Ananth Shanmugam
Psychologist/ Counselor
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Dear Doctor,
I am suffering from anxiety, restlessness and taking Clonazepam 0.75mg & Mirtazapine 30mg daily. I had depression and panic attacks for the last 7 years relieved by Ativan 1mg and with open angle glaucoma.
Need a second opinion.
Hi,
Welcome to icliniq.com.
Depression, anxiety, restlessness and panic attacks are best respond to a combination of a Selective Serotonin Reuptake Inhibitors (SSRIs) and Benzodiazepines.
Mirtazapine is not the most efficient ant depressant and it is not a true SSRI as fluoxetine, paroxetine, citalopram and sertraline are.
I recommend 20 to 40mg of Paroxetine (slowly titrated up from 10mg) and 1mg of either clonazepam or ativan (lorazepam) every 8 hours as needed for anxiety.
Glaucoma precludes use of any anticholinergics such as hydroxyzine or benadryl (diphenhydramine).
SSRIs are also at times likely to make glaucoma worse but a preliminary trial is always worth it.
Revert back to a psychiatrist online for further help --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist
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