Thank you for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
Anxiety symptoms/ co morbid disorder is vey common among the patient of bipolar 2. And this needs to be treated sytematically. I have gone through the list of medications that you have been and i failed to find the mention of paroxetine or venlafaxine which are two very good medicines for anxiety. Yoi should definately discuss these two options and infact paroxetine is considered drug of choice for anxiety disorder. Secondly i differ from the opinion of your treating doctor that benzos are so unsafe that they should not be tried. I have plenty of ky patients on benzos like clonazepam and they have improved with them andni could withdraw the benzos as well. Ofcourse i used them with either the paroxetinen or lexapro or venlafaxine .
Hope this help.
If you have any other query, let me know.
Dr. Srikanth Reddy
Patient replied :
Hi, Thank you so much for the advice.
We actually had a lengthy discussion where I think paxil was mentioned but I'll ask again.
However my one concern is that Paxil is an ssri; and I have usually had bad side-effects on those.
I was wondering if Paxil is unique and also what you thought of these two medications:
Latuda and Emsam.
Another doctor told me that Emsam might be helpful whereas my current doctor said that should only be a last-resort medication.
She also mentioned Latuda as well as the option I am currently taking: taking proponal.
A) What do you think of latuda and/or Emsam
B) How much proponal would one probably need to keep their anxiety in check (taken daily, not as needed...im currently on 10mg daily and it is not enough).
C) Is paxil different then other ssri's.
THANK YOU SO MUCH
Thanks for the follow up query.
Latuda may not help with the anxiety issues. Infact emsam can but its a new drug and it is not being promoted as a first line medication and as rightly said by your psychiatrist, it should be used only when other medicines are not effective.
Propranolol is usual prescribed in a daily dosage of 40 to 80 mg and can be predcridbed upto 240mg. So 10 mg is too low and you can definately increase the dose.
Yes you are right. Paroxetine is again an ssri but every ssri is surprisingly having its own tolerance. So there is nothinh wrong in trying it. If at all there are sexual dysfunctions the cyproheptadine may be tried.
Hope this helps
Dr. Srikanth reddy MD
Patient replied :
Thank you for all the information! I had no knowledge of cyproheptadine so again, thank you!
MY FINAL QUESTIONS:
since I have a failed history with SSRI's, if propanol doesn't work would you recommend trying EFFEXOR first over PAROXETINE for anxiety and related attention span issues?
do you think I should be concerned with propanol's lowering of blood-pressure?
lastly, what do you think of the drug GABAPENTIN, I once lowered my lamictal and went on gabapentin, and Not to be scary but I actually attempted suicide soon-after, which I think was PARTIALLY related to the lowering of the lamictal. Is there a way to try gabapentin w/o a lowering of lamictal and more importantly...should I?
Yes it would ve wise to try venlafaxine (effexor) before paroxetine.
Propranolol is used with proper BP monitoring should not be a trouble. I routinely start my OPD patients on 40 and 80 mg and never did any of them witness hypotension.
Gabapentin is also a good option. But i would rate it after effexor and paroxetine.
Hope this info helps
Dr. Srikanth Reddy