Patient's Query
Hello doctor,
I have esophageal dysphagia, and food gets stuck easily, which causes a lot of anxiety with every bite. But that is not even the worst part. When something does not feel right while swallowing, my body’s reflex makes it worse, and then I end up having a panic attack, which is terrifying. My long-time doctor, who I saw for over 20 years, understood my issue, but the last two doctors have not listened. I have been prescribed 2 mg of Alprazolam before each meal to help with the panic attacks, and I explained this to my most recent doctor. However, he suggested Klonopin might work better, so he prescribed me 2 mg of Klonopin instead. After over three weeks, I found that Klonopin is not working better. The problem is that Alprazolam acts faster, which helps with panic attacks quickly. So, I want to take 2 mg of Alprazolam before every meal because Klonopin is acting slowly. Kindly suggest.
Hello,
Welcome to icliniq.com.
I understand your concern.
As per your mentioned symptoms and history you are going through generalized anxiety disorder with panic attacks and somatization. Dysphagia is a somatic symptom. Alprazolam and Clonazepam (Benzodiazepines) are as and when required medicine and their effects last for four to six hours and no long-term improvement with these medicines. So for the long-term solution, you require medicine like Paroxetine or Venlafaxine (selective serotonin reuptake inhibitors). Start physical exercise daily, avoid smoking and drinking if any, take small but frequent meals rather than two large meals, and avoid fast food and oily food. Start with Etizolam (Benzodiazepines) and Propranolol (beta blocker) in combination with Paroxetine. Also, take psychological sessions particularly CBT (cognitive behavioral therapy) to understand and manage your condition. I hope you find this helpful.
Thank you.
Patient's Query
Hello doctor,
Thanks for your reply. If not Alprazolam, can you suggest some other medications or lifestyle changes that make me feel better? Please help.
Hello,
Welcome back to icliniq.com.
I can understand your concern.
I know that you are getting benefits with Alprazolam but it is short-acting and addictive, so you need to take it for a short duration only. Alprazolam is used for immediate results. Even though you feel good with Alprazolam, it is advisable to continue for a shorter period with other potent anti-anxiety medicines like Paroxetine and Venlafaxine for long-term improvement. With long-term Alprazolam use, individuals develop tolerance and later, we need to increase dosage gradually for better results. So, I suggest it is better to start with other potent anti-anxiety drugs like Paroxetine or Venlafaxine with Alprazolam so you will not require a higher dosage of Alprazolam in the future. Start Alprazolam 1 mg three times with Paroxetine 12.5 mg two times a day. I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
This is what I am looking for. If you think the other medication will work, I am open to trying it, but I have my doubts. I do not think you fully understand just how quickly this happens. I am assuming you have never experienced a panic attack like this, but when I take a bite, if I feel anything even slightly off, I panic instantly. It is so hard to explain just how overwhelming it is. Even the thought of reducing my dosage by just 1 mg scares me. I need medication now, but I can send you my files and X-rays to give you a better understanding. I appreciate your help, but I wish we could stick with the 2 mg and include the other two medications as well. If you see my records from a couple of hospitals, I think it would help you understand more clearly what I mean. Please suggest.
Hello,
Welcome back to icliniq.com.
I understand your concern.
The panic attack itself is an emergency and it comes very fast and goes to peak within seconds and you are frightened about situations. I understand that it is scary for a few minutes. You can attach all your files as you attach Alprazolam pictures. And yes, slightly decreasing the dosage will affect your anxiety and it worsens. So start Paroxetine with Alprazolam initially then reduce dosage after once you feel stable. I hope this will help you.
Thank you.
Patient's Query
Hello doctor,
Thanks for replying. I will certainly give it a try. Can I schedule another appointment with you in a month to see how it is working out for me?
Hello,
Welcome back to iclniq.com.
Yes, you can go for such a combination and after 10 to 15 days, book an appointment so we can discuss progress and improvement. Do physical exercise daily and avoid smoking and drinking if any. I hope you find this helpful.
Thank you.
Patient's Query
Hello doctor,
I will take the medicine exactly how you have prescribed and see the improvement and if it makes me feel better.
Hello,
Welcome back to icliniq.com.
I understand your concern.
It is good that you decided to take the same as prescribed and we will be in contact from time to time. You will be out of this situation. Follow whatever is suggested.
Patient's Query
Hello doctor,
I appreciate your time and thanks for explaining what I have been going on and how to move forward. I will talk to you soon.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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