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ANXIETY ATTACKS putting mind, body under lot of stress.

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Doctor,

I've been diagnosed two times with Anxiety, causing sincere Anxiety attacks. The Anxiety is most likely coming from my work life and adjoining lifestyle putting my mind and body under a lot of stress. I was treated by taking Lexapro, which helped me well to stop the attacks.

The first episode, I discontinued the medication, I spend a lot of time on exercising and at the gym. I must say I cannot remember ever feeling that great and was fitter and more active than ever. Unfortunately due to work related issues and falling back into a lesser healthy lifestyle the Anxiety came back.

The second episode, which I am going through right now, I am back on Lexapro and again it put a stop on the attacks. However unlike last time, I feel very drained during the day. I am back intensively exercising (maybe a bit too intensive), but I did not stop the medication like last time. Maybe the combination of Lexapro and exercise is not going very well. Or maybe there is something else.

I just recently did an annual checkup and all my blood levels were normal, besides the cholesterol was a bit too high. So I really don't know how it comes that I feel so drained. But I am desperate for a solution as I need to be fit and focussed to run my company.

I am based in BKK so it is more difficult for my to find a physician that besides subscribing meds, is accessible to find the root cause, mainly due to language barriers I guess.

I am really looking for a solution.

Thanks!

Kevin

Category: Psychiatrist

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Hello,
Thanks for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
The condition that you are having is basically panic attacks. This is a disorder of anxiety and occurs cause of imbalance of certain neurotransmitters in the brain. especially serotonin, nor adrenaline, and dopamine to some extent. Medicines are the best options to take care of these symptoms. Paroxetine is the the most popular medicine and my drug of choice. You have been prescribed escitalopram which is also a good drug fro anxiety disorder but fatigue is one of the side-effects of escitalopram. Its possible that first time you did not have a side-effect and still you may get this side-effect in the next round. Exercising with medications may not be responsible for the fatigue. I generally prescribe my patients 12.5 mg of paroxetine per day at night which takes care of anxiety symptoms. Also certain medicines like propranolol and clonazepam can be give as required when there is a panic episode or expected situation where panic attack can appear.
You may meet your doctor and consider switching you to paroxetine or venlafaxine or mirtazapine which are some other options other than escitalopram. You may keep exercising as it will help you.
Hope this helps,
In case if you have any further query, do let me know.
Kind regards
Dr. Srikanth Reddy


Patient replied :

Hi Dr. Srikanth,
Thanks a lot for your reply. I dont think changing meds is a solution to my problem, after all I've been on Lexapro already for over a year now. The treatment (if all goes well) should normally only last for 12-18 months.
I am currently in the process of decreasing the dose, in hope that helps, so I decreased from 10 MG to 5 MG. I would like to continoue this for let's say 2-3 months and then get off Lexapro and meds entirely.
I do have a question about decreasing the dose. Is it normall that also with decreasing the dose, withdrawel effect can occur. I am on the decreased dose already for over a week now and exprience the following:
1. Feeling drained, but not really tired. (Mostly afternoons at work)
2. Feeling hot, but no fever.
3. Feeling a bit more stressed and anxious, but still under full control.
4. Mood Swings
I know that the above I list are withdrawel effects, but can they also occur by just decreasing the dose?
Thanks a lot in advance!
Kind regards,
Kevin


Hello
The symptoms that you have mentioned may not occur with such a small reduction in the dosage of lexapro from 10mg to 5mg. Probably they are recurrence of the symptoms and may require additional treatment. I agree with you that in a normal course the treatment of anxiety disorder is for 12-18 months, provided the symptoms are well controlled even after withdrawing the medicines. If not then the medicines need to be added up. i am sure you wont like this idea, but many times we need to go by the nature of the illness. You may wait and watch for 7-10 days but if the symptoms persist then new medicines may need to be added up. You may even control the existing symptoms with the help of clonazepam 0.5mg temporarily until your body gets used to the reduced drugs.
Hope this helps,
Regards.


Dr. Srikanth Reddy
Category: Sexologist
Experience: 
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
Dr. Srikanth Reddy and 4 other Medical Specialists are ready to help you

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