Get E-Book on COVID-19

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

Answered by
Dr. Parth Nagda
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 19, 2020 and last reviewed on: Mar 31, 2020

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.

Dr. Parth Nagda



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?


Related Questions:
Having depression and not getting well with SSRI. Can you suggest any treatment?
I am suffering from generalized anxiety disorder and low self esteem. Please help.
Will my anxiety relapse if I stop SSRI?
Consult by PhoneConsult by Phone Video ChatVideo Chat
Also Read Answers From:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers

I have bipolar disorder. What are the lifestyle changes I can do to improve my mood?

Query: Hello doctor,I am a 35 year old male. I am suffering from a bipolar affective disorder. Currently, I take Magnesium Valproate 400 mg BD with Amisulpride 100 mg HS. My overall mental health remains stable with the above-said dose of medicines. But, in spite of that, I have had anxiety in the past. ...  Read Full »

I have intense anger issues. Is it due to bipolar disorder?

Query: Hello doctor, I m female, 21 years old, 4.8 height and 42 kg weight. I am suffering from psychic problem. I think I have bipolar disorder, I get too much angry, anxiety,stress, and get depressed soon. I will break every object when I get angry I will become out of mind in that time, I broke more th...  Read Full »

Is there a better medication to use long-term for generalized anxiety disorder?

Query: Hello doctor,I have GAD problem for more than two decades. Right now I am using Mirtazapine 15 mg and Rivotril 0.25 on SOS. Is there a better medication for long-term use? Previously I used Fludac 20 mg, Trazodone 25 mg and Buspar 5 mg (three times). After I shifted to Mirtaz. My problem is insuffic...  Read Full »

Also Read

This article provides you with all the information that you should be knowing about miscarriage. Although this is an emo...  Read more»
COVID-19 Testing
COVID-19 testing includes analyzing patient samples to determine current or past infections with SARS-CoV-2. Read the ar...  Read more»
I feel a restlessness in my legs, which decreases my sleep quality. How to get a refreshing sleep?
Hello doctor, I cannot get refreshing sleep some days in a week, and some days it is good. I also have difficulty sleep...  Read more»

Ask your health query to a doctor online?

Ask a Psychiatrist Now

* guaranteed answer within 4 hours.

Disclaimer: All health Q&As published on this website is not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care 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.