Which drug is better for anxiety and sweating in a 24-year-old?

Question

Hi doctor,

I am a 42-year-old male. I have had severe anxiety, IBS diarrhea, palpitations, abnormal sweating, and tachycardia for the last 20 years.

I have shown it to various psychiatrists but have not gotten satisfactory results. Recently, I have consulted an eminent psychiatrist, and he suggested these medications.

Nexito Forte.
Pronol H.
Nortimer 25mg.
D veniz 50mg.

I am not getting any benefit in my anxiety problem from Desvenlafaxine 50 mg, and if I increase the dose from 50 mg to 100 mg, then it causes a severe headache.

One of the psychiatrists suggested that I take Venlafaxine 37.5 mg initially, then increase to 75 mg, as Venlafaxine will help with both anxiety and IBS diarrhea. But Venlafaxine causes me to have excess sweating.

I am confused about how good Venlafaxine is compared to Desvenlafaxine in controlling my severe anxiety with IBS diarrhea, depression, palpitation, sweating, and long-term problems.

Please guide me as I am very much confused about which medicine I should use without many side effects. Should I start with Venlafaxine, but what about abnormal sweating?

Please guide.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

As per your mentioned symptoms and history, I know you are going through irritable bowel syndrome (IBS) and anxiety. You need to be calm to get results.

With Venlafaxine, you face perspiration on your hands, and that may be because of anxiety or thyroid hormone disturbance. Do check for thyroid hormone disturbance.

As you are getting benefits from Venlafaxine, you need to continue the same in a low dose. If not getting benefits with low dose, then gradually increase the dosage of Venlafaxine and add Etizolam or increase the dosage of Propranolol to control sweating.

Desvenlafaxine is the active component, though sometimes it does not work. So you need to add Venlafaxine to what you are already taking.

Start physical exercise daily.
Avoid smoking and drinking if any.
Start psychotherapy, particularly cognitive behavioral therapy (CBT), to understand and manage your condition and how to deal with it.

Anxiety and irritable bowel syndrome (IBS) are long-term illnesses, so you need to remain calm and stick to one treatment regimen for a long duration. If there are side effects, then lower the dosage and make proper adjustments.

I hope this information is helpful.

Please do not hesitate to contact me if you need to know anything else; I would be happy to answer.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

If sweating comes, then add one more tablet of Pronol-H (Propranolol Hydrochloride). Also, check thyroid levels at that time.

If thyroid comes normal, then go for pharmacological treatment options. If required, add Levocetirizine as that also helps. There is no issue in taking medicines for the long term.

I hope this helps.

Thank you.