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 Ralph LMHC Your Own Question

Ralph LMHC
Ralph LMHC, Therapist
Category: Mental Health
Satisfied Customers: 872
Experience:  20+ years as therapist, supervisor, clinic director at mental health, substance abuse treatment ctrs
Type Your Mental Health Question Here...
Ralph LMHC is online now
A new question is answered every 9 seconds

Hi. I suffer from mild infrequent panic attacks and depression.

Customer Question

Hi. I suffer from mild infrequent panic attacks and depression. I've recently been on escalitopram with no real success. I know I need to find that ideal dose/combination through hard work, but I want somebody to point me in the right direction. What are the best drugs for people with depression, specifically crippling motivational problems? Which should I ask my doctor about, and what should I be watching out for?
Submitted: 7 years ago.
Category: Mental Health
Expert:  Ralph LMHC replied 7 years ago.

Lexapro is often used for anxiety with panic attacks. Many psychiatrists, if using SSRI's for depression with panic attacks use Zoloft and Paxcil. But these truly tend to be what the physician is used to and what he/she has been told from the drug rep. Often Welbutrin is used as an add on or Abilify. Another option are the newer SNRI's that work on both the Seratonin and Noepinephrine neurotansmitters like Effexor and Cymbalta. What has been found to be most effective is the use of Cognitive Behavioral Therapy in conjunction with medication. In CBT, one is taught new ways of thinking and behaving and as a result, one's mood improves. anxiety and panic attacks decrease. In addition CBT is evidenced based as the most effective form of treating anxiety. See:

So speak to your psychiatrist about the SSRI's and SNRI's with add ons if necessary in conjunction with the use of CBT. I hope this information has been helpful and I wish you the best





If you require further clarification or more information, feel free to ask!


Ralph LMHC and other Mental Health Specialists are ready to help you
Customer: replied 7 years ago.

Thank you for the quick and detailed response. I will investigate the link and take note of your recommendations. However I'm not sure where to go with CBT. I live in a large city, but am on a limited budget (student, you know how it goes). My college-provided counselling services have proven to be of no help whatsoever. Can community counselling centers provide CBT? Are there other places in a typical city I could investigate CBT?

Also, is there anything you recommend for withdrawal from Escalitopram/Cipralex/Lexapro? I tried to taper off, but it's really not helping much.

PS: Absolutely will "Accept"... great response
Expert:  Ralph LMHC replied 7 years ago.

If you want a CBT certified therapist you can contact the National Asociation of Cognitive Behavioral Therapist at . Of the therapist does not have to be CBT certified, just oriented. So you can turn to your local community mental health center or university hospital and request a CBT oriented therapist. I am not a physician so I suggest that you speak with yours to delevelop a tapering plan-the slower the better so you do not experience seratonin withdrawal. If you are started on another med you will have to lower one as you build the other and that is why it has to be individualized. I wish you the best and hoped this helped as well as knowing with the right approach there is a good chance of feeling better.





If you require further clarification or more information, feel free to ask!


Customer: replied 7 years ago.
Thanks so much. I've been reading over the link - this looks very compelling. I will look into CBT at earliest opportunity. Hopefully it's a step in the right direction. Thanks again - you've put my mind at ease and given me something I can actually work with.

Expert:  Ralph LMHC replied 7 years ago.

Glad to be of service and again good luck! Thank you for the generosity!


Related Mental Health Questions