Dr. Suresh Kumar G D
Pediatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am suffering from panic disorder for the past four months. Initially, when I got my first panic attack, I just suffered without taking medical help since I am frightened to take medicine. This made matters worse and I started to have almost regular panic attacks followed by mild depression a month later. I am a 37-year-old healthy male with no diseases. I used to regularly jog or workout in the gym. I eat a healthy mostly homemade vegetarian diet in limits. I never drank alcohol or smoked.
I was happy with my life and had no regrets. But after I got my first panic attack I got so scared that I started to research internet furiously and overthink a lot. This made matters even worse for me and finally, I consulted my local GP. He prescribed me with Stalopam 10 mg at night and 0.5 mg Clonafit twice a day.
I was afraid to take them and finally after my panic was getting bad enough to cause insomnia, reluctantly with GPs persuasion I started to take the medicines. I took Stalopam daily but disregarding my GP I took only 0.5 mg Clonafit at night as I heard it can cause addiction. Initially for two to three weeks, I felt a little depressed every now and then but the panic attacks intensity decreased immediately. Though I got the attacks they were not scary. After the first month the depression too became better. Then I halved the Clonafit and started to take only 0.25 mg at night. It has been now two and a half months and I am feeling a lot better. Though some days I get anxiety episodes, it is not disturbing and depression too has gone. So I requested my GP to stop it. Accordingly, he asked to me take 5 mg Stalopam with 0.25 Clonafit for 30 days and stop completely.
Do you think it is right on my part or would it be advisable to continue the standard dose 10 mg for a few more months until anxiety completely disappears?
Hello,
Welcome to icliniq.com.
It is good to know that you are feeling better and the medication have been helpful. Regarding your query about medication, it is advisable to continue Stalopam 10 mg (Escitalopram) for at least six months even if you are feeling better. Stalopam is an SSRI (selective serotonin reuptake inhibitor) which is effective in treating anxiety disorders, panic symptoms and depression. If you are not experiencing any side effects, Stalopam is safe to continue for a longer term.
Clonafit (Clonazepam) is meant for short term use. I agree with your plan to take 0.25 mg at night only. Cut down to half the dose again for four weeks and then stop it. It can be used sparingly as needed if you feel anxiety is high. You also need to consider managing any underlying issues which precipitated this panic attacks. Was there anything stressful happening in your life during this period? Share any difficult feelings with a trusted family member or friend. If needed, consider counseling.
Develop self-help interventions to manage stress and prevent relapse of anxiety. Regular exercise helps. Cut down on coffee, tea, and alcoholic drinks. Take up yoga if feasible.
I hope this helps.
Patient's Query
Thank you doctor,
I am happy that you are willing to take over my case. I feel it is high time for me to sail through my further treatment under the guidance of a psychiatrist. Since I have been quite descriptive about the history of my issue and the medication, I will limit this reply to just asking a few questions.
Can I use Cipralex instead of generic versions? Will it be an issue if I switch brands? As I am doing fine these days, can I taper from 10 mg and stay on 5 mg until you decide to stop the course? Since increasing the dose of Stalopam from 5 mg to 10 mg in the month of February, I developed mild occasional rhinitis with sneezing. Is it a side effect and any medical recommendations for this minor issue? As I am a vegetarian, though I eat healthily, do you advise any mild low dose B complex medication? These are a few questions I have but I will leave it up to you to prescribe me whatever you feel is best for me in the long run. But I want to let you know that unlike most patients, I am not in a hurry to get better and can hold on until medicines start to work, hence if advisable I can stay on lower doses too.
Finally, how would I get the prescription and how can I privately keep in touch with you once or twice a month through icliniq.
Hello,
Welcome back to icliniq.com.
Regarding your queries, using Cipralex instead of generic Escitalopram should not be a problem but not necessary if you are already doing well with the current brand.
Even if you are doing well, it is advisable to continue 10 mg once daily for six months to minimize the chances of relapse. If you are experiencing any side effects, then we can consider tapering down to 5 mg if needed.
Antidepressant medication like Escitalopram can occasionally cause drug induced rhinitis. If it is mild and occasional, then nothing to worry. Did you have any allergic rhinitis before? If rhinitis becomes severe and persistent, we need to consider tapering down Escitalopram.
Since you have reported borderline vitamin D and B12 levels, it makes sense to take a supplement for some weeks as it will be beneficial for your health.
Regarding prescriptions, I will suggest booking a phone or video consultation to complete an assessment following which treatment advice and medication can be provided. Depending on the need for follow up, we can arrange either phone or video consultations once a month or so which will be discreet and confidential.
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