I stopped my Effexor tablet gradually, but my panic disorder worsened. Why?

Question

Hi doctor,

Seven years back, for two years, I had a complete breakdown with agoraphobia, panic attacks, weight loss, anxiety, depression. Little bouts throughout the prior ten years but they only last two weeks or few days. Nearly three years on Effexor for the panic disorder after a breakdown. I have taken eight months to come off slowly. Side effects included weight gain, no sex drive, severe fatigue at times, and not happy or sad but were working after not being able to for two years. It stopped panic attacks and anxiety so I could have a life working casually. I started full-time work two weeks before being off completely, but work anxiety is back after five weeks. I cannot sleep and have waves of panic attacks. My doctor started me on Lexapro 10, which lasted 12 days with nausea, diarrhea, anxiety, sleep coming and going. He stopped me straight away off Lexapro and, with a two days break, told me to start Effexor 75. I took three days gap and started day one on 37.5. Should I have gone straight to 75? I have to go back to work in four days. Anxiety is high. My doctor gave me Diazepam, which I have not taken. Currently in for four days teaching via zoom. I need to get through a month of work before two weeks of school holidays. I would try to ask for an hour reduction if I can make it back to work. Please guide me.

Answer 1

Hi,

Welcome to icliniq.com.

You have panic disorder. There is non-pharmacological management for it. However, it would help if you tried to follow the below guidelines to deal with it. It will help you:

1) You should do exercises daily for 30 to 45 minutes, like going for a walk.

2) You should do meditation for 20 minutes daily, sit at one place in a comfortable position, and concentrate on your normal breathing, do not stop or force yourself to stop your thoughts. Just let it be. It will help you to relax and reduces panic attacks.

3) You should eat healthy home-cooked foods, avoid junk foods.

4) You must drink enough water.

5) You should spend quality time with friends and family daily or do video calls if you live away from your family.

6) You should spend time on creative hobbies like reading good books, writing journals, painting, drawing, learning new skills or language or musical instruments.

7) You should take enough seven to eight hours of sleep daily.

8) You must avoid tobacco or alcohol or any substance abuse.

9) Live your life, do not just spend it.

10) Be bold and confident.

I suggest you gradually increase your Effexor (Venlafaxine) 37.5 mg to 75 mg within a week. I suggest you take tablet Clonazepam mouth dissolving 0.25 mg when you have a panic attack instead of Diazepam.

I hope this was helpful. Please get back if you have further queries.