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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4486
Experience:  MD Psychiatry
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panic or gad

Resolved Question:

Hi i been told i have gad and panic but that was 13years ago i was succsessfully treated for 4 years with lustral and 3years with paxil
.Would prozac work for me now also does pristiq work for panic disorder and would it work for me since i been on effexor for 2years.
I came off effexor 3 years ago and have not been on meds since
Submitted: 7 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 7 years ago.
Hi there,

Welcome to Just answer !

Well, from your description ,your diagnosis is Generalized personality disorder ( GAD ) with Panicity ( PANIC DISORDER) . You see both GAD and Panic disorder are types of anxiety disorders , so there is no need to give separate medications for them , as the anti depressants and anti anxiety drugs which work well for GAD , will also work well enough for Panic disorder.

So, now coming to your question , both Pristiq ( desvenlafaxine ) which is a modified version of venlafaxine ( effexor) as well as Prozac ( Fluoxetine) , will work well for your condition of GAD and Panicity , but here you have to choose one out of these two , as there is no need for the other when one is being used , plus using together may put you at the risk of developing cross tolerance , making both drugs less effective , and also causing severe side effects such as Serotonin syndrome which occur when SSRI s ( that is fluoxetine) and SNRI s ( pristiq ) are used together.

So, here is the treatment regime that you should get started on after discussing it with your doctor.

1) Start on Prozac ( Fluoxetine ) , as you have already used effexor for 2 years , so probably pristiq being a modified version of effexor , may not prove as effective as prozac .

2) Add to prozac , Buspar ( buspirone ) , which is an anti anxiety drug , to be taken two times a day , let your doctor decide on the dose , usual doses are 5 mg and 10 mg , but better to be started on low dose.

So, i suggess you discuss these two mentioned medications with your doctor and get started on them , and i am quite sure you will benefit from this regime.

I wish you best of health .

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

Please press the ACCEPT button if you are satisfied with the answer as only then will i be credited for my service.

Customer: replied 7 years ago.
since you say antidepressants that treat gad can also treat panic disorder i ask maybe cymbalta would treat my panic and gad but i read up on cymbalta and it says not yet approved for panic disorder.Also i dont understand why i would need buspar wouldnt cyumbalta or prozac work well without it.In the past just lustral on its own then years later effexor on its own treated my gad and panic succsessfully.
Expert:  Dr. Kaushik replied 7 years ago.
Well thanks for your input .

You see most of the anti depressants work both in GAD ,and Panic disorder , however some work better in one than the other disorder , this variability is expected as all drugs are not entirely similar , although belonging to the the same classes.

However , as far as Cymbalta , yes it is not yet approved for Panic disorder but approved for GAD , but you never asked about cymbalta in your question , you had mentioned pristiq and prozac , anyways , the reason cymbalta is not yet approved for Panic disorder is probably due to the fact that in clinical trials it's efficacy has not been upto the mark , as compared to other SNRI s such as effexor , pristiq , milnacipran , but may be in future it may get a shot in the arm and a newer version may get approved for panic disorder .

Now, for recommending buspar in addition to prozac , this is simply because you have been placed on many anti depressants before , which eventually become less effective as time goes by and you end up changing it with a newer one , you see addition of an anti anxiety drug such as buspar will be able to stabilize you on prozac for years without having to look for a newer anti depressant . Plus , when stabilized on these two, if you want to undergo withdrawl from prozac , it can be done safely without any relapse of symptoms .


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