Thanks, I hope this helps. Please feel free to ask further.
Behaviour therapy can help to reduce the anxiety
Detailed Answer:
Hello again and thanks for asking a follow up question
The symptoms like inability to remove repetitive thoughts from mind which make you uncomfortable are also occurring due to anxiety. The belief that psychological disorders or anxiety disorders can't be treated is wrong. With proper medicines and psychological therapy most of individuals function normally. No need to worry, you will not have to take medicines for life.
The medicines don't cause dependency. Just keep one thing in mind that it is not advisable to discontinue the medicines abruptly because this might result in withdrawal effects. Medicines if taken with proper prescription and with proper regular follow up of a psychiatrist result in early and best results. So be assured the medicines are safe and can treat anxiety easily.
Yes natural supplements help to reduce anxiety. Flex seeds which are rich in Omega-3-Fatty Acids are found to be useful in anxiety. Even green tea have anti anxiety effects and results in relaxation. Start taking supplement containing Omega-3-Fatty Acids, Vitamin B12 and you will see improvement in your anxiety.
Behaviour therapy by a good psychologist and relaxation exercises have efficacy comparable to medicines. Relaxation exercises include Progressive Muscle Relaxation Exercises (PMR) and Breathing Exercises. You can learn these methods with help of a psychologist or youtube.
In my opinion doses of Escitalopram considering your weight and age should be at least 10 mg per day and this can be increased depending upon response.
Escitalopram and Sertraline both are anti-anxiety drugs of SSRI class. Both have comparable efficacy. Sertraline is considered as safe for elderly and in individuals with liver or kidney impairment. Otherwise both drugs are good.
Thanks, I hope this helps. Please feel free to ask further.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor for your kind opinion. Now, yesterday I was telling you that no withdrawl effect of clonazepam is showing but today i feel dry mouth and heavy head and my leg has gone to be shaky and yesternight i couldn't sleep properly also. is this all the withdrawl symptoms of clonazepam or what ? its being 5 days i haven't take this but i'm continuing 5 mg of escitalopram in the night. My BP is 130/90 and also doc. here prescribe me propranolol hydrochloride 40 mg. in the morning but i haven't taken yet. Should i take this drug as i heard that BP 130/90 is not that much to continue on medicine. Now in your opinion what should i Do now, Should i continue clonazepam or try to fight as I dont want to be dependent upon medicines. Infact i start taking B-12 tab. i.e. neurobion forte and started PMR exercise in home today. today i'm feeling very low and fearful. Also kindly let me know the difference between anxiety and depression. today i'm fearful that i'm in the depression or what? Also can i continue escitalopram for the betterment or it should take alongwith clonazepam only. Please clarify. Also let me know the good psycologist address where i can get that therapy you are telling me. At last i conclude with the saying that I'm basically also from XXXXXXX settled in bengal.
Brief Answer:
The symptoms are due to anxiety and not due to depression.
Detailed Answer:
Hello thanks for asking again
These effects are not due to withdrawal of clonazepam but are due to anxiety only. If the symptoms are not tolerable then low dose (0.25) Clonazepam can help. Even as you have prescription of Propranolol then the drug can help you in reducing the anxiety.
Propranolol is also an anti anxiety drug and the drug would help in reducing the symptoms. Even if your BP is normal still the drug would help you. No need to worry.
So start taking Propranolol and you will start seeing reduction of symptoms you are having.
Anxiety is nothing but interstate of turmoil associated with symptoms of autonomic disturbance like tachycardia, tremors, sweating, chocking sensation in throat, behavioural disturbances, fear etc. Depression is a mood disorder in which individuals have persistently low mood. Your symptoms mimic anxiety and these are not due to depression. Please don't get worried about that.
So please continue with Escitalopram, start taking Propranolol and even you can take Clonazepam on SOS basis. This drug combination would help in earliest recovery. Remain relaxed and don't think about this thing again and again.
If you are situated currently at XXXXXXX then there is no problem I have one psychologist in my staff. For psychologist in Bengal best is to visit a medical college and get yourself evaluated for anxiety. There you can find a good psychologist and you will not lost much money.
Thanks, Please don't hesitate to ask again if you need more clarifications.
Take care :)
The symptoms are due to anxiety and not due to depression.
Detailed Answer:
Hello thanks for asking again
These effects are not due to withdrawal of clonazepam but are due to anxiety only. If the symptoms are not tolerable then low dose (0.25) Clonazepam can help. Even as you have prescription of Propranolol then the drug can help you in reducing the anxiety.
Propranolol is also an anti anxiety drug and the drug would help in reducing the symptoms. Even if your BP is normal still the drug would help you. No need to worry.
So start taking Propranolol and you will start seeing reduction of symptoms you are having.
Anxiety is nothing but interstate of turmoil associated with symptoms of autonomic disturbance like tachycardia, tremors, sweating, chocking sensation in throat, behavioural disturbances, fear etc. Depression is a mood disorder in which individuals have persistently low mood. Your symptoms mimic anxiety and these are not due to depression. Please don't get worried about that.
So please continue with Escitalopram, start taking Propranolol and even you can take Clonazepam on SOS basis. This drug combination would help in earliest recovery. Remain relaxed and don't think about this thing again and again.
If you are situated currently at XXXXXXX then there is no problem I have one psychologist in my staff. For psychologist in Bengal best is to visit a medical college and get yourself evaluated for anxiety. There you can find a good psychologist and you will not lost much money.
Thanks, Please don't hesitate to ask again if you need more clarifications.
Take care :)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanx doctor for your kind opinion. now as per your advice I'm taking escitalopram at night and propranolol in the morning. for propranolol i'm taking inderal 40. Does SR propranolol is better or should i continue the same. Also I want to tell you that this become 3 days on this routine and I'm feeling an heavy head and little bit of shaky inside. Is this due to the propranolol or because of I left clonazepam? Also I'm taking as per your advice Vitamin B12 i.e. neurobion forte after lunch. is Propranolol also a dependent drug and for how many days i have to continue escitalopram and propranolol. Can one left propranolol after taking 1-2 months or so. kindly advice also pl. send me your clinic address in XXXXXXX or XXXXXXX as i've plan to visit in XXXXXXX in october or november.
Brief Answer:
Propranolol does't produce dependence no need to worry.
Detailed Answer:
Hello again and thanks for asking a follow up
Thanks for following my advice. Inderal 40 is good but if sustained release is available then that would be a better option. Betacap TR 40 is commonly available brand.
The heaviness in head is due to the mildest form of Clonazepam withdrawal. This is not due to Propranolol. Propranolol is not a dependence producing drug so no need to worry for that. Yes you can leave propranolol without any fear on completion of treatment. Just don't stop the drug abruptly and reduce the doses gradually.
The drugs should be continued for at least 2-3 months post remission of symptoms.
You can meet me at Medical College, Agroha, XXXXXXX in Department of Psychiatry and can discuss with me regarding your problem.
Thanks, Hope this helps you. Take care
Propranolol does't produce dependence no need to worry.
Detailed Answer:
Hello again and thanks for asking a follow up
Thanks for following my advice. Inderal 40 is good but if sustained release is available then that would be a better option. Betacap TR 40 is commonly available brand.
The heaviness in head is due to the mildest form of Clonazepam withdrawal. This is not due to Propranolol. Propranolol is not a dependence producing drug so no need to worry for that. Yes you can leave propranolol without any fear on completion of treatment. Just don't stop the drug abruptly and reduce the doses gradually.
The drugs should be continued for at least 2-3 months post remission of symptoms.
You can meet me at Medical College, Agroha, XXXXXXX in Department of Psychiatry and can discuss with me regarding your problem.
Thanks, Hope this helps you. Take care
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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