Q. I have bipolar disorder, panic attacks and generalized anxiety. What are the treatment options?

Answered by
Dr. Parth N. Nagda
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 19, 2020 and last reviewed on: Jan 09, 2023

Hello doctor,

I have bipolar disorder, panic attacks, social and generalized anxiety disorder. I have one to three panic attacks per day, constant anxiety, and fear of leaving the house. No motivation to work, no energy, apathetic, without mood. Right now I am in a depressive episode.

I previously tried Valproic acid, Lithium, Carbamazepine, Xanax, Lorazepam, Clonazepam, Rudotel, Lexotanil, Fluoxetine, Sertraline, and Escitalopram. SSRI does not have an effect on me.

Right now, I take Lamictal 50 mg daily and Tranxene 5x5 mg daily. Tranxene loses its anxiolytic effects and my anxiety becomes more severe. I am planning to titrate Lamictal 100 mg. However, it should not help with anxiety.

What are my treatment options? Benzodiazepines are not an option because I am getting used to them. Two days later I have a consultation with my psychiatrist, but I want to hear possible treatment for my conditions from another option.

I have done thyroid, heart function, men hormones, prolactin, kidney and liver function tests. All are normal.



Welcome to

If your anxiety is not responsive to SSRI's (selective serotonin reuptake inhibitors), then you should consider trying TCA (tricyclic antidepressants) class of antidepressants. They will help with your anxiety and panic attacks.

Apart from Tranxene and Benzodiazepines, there are few other options for anxiolysis. If you are specifically looking for something to be added to the TCA such as Propranolol, Buspirone, Tofisopam, Clobazam, Hydroxyzine, and Pregabalin.

Also, you can consider Mirtazapine, which will act as an antidepressant and also for anxiolysis. It is a NaSSA (Noradrenergic and specific serotonergic) class of antidepressants.

Was this answer helpful?


Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Related Questions:
Having panic attack, anxiety, and fear of brain tumour for past six years. Please help.

.. are very anxious with thoughts of having a brain tumor. It may be part and parcel of your previous anxiety problem, which might have increased recently. I suggest you consultant a psychiatrist for anxiety issues. For relieving your current thought...   Read full

Can people with a generalized anxiety disorder (GAD) go to work?

Hi doctor, How do you diagnose someone with a generalized anxiety disorder (GAD) ... How much are they stressed, and what is the highest intensity of generalized anxiety disorder (GAD) ...   Read full

I am suffering from generalized anxiety disorder and low self esteem. Please help.

I am suffering from a generalized anxiety disorder since childhood ... A lot of individuals have generalized anxiety disorder and this often causes significant comorbidity and depression ...   Read full

Also Read Answers From:

ideaComprehensive Medical Second Opinion.Submit your Case

Also Read

Malaria Prevention Using Monoclonal Antibodies
A recent phase 1 study proved monoclonal antibodies effective in preventing malaria. Read the article to know more.  Read more»
Surgical Ostomy - Types, Causes, Procedure, and Complications
This article briefly discusses ostomy, a surgical procedure where an opening is created between the segment of the gastr...  Read more»
Rotavirus Infection - Symptoms, Diagnosis, and Treatment
Rotaviruses are among the most common causes of severe diarrhoeal disease in young children worldwide. Read the article ...  Read more»

Ask your health query to a doctor online?

Ask a Psychiatrist Now

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.