What Is The Cure For Panic Attack And Fast Heart Beat?

Posted on Sat, 28 Sep 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 28 Sep 2013 Answered on

Fri, 20 Dec 2013 Last reviewed on

Question : I am on dosulpin for anxiety,I keep getting panic attacks all night keep waking up.my heart beat is fast, mouth dry and headaches can't sleep. I am suffering a lot.

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: SSRI and clonazepam will bring relief. Detailed Answer: Hi XXXX, Welcome to Healthcare Magic! I understand that you are on dosulepin 75 mg per day but have not found relief in anxiety. In my opinion, the dose of dosulepin that you are taking can be hiked further for better symptom control. If the current dose has given you some relief, you can discuss with your doctor regarding gradually hiking the dose to around 100 to 150 mg per day. However, this dosage may be associated with some adverse effects like constipation, sedation, dizziness etc. If, however, you have found no improvement with dosulepin and are willing to consider a change of medicine, then I think there are better options available for you. Dosulepin works in low level anxiety, but it is not a first line agent for people with significant anxiety. I prefer to treat people with anxiety with medications belonging to the SSRI class (sertraline, paroxetine, escitalopram etc.) along with a benzodiazepine like clonazepam. For you, I would have preferred paroxetine controlled release preparation, which gives excellent results even in low dosages like 12.5 to 25 mg per day. Since paroxetine and other similar agents take a few weeks to become fully effective, till that time clonazepam can be used to supplement the action of paroxetine. After one to two months, clonazepam can be tapered off. Please discuss with your psychiatrist if you can be started on this regimen. Apart from a change of medicine, relaxation exercises can also give you good results. In my experience, patients who were unwilling to take medicines, have also improved a lot solely from doing relaxation exercises like deep breathing and progressive muscular relaxation. Please try and see whether these work for you. There is one more thing you need to ensure. Many times thyroid and heart disease may also present as anxiety. I hope your doctor has thoroughly evaluated you and ruled these out before diagnosing an anxiety disorder. If not, please ask him to do so. Hope this helps you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (15 minutes later)

I tried proxitine.Terrible side effects, pins and needles all over the body, my tongue was shaking, my body was aching, felt unfocused all the time. I couldn't drive at all.

Answered by Dr. Preeti Parakh (19 minutes later)

Brief Answer: Escitalopram or sertraline may be tried. Detailed Answer: Hi XXXX, Welcome back! If you had adverse effects from even low dosages of paroxetine like 12.5 mg/day, then there are other options like escitalopram, sertraline, fluoxetine etc. Just because one of the SSRIs did not suit you, it cannot be said that you will not be able to tolerate others too. If, however, the dose of paroxetine that you took was higher than 12.5 mg, then I feel that paroxetine can be given another trial. If you have been able to tolerate dosulepin 75 mg, then I believe you will also find at least one or the other SSRI suitable. Please do not worry and ask your doctor to start either escitalopram 5 mg or sertraline 25 mg per day. If this dosage suits you, it can be hiked up later for better results. Do not start at higher dosages. Hope this helps you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (1 hour later)

I develop anxiety 2 yrs ago, my son who is 19 yrs fell off 1floor window when he was 2 yrs old,he had a severe brain injury,now he gets lots of fits and seizures, I have to look after him day and night and keep myself alert. I can't relax as he needs constant help and he is suffering and I cannot go out much as he doesn't like to stay with anybody. If I go somewhere then I have to take him with me.He doesn't let me go anywhere without him. my anxiety effected my stomach,I feel something bubbling under my left ribcage,all my head, face, neck and upperback r stiff. My body shakes.its effecting my bowels,I feel pain,I get loose type of stools and become anemic.doc says I have irritable bowel syndrome.

Answered by Dr. Preeti Parakh (16 minutes later)

Brief Answer: Please try the relaxation exercises. Detailed Answer: Hi, I understand that constantly having to be on an alert for your son has taken its toll on you. Now you find it difficult to relax and this has resulted in severe anxiety. While this circumstance cannot be changed, you must learn to let go as you cannot take good care of your son if you yourself are not well. Please practice the relaxation exercises that I mentioned earlier as you are sure to find them beneficial. I was also wondering if your son has received treatment for seizures or not. Anti-epileptic drugs can control seizures very well. I hope you get better soon. Wishing you all the best, Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (2 minutes later)

how to do these exercises plz help me

Answered by Dr. Preeti Parakh (19 minutes later)

Brief Answer: Try deep and slow breathing. Detailed Answer: Hi XXXX, Deep breathing is the easiest to do. You just have to breathe slowly and deeply in through your nose, and out through your mouth in a steady rhythm. Try to make your breath out twice as long as your breath in. Do this for two to three minutes at a time every day, especially when you are anxious. It will instantly make you feel better. Progressive muscular relaxation is slightly complicated but detailed instructions are freely available online on many websites. It involves initially tensing and later relaxing different groups of muscles. It is very effective but takes more time than deep breathing. It is better if one needs to lie down before doing this. I hope you will benefit from these exercises as many of my patients have done. Irritable bowel syndrome is also anxiety related and will improve once your anxiety remits. Wishing you all the best, Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (7 days later)

I am getting lot of panic attacks especially when I am going to sleep. I wake up with a pain in my head ,body shaking and heart beating fast.All night I stay awake in this pain. I am taking dosulpin 75 mg per day.Is there any medicine which can be taken in combination with dosulpin to stop panic attacks. My GP want me to take 75 mg of dosulpin daily no more than this.

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Clonazepam may be added. Detailed Answer: Hi XXXX, Welcome back! You can take a benzodiazepine, preferably clonazepam, along with dosulepin for better relief on days when the anxiety is more. I feel 0.25 mg clonazepam would be sufficient. Ask your doctor if he agrees with this as dosulepin is not giving you complete relief. If benzodiazepines are used for long, then there is a chance of becoming dependent on it. So it is better that you use it only on a SOS basis, that is only when the anxiety is too much for you to bear. It will give you fast relief. Hope this helps you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (4 minutes later)

my GP doesn't allow clonazepam he doesn't give addictive drugs.I want to know can I take 2 dosulpin at night and 1 In the morning will it be okay.

Answered by Dr. Preeti Parakh (21 minutes later)

Brief Answer: Yes, you can, for a 25 mg tab. Detailed Answer: Hi XXXX, I am sorry to learn that your doctor is willing to see you suffer but unwilling to do anything about it. You have not mentioned the strength of the dosulepin tablet that you wish to take 1 in morning and 2 at night. I guess you are referring to the 25 mg tablet. Yes, you can do this. Better still, you can take the entire 75 mg as a single dose at night. Ideally dosulepin should be taken either in three divided doses or as a single dose at night. But since you are having so much trouble at night even two divided doses would do, but a single nighttime dose would be better. Hope this helps you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 minutes later)

I am very scared to take such a strong strength of 75 mg at one go.Can I take 50 mg at night and 25 mg in the morning! Taking 50mg will make me drowsy, sick or dizzy. Please explain!

Answered by Dr. Preeti Parakh (14 minutes later)

Brief Answer: No, it is safe. Detailed Answer: Hi XXXX, No, you will not become drowsy or dizzy by taking 50 mg at night and 25 mg in the morning. You can try this and if it suits you, you can shift to the single nighttime dose if you wish. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (15 minutes later)

Thanks s lot!! I hope it works for me!!

Answered by Dr. Preeti Parakh (4 minutes later)

Brief Answer: I hope so too! Detailed Answer: Hi XXXX, Yes, I hope it will help you. I know for sure that it will not harm you because single nighttime doses are officially recommended by the manufacturers and found safe and equivalent to divided doses in many research studies. So, shifting some of the dose to night will not harm you. Go ahead! Good luck! Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (3 hours later)

hi My Gp also prescribe me FLUANXOL for anxiety. What do u think?

Answered by Dr. Preeti Parakh (37 minutes later)

Brief Answer: yes, you can try it. Detailed Answer: Hi XXXX, Yes, you can take Fluanxol. It can be expected to bring you some relief from anxiety, although it is not a very popular medicine. But some patients find it beneficial. Try it and see how it works for you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (5 minutes later)

can I take dosulpin with this medicine.How to start the new medicine. Do I have to take dosulpin and fluanxol together

Answered by Dr. Preeti Parakh (10 minutes later)

Brief Answer: 0.5 mg in the morning. Detailed Answer: Hi XXXX, Yes, fluanxol can be taken with dosulepin or a time gap can be kept, if you wish. Usually it is started in the dose of 0.5 mg, as a single dose in the morning. Please follow your doctor's instructions regarding the dose. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 minutes later)

doctor gave me 1mg three times.I am scared because I read that it I'd anti physcolotic drug for sczezophinia

Answered by Dr. Preeti Parakh (7 minutes later)

Brief Answer: better to start with a low dose. Detailed Answer: Hi XXXX, It is used in schizophrenia in far higher dosages. In low dosages, it works in depression and anxiety. In my opinion, you should start with a very low dose of 0.5 mg in the morning only. It can be increased later if it suits you. You can discuss this issue with your doctor and ask if it is ok to start with a low dose. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (14 minutes later)

I should take low dose. 5mg of fluanxol.When to take dosulpin and what dose and what time gap should be kept

Answered by Dr. Preeti Parakh (7 hours later)

Brief Answer: Dose as discussed before. No change needed. Detailed Answer: Hi XXXX, You can take dosulepin either 25 mg thrice daily or one in morning and two at night. You can keep a time gap of around an hour between the fluanxol and the morning dose of dosulepin. For example, dosulepin at 8 am and fluanxol at 9 am. The time gap is not a hard and fast rule. It can be adjusted as per your convenience. If your doctor has given any other instructions, they can be followed. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (32 hours later)

hi doc I heard that BUSPIRONE is better than dosulpin Is it more stronger? Is it benzodiazepine? My GP will never give me addictive drugs. If I take BUSPIRONE do have to totally stop dosulpin

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Buspirone is not a benzodiazepine. Detailed Answer: Hi XXXX, Nice to hear from you again! It is not that buspirone is better than dosulepin or dosulepin is better than buspirone. Both are different in the sense that both belong to different classes of medications and have different mechanisms of action. The one that suits you and works for you is better. Buspirone is used to treat anxiety disorder. It is also used with other medicines like SSRIs to augment their action. You can use it with dosulepin but just take care that it may make you slightly sleepy. You should start with a low dose like 5 mg twice daily. It is not a benzodiazepine and it is not addictive, so your GP should have no problem in prescribing you this medicine. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (7 days later)

hi doctor, my mother is 71 years old. She takes STILNOX 10 mg every day to sleep.She has been taking it for last 8 years but now it's not helping her at all.She suffers from insomnia and diabetes.Please tell me some medicine that can help her sleep at least 4/5 hours.Thanks!

Answered by Dr. Preeti Parakh (6 hours later)

Brief Answer: Extended release preparation of Stilnox may help. Detailed Answer: Hi XXXX, Welcome back! Your mother is taking zolpidem 10 mg which is a safe medicine but for her age, the dose should not have been more than 5 mg. If this medicine is not helping her maintain sleep for at least a few hours, then she can take an extended release preparation of the same medicine (Stilnox CR), which comes in strengths of 6.25 and 12.5 mg. She will need the 12.5 mg tablet and it will give better results than her present tablet and will be safe in diabetes too. Benzodiazepines will not be very safe for her as if there is sedation, she may fall and injure herself. Also ask her to avoid sleeping in daytime completely. Hope this helps her. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 days later)

hello doctor!my doctor prescribed me BUSPIRONE 5mg 3 times a day. But he said I can't take it more than 6 weeks. What do I do now?Please tell me an anti depressant which is stronger than disolupin in controlling my anxiety.Now A days I can't sleep in the night. I wake up with a electric shock in my head and all my chest and body shakes,why is this happening now,it didn't happen before.Please tell me anti depressant which has less side effects and control my anxiety.What do u think of Escitalopram? Does it have less side effects?please help me! Thanks

Answered by Dr. Preeti Parakh (4 hours later)

Brief Answer: Escitalopram is likely to suit you better. Detailed Answer: Hi XXXX, Welcome back! How have you been? I do feel that a drug of the SSRI class would suit you better. Though you were not comfortable with paroxetine, other SSRIs may not give you adverse effects. Both escitalopram and sertraline are very good options. Remember to start escitalopram in half dose, that is 5 mg once daily for two days and then 10 mg once daily. Please do not worry about side effects. Give it a trial. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (7 minutes later)

Hi doctor I wanted to know why I cannot take BUSPIRONE for long period of time Is it a XXXXXXX drug?

Answered by Dr. Preeti Parakh (12 minutes later)

Brief Answer: Buspirone is safe for long term use. Detailed Answer: Hi XXXX, Buspirone is very safe and can be taken for long periods of time. In fact, it takes around three to four weeks for the drug to show its full response. So I do not know why your doctor is advising you to take it only for six weeks. Maybe you misunderstood him. Please talk to him again and clarify this with him. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (1 hour later)

hi doctor, I want to know why I am getting electric shocks in my head.Is it a side effect of medication or anxiety.I never get it before.The shock wake me up from sleep.I hurts my side of the head so much that I couldn't stop crying because of pain.I am very worried and scared.Do medicines give u electric shocks in the head.I am attaching my pic so u will know how happy I was before and never wanted to become miserable.

Answered by Dr. Preeti Parakh (26 minutes later)

Brief Answer: Anxiety related. Detailed Answer: Hi XXXX, In my opinion, the electric shocks that you are describing are due to anxiety. Please see if trying a different medicine helps you. I saw your snap and you were looking very happy in it. I hope that you will soon become like your previous happy self. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (3 days later)

hello doctor! My shocks still continue in my head couldn't sleep at all.Does buspirone work like SSRIs? Does it increase serotonin levels or decrease it.Please explain their action especially in severe anxiety.Thanks.

Answered by Dr. Preeti Parakh (3 hours later)

Brief Answer: It doesn't work like SSRIs. Detailed Answer: Hi XXXX, Nice to hear from you again! Buspirone does not work like the SSRIs. It does not increase serotonin levels like the SSRIs do. Rather buspirone acts as an agonist, partial agonist, or antagonist on serotonin receptors in different parts of the brain. That is, in some parts of the brain, it decreases serotonin release while in other parts of the brain, it acts like serotonin. It also increases the activity of dopamine and noradrenaline in certain parts of the brain. The therapeutic effects of buspirone are due to the modulation of several neurotransmitters and intraneuronal mechanisms in different parts of the brain. That is why, it takes two to three weeks to show a response and has no immediate effects. I hope this helps you understand how buspirone acts. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (10 minutes later)

Thanks a lot for explaining! I hope the shocks in my head get better so I can sleep in the night.Do u think if I take paracetamol to reduce the pain from the shocks, will it help?

Answered by Dr. Preeti Parakh (15 minutes later)

Brief Answer: Yes, you can. Detailed Answer: Hi XXXX, You can try paracetamol and see if it works for you. If it helps, then it will be very good. In a few days, you will feel better as buspirone starts showing its response. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (31 minutes later)

hello! I wanted to know if I increase the dose of BUSPIRONE will it stop the shock in my head or I have to wait.Its been 10 days I am taking buspirone5mg 3 times daily.Do ur patients complain of muscle cramps and heat in the body as a side effect of this medicine or will it go with time?

Answered by Dr. Preeti Parakh (5 hours later)

Brief Answer: Wait for the full response. Detailed Answer: Hi XXXX, I do not feel that you should consider increasing the dose of buspirone now. Let the same dose continue for a few more days for the full response to manifest and then let us see whether you are feeling better or not. In my experience, buspirone does not cause muscle cramps or heat production. Please consider if something else may not be causing these. Take care to avoid dehydration and electrolyte imbalance. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (38 hours later)

My GP told me he cannot give me BUSPIRONE more than 6 weeks.But he gave me Escitalopram 20mg daily.Can I start while I am taking buspirone 5mg daily.What r the side effect of this medicine that people mostly complain about?

Answered by Dr. Preeti Parakh (21 minutes later)

Brief Answer: Do not start with 20 mg per day. Detailed Answer: Hi XXXX, There is absolutely no problem in starting escitalopram with buspirone. But escitalopram must never be started in the dose of 20 mg per day. The dose of 20 mg is a fairly high dose and needs to be built up gradually. If you start at this dose, you may have the same problems that you had with paroxetine in the past. Start with just 5 mg once a day, preferably in the morning. If you are okay with it, hike to 10 mg per day from the third day onward. You may or may not have some nausea or abdominal discomfort initially which improves in a few days. Continue with this dose for a few weeks. You may not even need to hike this up. You can even continue the dosulepin with this for the first few weeks as it will take a few weeks for the full response. Later dosulepin can be tapered off. Do not stop dosulepin now. The common side effects are nausea, diarrhea, constipation, heartburn, stomach pain etc. At higher dosages some people perceive changes in sex drive or ability. It is a very safe and effective medicine when taken correctly. Hope this helps you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (5 hours later)

I have stopped disolupin now.I need to know now I am taking 5mg of BUSPIRONE 3 times a day.Tomorrow I will start Escitalopram 5mg. What dose of BUSPIRONE should be taken with 5mg of Escitalopram.And when Escitalopram dose become 10mg then what dose of BUSPIRONE should be taken and for how long plz let me know. THANKS!

Answered by Dr. Preeti Parakh (5 hours later)

Brief Answer: No dose reduction needed. Detailed Answer: Hi XXXX, You should continue taking buspirone in the same dosage, that is 5 mg thrice daily, now as well as later. If you reduce or stop, there is a risk of your anxiety worsening as you are no longer on dosulepin and the escitalopram will need weeks to become effective. In the meantime, buspirone will take care of you. The other thing is that buspirone is very commonly used together with SSRIs as it is known to augment their action. So you need not worry about taking buspirone with escitalopram. Start escitalopram 5 mg without fear and hike to 10 mg after two days, continuing buspirone 5 mg three times daily. You can continue the same dose of buspirone even when you later hike escitalopram to 15 mg and 20 mg per day. I am worried that if dosulepin was stopped abruptly, you may have rebound increase in anxiety, which you may misunderstand as a side effect of escitalopram. I hope this doesn't happen. Take care. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (5 hours later)

Hi doctor my doctor told me to stop dosulpin totally now.How can I take so many medicines it really hurt in my head I get bad headache and I feel weak and dizzy.I am already suffering from stiff head and stiff face and stiff neck.when I started my anxiety all my body was shaking and my face was shaking as well. I have to stay alert all the time because of my son even in the sleep.I have to wake up so many times in the night to take my son to the toilet.I have to keep an eye on him all the time until my eyes get tired.He had so many fits so I had to run day and night to catch him.Can't go out, can't see my friends can't do anything like I am in prison.

Answered by Dr. Preeti Parakh (35 minutes later)

Brief Answer: Please do not worry. Detailed Answer: Hi XXXX, It is not your fault. You just followed your doctor's orders. So please do not worry. Continue with buspirone and start escitalopram 5 mg. In a few days, you will begin to see a difference and things will improve. If possible do the relaxations exercises I had explained earlier, for added advantage. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (17 minutes later)

HI doctor, please tell me why my GP doesn't want me take BUSPIRONE for long period of time. It says on the leaflet as well not for long period.What r the disadvantages of taking it longer.I am really worried.

Answered by Dr. Preeti Parakh (4 hours later)

Brief Answer: Explained below. Detailed Answer: Hi XXXX, I do not know why your GP has refused to prescribe buspirone for more than 6 weeks. My guess is that being a GP, obviously his knowledge of psychiatric disorders and medicines is limited. I'll again say that there is no harm in taking it for longer than 6 weeks. I do not know what is written on the leaflet that you mentioned, but here is the link to the package insert of BuSpar ( WWW.WWWW.WW . I have copied the following lines from the package insert: "The effectiveness of BuSpar in long-term use, that is, for more than 3 to 4 weeks, has not been demonstrated in controlled trials. There is no body of evidence available that systematically addresses the appropriate duration of treatment for GAD. However, in a study of long-term use, 264 patients were treated with BuSpar for 1 year without ill effect. Therefore, the physician who elects to use BuSpar for extended periods should periodically reassess the usefulness of the drug for the individual patient." So if a patient requires long term treatment with buspirone, there is no harm in prescribing this. Though the available data is for use up to one year, I shall have no problem in prescribing it for more than a year if I feel that it is required. However, if the patient has recovered, then there is no need to continue the drug for a long time. There is no need for you to worry. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (29 minutes later)

U r so lovely thanks for ur advice.It put my mind at rest!!!

Answered by Dr. Preeti Parakh (45 minutes later)

Brief Answer: Thank you, XXXX. Detailed Answer: Hi XXXX, Thank you. I sincerely hope that your anxiety reduces and you are able to live your life the way you want it. It must be very difficult and tiring to have to be constantly on your feet for your son. You deserve to be able to relax, enjoy and be happy. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (4 hours later)

Hi doctor I wanted to know that Am I suffering from PANIC DISORDER or GENERALIZED ANXIETY DISORDER please explain this difference. Thanks!!

Answered by Dr. Preeti Parakh (35 minutes later)

Brief Answer: Most probably GAD. Detailed Answer: Hi XXXX, Panic disorder is characterized by recurring episodes of severe panic attacks. Panic attacks are episodes of severe anxiety associated with symptoms like breathlessness, palpitations, sweating, numbness, tingling, choking, feeling of impending doom etc. These episodes usually improve within an hour and the person is reasonably well the rest of the time. But in Generalized Anxiety Disorder, anxiety persists all the time and is associated with worrying about almost all day to day situations. The worrying is excessive, uncontrollable and often irrational, is related to everyday things and is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering from GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties. Symptoms like breathlessness, palpitations, sweating, numbness, tingling etc can be seen in this disorder also. Though we have not discussed your symptoms in detail, the impression I have from our conversation is that you have GAD. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (23 minutes later)

Thanks a lot again!!This is my son who I love a lot!

Answered by Dr. Preeti Parakh (12 minutes later)

Brief Answer:
Many thanks!

Detailed Answer:
Hi XXXX,

Thanks for sharing the photos.

Best wishes.

Dr Preeti Parakh
MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 hours later)

Hi today I noticed rash on my face and slight itching sensation in my head and body.Is this a side effect of BUSPIRONE.Will it go.Shall I continue this medicine or stop it or go to my GP.Did anyone complain about this?

Answered by Dr. Preeti Parakh (4 hours later)

Brief Answer: May be buspirone induced, but uncommon. Detailed Answer: Hi XXXX, While none of my patients have reported a rash with buspirone, every drug has the potential to cause an allergic reaction resulting in a skin rash. In my opinion, you should inform your GP and show him the rash. It could also be due to reasons other than drug-induced. In that case there will be no need to stop the drug. Till you get to see your GP, do not take the medicine. Please do not worry. Most probably it is due to some other cause. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (3 hours later)

I couldn't sleep all night anxiety was very high heat in the body and legs.Heart was beating very fast, headache,electric shocks in head I want to start Escitalopram today but I know it will not work immediately.how many buspirone and how many dosulpin I have to take to controll my anxiety. Is it save to take all of them in one day.Buspirone is helping but not too much what to do I am confuse.

Answered by Dr. Preeti Parakh (12 minutes later)

Brief Answer: Explained below. Detailed Answer: Hi XXXX, The best thing would have been if your GP could have prescribed you a benzodiazepine for just a few weeks, till escitalopram showed its full response. Since he will not agree to that, I guess you will have to restart dosulepin, as the present worsening is most probably due to sudden stopping of dosulepin. I think taking 25 mg dosulepin twice a day should provide some relief while escitalopram starts working. After one week of escitalopram, cut down dosulepin to 25 mg once a day and stop after one more week. I hope your GP will not object to this suggestion, provided he is aware that escitalopram takes a few weeks to show its response. Along with dosulepin, continue with buspirone in the same dose as before (5 mg thrice a day) if the rash is no more a problem. Please do not worry about over-medication. In your case, under-medication is causing you suffering. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (19 minutes later)

Apart from clonazepam which other benzodiazepines is better. In UK doctors don't give clonazepam for anxiety just for epilepsy.

Answered by Dr. Preeti Parakh (1 hour later)

Brief Answer: Alprazolam will do very well. Detailed Answer: Hi XXXX, Alprazolam works very well but is shorter acting than clonazepam, so may need to be given thrice a day. But clonazepam can easily be given just twice a day and also has less dependence potential than alprazolam. Please request your doctor to give you alprazolam or any other benzodiazepine he is comfortable with, to help you tide over the next few weeks till escitalopram starts working. Assure him that you will take the medicine only as prescribed. Since you are in the UK, you can tell him that even the Maudsley Prescribing Guidelines allow for the prescription of benzodiazepines in Generalized Anxiety Disorder for up to four weeks. I hope the next few weeks become easy for you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (24 hours later)

hello doctor, my mother wants to know can she take STILNOX CR6.25 mg together with XOLNOX 10mg.Is this combination safe?Or what is the dose of them together that will make her sleep better.She is worried that STILNOX CR and STILNOX is not available in Pakistan nowadays.Which other insomnia medications r available because she is 71 now and has diabetes.Please if u can help Thanks!!!

Answered by Dr. Preeti Parakh (30 minutes later)

Brief Answer: Explained below. Detailed Answer: Hi XXXX, Stilnox Cr 6.25 and Xolnox 10 contain the same medicine, that is zolpidem. Xolnox is immediate release while Stilnox Cr is controlled release and acts for a longer time. Stilnox CR 6.25 is equivalent to Xolnox 5 mg and Stilnox CR 12.5 is equivalent to Xolnox 10 mg with the difference just being in the duration of action. For people who find it difficult to fall sleep, but once asleep do not suffer from frequent breaks, the immediate release preparation is fine. The controlled release preparation is for people who suffer from frequent breaks in sleep. So for your mother, you can choose one of the two preparations depending on her sleep pattern. Ideally for her age, half dose should be prescribed, that is either 6.25 mg of CR preparation of 5 mg of immediate release preparation. But if she has been taking the full dose for long and has no problems from it, then she can continue with it. But there is no point in combining the both together or increasing the dose any further. I could not find an alternative brand for Stilnox CR that is available in Pakistan. If she is still having sleep difficulty even after taking zolpidem, she may need to add another medicine. Trazodone, available in Pakistan as Deprel, is an antidepressant with good sedative action. It can be taken by her in the dose of 50 mg at bedtime, along with zolpidem. She can also take mirtazapine, which is another antidepressant with sedative action, 7.5 mg at bedtime. It is available in Pakistan as Mirtazep and Remeron. Both trazodone and mirtazapine are not addicting drugs. Benzodiazepines are an option but then she will find it difficult to come off them. I hope either trazodone or mirtazapine suit her and serve her purpose. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (18 minutes later)

hi! My mother doesn't want to take antidepressant.She only want some sleeping medicine which is available in Pakistan plz let me know! Thanks!!

Answered by Dr. Preeti Parakh (31 minutes later)

Brief Answer: Explained below. Detailed Answer: Hi XXXX, The medicines that I have suggested are antidepressants only in higher dosages. In the low dosage that I have suggested, they are used only for sleep. For example, trazodone has antidepressant action only in doses of 150 to 300 mg, while I have suggested 50 mg to you. Similarly mirtazapine is an antidepressant only in doses of around 15-45 mg. In low doses, both mirtazapine and trazodone are prescribed for sleep to people who are not depressed. Amitryptiline is also an option since your mother has diabetes. Amitryptiline is an antidepressant in doses of 75-300 mg per day, but in low doses of 10-50 mg, it is prescribed to diabetics for neuropathic pain and also has sedative action. So, amitryptiline 10 mg will also be a good option for her and help her in two ways. It is available in Pakistan as Amitryp, Tryptin etc. There are very few medicines which are just for sleep. Ramelteon is one such medicine but as far as I know, it is not available in Pakistan. Most medicines are for other purposes but also induce sleep. For example, benzodiazepines are for both anxiety and sleep. So please do not worry that your mother is being asked to take antidepressants. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (9 hours later)

Hi It's becoming very hard for me to leave disolupin totally. Can disolupin and buspirone be taken together for long Time

Answered by Dr. Preeti Parakh (3 hours later)

Brief Answer: Yes, they can be taken together for a long time. Detailed Answer: Hi XXXX, Yes, dosulepin and buspirone can be taken together for a long time. But I still feel that escitalopram is a better choice for you. Your doctor will never allow you to hike dosulepin above 75 mg per day. which a very low dose but he will gladly allow you to take 20 mg escitalopram, which is a fairly high dose and what we are targeting for you. The benefit with escitalopram plus buspirone will be greater than with dosulepin plus buspirone. I would like to know if you have started escitalopram or not. If not, please start it as soon as possible. Within a few days you'll notice a difference. Please also let me know if the rash has gone and what dose of dosulepin you are taking now. I feel your difficulty in leaving dosulepin is probably because it was abruptly stopped, without adequate cover from another agent. Please also let me know how many days you went without dosulepin, how did you feel during this period and when was it restarted. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (9 hours later)

Thanks for ur concern! I am taking disolupin and buspirone simultaneously at the moment.I hope it helps.My mother found mitrazepine in Pakistan.She has some XOLNOX ZOLPIDEM HEMITARTARATE 10mg left.Can she take mitrazepine 12mg with XOLNOX 10 mg together.Is it safe?

Answered by Dr. Preeti Parakh (52 minutes later)

Brief Answer: Yes. Detailed Answer: Hi XXXX, Yes, your mother can take mirtazapine with zolpidem 10 mg, but mirtazapine is available all over the world in strengths of 7.5 and 15 mg. I am not aware of any 12 mg preparations. She can take 7.5 mg mirtazapine with zolpidem 10 mg. If that suits her, later it may be hiked to 15 mg. Further hike is not recommended. Please check if it is indeed 12 mg and if so, confirm that the drug is mirtazapine. If there is any confusion, you can ask her to mail you a snap of the strip, with the labels clearly visible. Take care. I hope you start escitalopram soon. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 hours later)

Hi! My mother has some STILNOX 10mg AND STILNOX CR 6.25 mg.Can my mother take one of them with Mitrazepine 15 mg before going to bed.She wants to finish these medicines and also wants mitrazepine to take its action.what doses will be advisable! Thanks!

Answered by Dr. Preeti Parakh (6 hours later)

Brief Answer: Explained below. Detailed Answer: Hi XXXX, She should take mirtazapine 7.5 mg in the beginning, and not 15 mg. With this she can take Stilnox CR 6.25 mg or Stilnox 10 mg. But I feel she should use this combination only on a SOS basis, that is only on days when sleep is really bad and mirtazapine is not enough. If she takes both daily, she would later find it difficult to sleep with only one of the two medicines. So in my opinion, she should take only mirtazapine 7.5 mg and see how it works, using the Stilnox/Xolnox only when she needs extra help. The 6.25 mg dose can be used when the sleep difficulty is less and the 10 mg dose can be used when the difficulty is more. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (11 hours later)

hello! buspirone make my body shake a lot I am feeling sick today. I didn't feel like that before. My anxiety not in control. Feeling weak and dizzy and hurts in my head a lot.Last night kept waking up with shocks in my chest mostly,My chest was hurting and shaking what to do?I have IBS I feel lot of heat in my stomach.Shall I start Escitalopram will it ever work I have bad experience with SSRI.Is there any place I can buy clonazepam any website which is reliable.

Answered by Dr. Preeti Parakh (1 hour later)

Brief Answer: Start escitalopram as soon as possible. Detailed Answer: Hi XXXX, I do not feel that worsening of anxiety is due to buspirone. In my view, the medications you are taking are not enough to control your anxiety. That is, medications are not causing anxiety but they are not able to do enough to control it. I seriously believe that you should not put off trying escitalopram. Your previous bad experience of paroxetine does not mean it will be repeated with other SSRIs. I guess that you had probably been prescribed the wrong dosage of paroxetine, which could have caused this. Be brave and start escitalopram. I do not think buying clonazepam from online pharmacies without prescription is a good idea as you are likely to get swindled. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (19 minutes later)

When is the best time for escitalopram to be taken,how many buspirone should I take and what times, and how many disolupin I have to take so hard for me.

Answered by Dr. Preeti Parakh (6 minutes later)

Brief Answer: In the morning. No change in other medicines now. Detailed Answer: Hi XXXX, Start taking escitalopram 5 mg in the morning after breakfast. Continue with whatever dose of buspirone and dosulepin you are taking for now. We will start reducing the dosage after around a week, not now. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (2 hours later)

Hello doctor! I will take Escitalopram 5mg at 9am then after how long after I take buspiron5mg which I take at 9am usually, how many hours should be left so I take the next dose.I have never taken so many medicines in my life. Please explain how to take them and what time gap?

Answered by Dr. Preeti Parakh (8 minutes later)

Brief Answer: take escitalopram at ten am. Detailed Answer: Hi XXXX, Take buspirone at your usual time, that is nine am. Take escitalopram a little later, at around ten am. There is no need to make any change in the timing of buspirone. Do not worry about the number of tablets. It is only for a few days. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (24 hours later)

Hello doctor if I take BUSPIRONE at 9 am and take Escitalopram 5mg after 1 hour then when to take disolupin.Do I stop it totally.I take BUSPIRONE every 7/8 hours. When to take disolupin and how much now?Please explain?

Answered by Dr. Preeti Parakh (6 hours later)

Brief Answer: As before. No change needed now. Detailed Answer: Hi XXXX, You should continue taking whatever doses of buspirone and dosulepin you were taking earlier and at the same time. There is no problem if you have just taken another tablet at 10 am, when you have to take escitalopram also. Dose reduction will be done later, once you have been on escitalopram for a few days, not now. If you are taking dosulepin thrice daily, try to keep a seven to eight hour gap between the three doses. Buspirone and dosulepin can be taken together. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (7 hours later)

My eyes hurting with BUSPIRONE and light seems reduced.My eyes feels dry and iitching.when I take disolupin light in the eyes become bright and they don't feel dry or itch. Will this happen with escitalopram. I cannot concentrate with buspirone how will I drive now?

Answered by Dr. Preeti Parakh (40 minutes later)

Brief Answer: Be brave, XXXX. Detailed Answer: Hi XXXX, No one can predict whether escitalopram will suit you or not. I can just say that it has been taken by millions of people all over the world and found to be both safe and effective. I myself have prescribed it to many more patients than whom I have prescribed either buspirone or dosulepin. Escitalopram has a much better side effect profile than dosulepin and is a first line agent for management of anxiety and depression, while dosulepin is not. It appears to me that you are very much biased against escitalopram and your preconceived notions will probably make you feel uncomfortable if and when you are finally able to start it. It will be in your best interests if you can gather some courage and start it with a promise to yourself that you will give it a fair trial. If however you are satisfied with the level of response shown by dosulepin and buspirone, then you can continue with them. XXXX, no one can force you to take one medicine or the other. It is you who has to decide what will be the best for you. But worrying about what will happen when you take a particular medicine is just a manifestation of your anxiety and do not let it stop you from trying something which has worked for millions. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (20 minutes later)

U r so nice I will take it now I am very scared but I have to be brave.My mother also started mitrazepine 15mg.She took it before going to bed but she said she couldn't sleep 5 hours after taking it, but she started to feel sleepy after 5 or 6 o clock in the morning.She wake up by 9 o clock in the morning.She wants to know why sleep is coming so late,please tell me what's the best time for this medicine? Thanks a lot?

Answered by Dr. Preeti Parakh (19 minutes later)

Brief Answer: Ask her to shift the time as per her convenience. Detailed Answer: Hi XXXX, Just don't worry and start escitalopram. In fact, just take 5 mg now, regardless of what the time is and what other medicines you have taken. Do not take more than 5 mg. Usually mirtazapine is taken half an hour before bed time but since metabolic rates vary in different people, ask your mother to take it early in the evening, say around seven pm and see how it works. She can then adjust the time of the dose as per her preference to ensure that she gets the maximum benefits. Also ask her to avoid napping in the day time, if she does it. I just hope the 15 mg dose is not too much for her. I would have liked it better if she had started with 7.5 mg, as I had mentioned earlier. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (23 hours later)

Hi doctor I have started escitalopram 5 mg from today. I feel sick and in my upper abdomen I feel too much heat. I have Ibs as well and acid reflux. What causes all this heat in the body.At the same time I am getting shivers as well. What can be the side effects of 5mg Escitalopram which r mostly reported. Please let me know. Thanks.

Answered by Dr. Preeti Parakh (14 minutes later)

Brief Answer: No side effects at this dose. Detailed Answer: Hi XXXX, Nice to know that you have started escitalopram finally. Well done! You need not worry about any side effects at this dose. The acid reflux appears to be responsible for your heat like sensations. It is not new and you have had this earlier also. Just continue with escitalopram and forget about side effects. Just tell yourself that you are going to stick to it. You are to take 5 mg again tomorrow, and 10 mg from the next day onwards. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Preeti Parakh (22 hours later)

Doctor I am feeling very bad I have pain in my head too much heat In my body mouth is very dry. My doctor said I can't take disolupin now. If I take it will it harm me. R these medicines XXXXXXX together when do I have to take disolupin if I take Escitalopram 5 mg in the morning.please explain I am feeling worse than before.what to do

Answered by Dr. Preeti Parakh (3 hours later)

Brief Answer: Dosulepin should be tapered off. Detailed Answer: Hi XXXX, Headache, heat sensation and dry mouth are all signs of anxiety. You will not need dosulepin once escitalopram starts working. You have not mentioned what dose of dosulepin you are on currently. Earlier you were on 25 mg thrice daily. If you are still on it, then you should reduce it to 25 mg twice daily on the day you increase escitalopram to 10 mg per day. After 4 to 5 days, reduce dosulepin to 25 mg once daily and again after 4 to 5 days, stop it. Do not stop it abruptly, like you had done a few days back. The time gap between the tablets is not important as these medicines do not have any immediate effects. By the time escitalopram starts working, you will be off dosulepin. So, there is no danger. But if you stop dosulepin immediately and before escitalopram starts working, you will see that your anxiety worsens. Probably your present discomfort is because you had stopped dosulepin completely a few days back. Please hike up escitalopram to 10 mg tomorrow as scheduled and reduce your dosulepin dose by 25 mg. Do not worry and give this medicine a chance. If it works for you, you will notice a huge difference. The discomfort is for a few days only. Please bear with it. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (25 minutes later)

I am finding it hard all my body is shaking heart beating.I am already taking BUSPIRONE why is not working. I cannot concentrate ever since I start this medicine escitalopram.I think I go back to disolupin I could concentrate before.

Answered by Dr. Preeti Parakh (52 minutes later)

Brief Answer: Have patience, XXXX. It will get better. Detailed Answer: Hi XXXX, Buspirone also takes around two to three weeks to start acting and going by that, you will start seeing its effects within a few days. And XXXX, you were having severe anxiety on dosulepin as well and that is why you were looking for other medicines. And you are still on dosulepin even now. Have patience and continue with escitalopram for at least a few more days, before taking a decision. Just hang on. Things will get better soon. You are such a brave person. You can do this. Take slow and deep breaths whenever you feel the palpitations. You will immediately feel better. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (12 minutes later)

Doctor I didn't take disolupin from the past two days. Taking so many medicines hurt my head and hurt my body from inside especially under my ribs where I already have sharp pain and left side of my chest.

Answered by Dr. Preeti Parakh (11 minutes later)

Brief Answer: Never count the number of tablets you are on. Detailed Answer: Hi XXXX, I had explained earlier as well that you should not stop dosulepin abruptly. There is an immediate worsening if it is stopped abruptly. Now that you are already off dosulepin, you should hike up escitalopram as soon as possible so that it starts acting soon. If you have some tablets of dosulepin with you, take at least 25 mg at bedtime for the next few days. You should not count the number of tablets you are taking. Just try to relax a bit. Do the slow and deep breathing exercises. You will notice an instant benefit. Don't worry. You will be better soon. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (23 hours later)

Hello doctor, I am thinking of increasing the dose of Escitalopram to 10 mg. What side effects can I have at this dose.Will I be ever get cured.Will it cure me or manage my anxiety.Last night I had 2/3 shocks,keep waking up every 1/2 hour. Very painful.I feel that waves are moving in my head and in my stomach is it because I am alert and anxious all the time.What is reason I have this anxiety and why it's growing not going down.Do every one get shocks in anxiety, is my brain working too fast why I am in pain. I can't even have a nap because I know I will get shocks.

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Hike up escitalopram soon. Detailed Answer: Hi XXXX, Please do not just think about starting escitalopram 10 mg but start it as soon as possible if you want to get better soon. There is no need to worry about its side effects. It has worked for millions of people and there is no reason why it will not be able to manage your anxiety. But if you remain biased against it, then it will not work for you. So just forget about the effects or side effects and just focus on your day to day tasks. You have asked the reason of the worsening of anxiety. I have explained this to you earlier as well that when you stop dosulepin or similar medicines abruptly, there is worsening of anxiety. When you did not worry about side effects at the time of stopping dosulepin, there is no need to worry now also. Just hike up the dose of escitalopram and give it a chance to work. You have been so brave. Just hold on a bit more. You will notice a difference within a few days. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (43 hours later)

Hi doctor I am worried that I take buspiron and escitalopram now together. Will it cause serotonin syndrome or some danger to my health please explain. Lot of people die of that.

Answered by Dr. Preeti Parakh (12 minutes later)

Brief Answer: No need to worry. Detailed Answer: Hi XXXX, There is no increase in the risk of serotonin syndrome on combining buspirone with escitalopram as buspirone does not increase serotonin release in the brain. Since you are on a low dose of escitalopram, the amount of serotonin released will be too less to cause serotonin syndrome. Supposing if you were to take many tablets of escitalopram at a time, then you would have a serious risk of serotonin syndrome. There is no need to worry, XXXX. I hope you are now better than before. Take care. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (1 hour later)

hi I am going to see psychiatrist soon if they give me any benzodiazepine do u think it will work on me. What will happen as soon as I take it? Does it take all my pain away all of a sudden?Do I have to take it until my symptoms improve, if they don't improve on escitalopram do I have to go back on benzodiazepine?

Answered by Dr. Preeti Parakh (28 minutes later)

Brief Answer: Benzodiazepine is not a long term solution. Detailed Answer: Hi XXXX, Benzodiazepines are prescribed only for a short term to help people tide over the time that takes for the SSRI to become effective. SSRI is the first line of management for all anxiety disorders, please be very clear about that. Benzodiazepines provide immediate relief which however lasts only as long as the medicine is in the body. It cannot prevent the anxiety from returning again, while SSRI can. I expect it to have the same result on you as it has on others. If your symptoms do not improve on escitalopram, which is highly unlikely, your psychiatrist will probably try other SSRIs or psychotherapy. Benzodiazepines are not a long term solution. I guess you are feeling better for last couple of days and by the time you get to see the psychiatrist, you will already be much improved. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (19 minutes later)

I was on disolupin 75mg for the last 6 months it didn't cure me my anxiety got worse why this happen doctor? Did my GP did not give me right medicine? Shall I change my GP?

Answered by Dr. Preeti Parakh (14 minutes later)

Brief Answer: Right medicine, wrong dose! Detailed Answer: XXXX, Dosulepin is not a wrong medicine but the dose was wrong. The dose of 75 mg was just the starting dose and he should gradually built it up to 300 mg per day. No medicine will work if the dose is not correct. Your GP was also very wrong when he asked you to start escitalopram in the dose of 20 mg per day. I guess he might have prescribed paroxetine also in the wrong dose which has led you to have such a fear of SSRIs. You will have to decide about changing your GP as I do not know what other options you have. If the other GP is also not knowledgeable about psychiatric illnesses, then it may not be of benefit. I guess you will have to make some enquiries and then decide. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (26 minutes later)

Thanks doctor for ur lovely advice. My mother wants to know if she can take mitrazepine 15 mg Now or she has to wait more.

Answered by Dr. Preeti Parakh (1 hour later)

Brief Answer: At least two weeks. Detailed Answer: Hi XXXX, Ask her to be on mirtazapine 7.5 mg for at least a couple of weeks. Then, if she is not satisfied with the response from 7.5 mg then she can hike it to 15 mg per day. In the meantime, she will also know if the medicine is suiting her or not. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (37 hours later)

Hi doctor I am going to increase escitalopram 10 mg a day very scared though. Can I take it in two different times like 5 mg in the day and 5 mg in the night please help me!! Is it ok or not?

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Yes, it is fine. Detailed Answer: Hi XXXX, Please do not worry and increase the dose to 10 mg per day. If you want, you can take it in two divided doses, in stead of one dose. It is absolutely fine. Please do not delay in hiking up the dose. XXXX, I received a call from people at Healthcare Magic, asking me to ask you to close this query and start a new one. They told me that there is some issue with the payment. You can sort it out with them. If required, I can be contacted directly at WWW.WWWW.WW Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (23 minutes later)

what time difference should it be will it cause insomnia if I take it in the evening please let me know I am still suffering a lot. I will sort out the payment soon

Answered by Dr. Preeti Parakh (6 minutes later)

Brief Answer: five pm. Detailed Answer: Hi, Take it in the evening around five pm so that it does not cause insomnia. Take the morning dose at around nine am. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 minutes later)

Is there any way I can contact u over the phone I really need it help all the time without u I will panic a lot

Answered by Dr. Preeti Parakh (11 minutes later)

Brief Answer: sorry Detailed Answer: XXXX, I am sorry that it will not be possible for me to help you over the phone. Please do not worry. You just have to close the query and start a new one. Best wishes.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (1 hour later)

Hi doctor I went to my GP today he is not happy for me to take 5mg twice daily of Escitalopram. Do u think it will not work like this.does it have to be taken in one dose only?

Answered by Dr. Preeti Parakh (5 hours later)

Brief Answer: No problem in taking two divided doses. Detailed Answer: Hi XXXX, It makes no difference if you take it as 5 mg twice daily in stead of 10 mg once daily. It will not reduce either the effects or the side effects. However, if it makes you happy, then go for it. Please sort out the payment issues soon as otherwise, it will not be possible for me to answer any more of your queries. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (41 hours later)

Doctor I had a shock last night again was very bad too much headache cannot concentrate. I cannot drive either my anxiety is too high. I increased the dose to 10 mg from 2 days last night my body was burning I cannot relax. Is this the side effect of medicine will this burning ever go. Taking the other dose at 5 pm make me uncomfortable.Make me dizzy and weak. Will these shocks ever stop!

Answered by Dr. Preeti Parakh (32 hours later)

Brief Answer: Things will improve in just a few days. Detailed Answer: Hi XXXX, If you are not comfortable taking escitalopram in two divided doses, take the entire 10 mg in a single dose. As I had mentioned earlier, there is no need to split the dose. Just wait of a couple of days and continue the medicine. You will notice a difference. Meanwhile sort out the payment issues with the customer care people and also let me know. Otherwise, I'll not be able to answer any more questions. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (2 days later)

My eyes water and sting when I take buspiron with escitalopram. Why is this happening it never happened before doctor. Feeling little better with escitalopram. Hi doctor I am taking escitalopram 10 mg daily head still very stiff and hurts.pain around the temples and eyes and face.I noticed sleep is reducing.anxiety still high.