Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Severe Panic Attack With Anxiety
Brief Answer:
Private Consultation
Detailed Answer:
Hello, and thank you for using my private service on this website. I now consider you my private patient, and will do absolutely everything within my power to answer any question you have, and to help you lead a more satisfying life.
You describe symptoms consistent with a diagnosis of panic disorder with agoraphobia. I have seen many patients with this condition. It is extremely unpleasant, and I am sorry you are suffering through this.
The good news is this is a very treatable condition. Let's talk about how we can get you feeling better.
The treatment of this condition involves three components.
First, you need to be on an effective dose of an antidepressant. This is the most effective long-term treatment of panic disorder and can be curative. You mention that you are taking Lexapro 20mg, the maximum dose.
How long have you been on this dose?
If it has been more than 6 weeks, I would consider it a failed trial and move on to a different antidepressant.
Given your concurrent pain, I would choose an SNRI such as Effexor, Cymbalta, or Pristiq.
Second, you should be on a long-acting Benzodiazepine to manage your panic symptoms while the antidepressant is taking time to kick in, at which point the benzo should be discontinued. For the long-acting portion I recommend Klonopin, with the use of short-acting Ativan for short-term emergencies.
I never prescribe Xanax, as it acts too quickly and leaves the system too quickly, resulting in rebound anxiety and addiction.
Third, and most important, you should be involved in cognitive behavioral therapy (CBT). This type of therapy is equally effective as medications to cure panic and anxiety. If you do not have a CBT therapist in your area in Michigan, I would be happy to do CBT therapy with you.
What are your thoughts about these suggestions?
Dr. Sheppe
Private Consultation
Detailed Answer:
Hello, and thank you for using my private service on this website. I now consider you my private patient, and will do absolutely everything within my power to answer any question you have, and to help you lead a more satisfying life.
You describe symptoms consistent with a diagnosis of panic disorder with agoraphobia. I have seen many patients with this condition. It is extremely unpleasant, and I am sorry you are suffering through this.
The good news is this is a very treatable condition. Let's talk about how we can get you feeling better.
The treatment of this condition involves three components.
First, you need to be on an effective dose of an antidepressant. This is the most effective long-term treatment of panic disorder and can be curative. You mention that you are taking Lexapro 20mg, the maximum dose.
How long have you been on this dose?
If it has been more than 6 weeks, I would consider it a failed trial and move on to a different antidepressant.
Given your concurrent pain, I would choose an SNRI such as Effexor, Cymbalta, or Pristiq.
Second, you should be on a long-acting Benzodiazepine to manage your panic symptoms while the antidepressant is taking time to kick in, at which point the benzo should be discontinued. For the long-acting portion I recommend Klonopin, with the use of short-acting Ativan for short-term emergencies.
I never prescribe Xanax, as it acts too quickly and leaves the system too quickly, resulting in rebound anxiety and addiction.
Third, and most important, you should be involved in cognitive behavioral therapy (CBT). This type of therapy is equally effective as medications to cure panic and anxiety. If you do not have a CBT therapist in your area in Michigan, I would be happy to do CBT therapy with you.
What are your thoughts about these suggestions?
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
I forgot to mention I also take 5mg of Oxycodone prescribed for pain. I have been on the lexapro for 2 years. I love the sounds of this plan and would like to go forward with all of it from the medications you suggest and I am currently looking for a CBT therapist in my area. how do we get started with both of these?
Brief Answer:
Private Followup
Detailed Answer:
Yes, I recall the use of oxycodone from your previous questions and figured that into my plan, don't worry.
On the medication front, I would ask your prescriber to switch you from Lexapro to Effexor XR. The starting dose of Effexor XR is 37.5mg, and you will slowly work your way up to the maximum effective dose of 225mg. You should keep me updated with any side effects or improvements you experience so we can work together on changing the doses appropriately.
On the CBT front, while you are looking for a CBT therapist in your area, we can start CBT here (please see the email I sent you for more details). Now that we have a medication and therapy plan, open up a new question thread to begin the therapy.
For our first session, I want you to think about and tell me what anxiety means for you.
When did it start becoming a problem for you?
What situations make it worse?
Which makes it better?
Think of a time your were having a panic attack. What was going through your mind?
Really break down your thoughts and feelings and examine them. CBT will focus on undoing automatic negative thoughts and instead reworking them into more productive thoughts and feelings.
Also, you should purchase a CBT workbook. They are inexpensive and incredibly useful. I'll place links to a couple below that I really like:
http://www XXXXXXX com/The-CBT-Toolbox-Workbook-Clinicians/dp/0000/ref=zg_bs_491494_9
http://www XXXXXXX com/Cognitive-Behavioral-Workbook-Anxiety-Step-/dp/0000/ref=sr_1_2?ie=UTF8&qid=0000&sr=8-2&keywords=cbt+workbook
Let me know here if you have any more questions about medications. I look forward to starting therapy with you in our new question thread. Go ahead and open it up!
Dr. Sheppe
Private Followup
Detailed Answer:
Yes, I recall the use of oxycodone from your previous questions and figured that into my plan, don't worry.
On the medication front, I would ask your prescriber to switch you from Lexapro to Effexor XR. The starting dose of Effexor XR is 37.5mg, and you will slowly work your way up to the maximum effective dose of 225mg. You should keep me updated with any side effects or improvements you experience so we can work together on changing the doses appropriately.
On the CBT front, while you are looking for a CBT therapist in your area, we can start CBT here (please see the email I sent you for more details). Now that we have a medication and therapy plan, open up a new question thread to begin the therapy.
For our first session, I want you to think about and tell me what anxiety means for you.
When did it start becoming a problem for you?
What situations make it worse?
Which makes it better?
Think of a time your were having a panic attack. What was going through your mind?
Really break down your thoughts and feelings and examine them. CBT will focus on undoing automatic negative thoughts and instead reworking them into more productive thoughts and feelings.
Also, you should purchase a CBT workbook. They are inexpensive and incredibly useful. I'll place links to a couple below that I really like:
http://www XXXXXXX com/The-CBT-Toolbox-Workbook-Clinicians/dp/0000/ref=zg_bs_491494_9
http://www XXXXXXX com/Cognitive-Behavioral-Workbook-Anxiety-Step-/dp/0000/ref=sr_1_2?ie=UTF8&qid=0000&sr=8-2&keywords=cbt+workbook
Let me know here if you have any more questions about medications. I look forward to starting therapy with you in our new question thread. Go ahead and open it up!
Dr. Sheppe
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
