Can panic attack occur while taking antidepressants?

Question

Hi doctor,

I am a 29 year old female with a 15 year history of panic disorder with medicine sensitivity. I have been on Effexor XR 75 mg for six months and have been stable. Last week my tooth was pulled out and I was put on Motrin 800. I had around two tablets for three days and it made me feel fuzzy and my chest heavy. My vitals are all normal. My boyfriend is a surgeon and he monitored me. I was also put on Amoxicillin 875 mg BID. After my follow-up visit with oral surgeon, I was put on Z-Pak. Within a few hours of my first dose of Z-Pak I felt sick. That night, I woke up with chest pain and dizziness and had a panic attack. It subsided after a few minutes, but I have not been feeling good since. I do have a low grade temperature (99.2), chills and hot flashes. When I am sick, my anxiety does kick into high gear. I took Ativan 0.5 mg. I am nervous because this is the most anxiety I have had in a while. Does this mean my Effexor is not working?

Answer 1

Hi,

Welcome to icliniq.com.

The heightened anxiety, panic attacks, uneasiness, hot or cold flushes, sleep disturbance, low grade fever could all be the symptoms of Venlafaxine withdrawal. Did you miss a dose of Venlafaxine? Another explanation is that these medicines that you are taking for your tooth issue interacted with Venlafaxine, thereby reducing its effect. Though, there is no reported interaction between these medicines, individual differences in metabolism are common and could be a cause in your case. My advice for you would be not to jump to the conclusion that Venlafaxine has stopped working. Take higher doses of Ativan, even up to 2 mg thrice a day if required for the next few days. Wait till the other drugs are out of your system that is for three to four days and check whether the anxiety disappears on its own or not. The most obvious remedy would be to increase the dose of Venlafaxine by 37.5 mg and watch. Since we are not sure of the interaction yet, you could rather wait for a few days. If you can do a plasma drug level test of Venlafaxine, that would be great. Another thing to do would be an ECG and rule out QT interval prolongation by medicines, unlikely but better to rule out. In the worst scenario, if Venlafaxine has stopped working at 75 mg then you would be increasing the dose of Venlafaxine, but not looking for alternatives. Thank you,

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, the fear of re-experiencing your initial days of excessive anxiety and panic could have set off your anxiety response and cause all the symptoms mentioned. The other two explanations are plausible also. Dental treatment and taking antibiotics are distressing for everyone. This along with your previous experience could be the cause of your heightened anxiety. In both cases, you need not worry and wait for some time to pass. I would advise you to try deep breathing techniques. These help with panic in general. Thank you.