How to slowly taper off the medication dosage in a patient with anxiety and panic disorder?

Hello doctor,

I have been dealing with generalized anxiety disorder (GAD), premenstrual dysphoric disorder (PMDD), and panic disorder. I have been taking tablet Sertraline 100 mg, currently. Before that, I was on 75 mg for about three months. I used the tablet Alprazolam at a maximum dose of 0.75 mg, divided into doses, a few months back. After that, I shifted to tablet Diazepam, taking about 7.5 mg divided into doses till now. I briefly tried the tablet Lamotrigine but stopped it due to experiencing a very bad mood, irritability, a dull feeling, and severe anxiety. My doctor has advised starting the tablet Buspirone 5 mg twice a day for two weeks and then increasing it to 10 mg twice a day after two weeks. I am concerned about the possibility of serotonin syndrome. Additionally, I am seeking guidance on tapering off Diazepam to avoid increasing my dependence. I plan to seek a second opinion from a psychiatrist to ensure I am making informed decisions about my treatment plan. Kindly help.

Thank you.

Hello,

Thank you for your reply.

To ensure clarity, could you please verify the following medication plan:

1. Tablet Zoloft 100 mg (I started taking it at night as this dose makes me sleepy) taken twice daily for a week. Occasionally, I use it at a four-hour interval, as my condition necessitates it rather than the usual 12 hours. However, I never surpass a total of 7.5 mg.

2. Tablet Diazepam 2.5 mg once for 10 days if my condition is stable after starting tablet Buspirone.

3. Tablet Diazepam 2.5 mg every other day for 10 days and then I need to stop it.

4. As for the tablet Buspirone 5 mg, I will take it twice daily for the first 10 days and then increase it to 10 mg twice daily.

Can you tell me if the plan we discussed will work for my situation? If you know of any other approaches that have been successful, I would appreciate your input. My main aim is to feel like my usual self without fear, and I am really eager to make progress. Kindly help.

Thank you.

Hello doctor,

Hello doctor.

Hello doctor,

Thank you for your reply.

I have recently increased my Zoloft dosage to 100 mg, and over the past 11 days, I have been experiencing irritability and anxiety. The last three days have been particularly challenging, with severe dizziness, trembling hands, a racing heart (despite a normal pulse and blood pressure), and a feeling of potential collapse. I also had an episode of hyperventilation, despite my oxygen saturation being normal at 100 %. Initially, I associated these symptoms with Lamictal, which I took for five days before stopping three days ago. However, my intrusive thoughts have intensified in the past two days, and I am struggling with mental fogginess. Currently, my medication consists of Zoloft 100 mg and Diazepam 7.5 mg per day. Considering my sensitivity to medication doses, would it be wise to lower Zoloft back to 75 mg? At that dose, I did not experience intrusive thoughts. Your guidance is deeply appreciated, and I apologize for the lengthy message.

Thank you.