How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Kaushik Your Own Question

Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4050
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

I suffer from an anxiety/panic disorder and have been on klonopin

Resolved Question:

I suffer from an anxiety/panic disorder and have been on klonopin (.5 3 X per day) and Cymbalta (60mg) for many years. During this time, I can't remember having a panic attack. Recently, I started having moderate anxiety and panic attacks. My doctor changed my two daily doses of Klonopin to one evening dose (1mg) and started me on a morning dose (1mg) of Xanax XR. He also gave me Ativan (.5mg) for use when needed. The problem is I feel worse and attacks are more frequent. Could this be withdrawal from the two daily doses of Klonopin or possibly low doses of the new medication?
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 5 years ago.

Hi there,

 

Besides these drugs are you still on cymbalta?

Customer: replied 5 years ago.
Yes, still on Cymbalta and have been for approx. 2 years with no recent changes in dosage.
Expert:  Dr. Kaushik replied 5 years ago.

O.K , Now let me explain to you why after a long period of abeyance from panic attack you again started having them and why are the current drugs not working and what needs to be done as of now.

 

Since you were placed on Klonopin for many years , klonopin (clonazepam) which is a benzodiazapine , though very effective in controlling panic attacks , has a flip side like other benzodiazepines , and that is, one develops tolerance to the drug making it less effective , requiring either increase in dose or changing it with a different benzodiazepine.

 

For the same reason , that all benzodiazepines develop tolerance, they are given for short periods and if at all given for long duraion their dose is to be managed along with the timing of intake.

 

As of now, since your panic attacks have increased in frequency , despite being placed on 3 benzodiaepines -- klonopin, xanax xr , and ativan , the problem lies here itself, as instead of giving 3 benzodiazepines at the same time , your doctor should have increased the dose of klonopin to 1 mg from .5 mg and instead of giving it 3 times a day , it should have been given 2 times a day -- one at morning and second at night , while keeping you continued on cymbalta. Too many of benzodiazepines , will make you so strongly tolerant towards them , that you have no other benzodiazepine to feed upon in order to alleviate your panic attack. And that is what is happening with you right now, and is due to reduction in the dose of klonopin and sporadic use of other benzodiazepine.

 

 

 

So, i suggest you that as soon as your doctor comes back after vacation, you should better re work out the treatment plan , avoiding use of so many benzodiazepines, sticking to one with increased dose given two times a day along with contnued use of cymbalta.

 

I hope my answer serves your query according to your satisfaction.

 

Regards...

Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4050
Experience: MD Psychiatry
Dr. Kaushik and 5 other Mental Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education