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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4484
Experience:  MD Psychiatry
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I have anxiety/panic disorder and my symptoms when not under

Resolved Question:

I have anxiety/panic disorder and my symptoms when not under control are, anxious feeling, hot and cold/ tingling sensations on my chest and arms when trying to fall asleep at night. It can continue throughout the whole night and the next day, as a result I have severe insomnia.

I started the treatment with lexapro 5mg nightly, valdoxan 25mg at bedtime, xanax 0.25mg as when needed. It went well for one month, during which I only had one occurrence of anxiety attack.

Then on instruction of my doctor, i began to taper off valdoxan because according to him, it's for sleep and not for controlling anxiety/panic. He wanted to start some behaviorial therapy. I noticed my MOTN insomnia slightly worsened (wake up 3,4 times MOTN) when on half dose and complete stop, but no anxiety attack.

After one week of stopping valdoxan, I began to have a relapse. Two anxiety attack episodes happened in two afternoons which I coped with deep breathing, music and xanax, followed by one that happened at night, which I failed to cope even with xanax.

I called the doctor and he told me to resume valdoxan at one dose, and the problem will improve. This is the second day I have resumed the med, and the anxiety attack has reduced in severity, but it's still there and i couldn't sleep. I also experienced some acid reflux.

I would like a second opinion, on what to proceed from here? My next appointment is on 6th, and I am very miserable at the moment, coping with insomnia and anxiety attack. On the side note, I stored my lexapro at room temperature about 27~29 degree, could it cause it to lose strength, because it has instruction to be stored at below 25 degree.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 4 years ago.

Hi there,


Welcome to Just answer !


Well, although valdoxan is a good drug for sleep but as your doctor rightly pointed out it is not meant for anxiety / panic attacks , but as of now you may continue it for a week or two but not longer than that because it causes acidity , and is not recommended for too long a duration..


And i would like to tell you that the temperature did not have any effect on lexapro , the thing is that for an adult 5 mg dose is too less and substandard , it is merely a starting dose or a maintainence dose and nothing more than that and this explains why your anxiety and panicity returned after 1 month of its use because you were never put on the much desired and effective therapeutic dose of lexapro that is 10 -- 20 mg / day .

So ask your doctor to raise the dose of lexapro to 10 mg in morning ..


Im addition to above changes .. ask your doctor to prescribe you ambien cr ( zolpidem ) at night for your sleep and this is a safe drug at that with no dependence quality to it..


So, kindly make the changes as mentioned here and maintain on this for atleast 3 months and i am sure this will control your anxiety and panic attacks effectively with no relapse to be seen again..


I hope this helps..


Wish you all the best..




Customer: replied 4 years ago.
acidity - do you mean acidity of the stomach? could it have caused my acid reflux?

ambien cr ( zolpidem ) - how should I take the drug?
if the above is not available in his clinic, what other alternative?
Expert:  Dr. Kaushik replied 4 years ago.

Yes it is acidity of stomach .. and it could have caused acid reflux..


ambienc cr ( zolpidem controlled release ) should be taken at a starting dose of 6.25 mg dose and taken half hr before bedtime ...and the dose could be increased to 12.5 mg bedtime.


The drugs i have mentioned are available at all pharmacies and clinics in singapore, so do not worry about their availability .. and anyways i have mentioned their generic name along with the brand name , so if this particular brand is not available any other generic could be taken in its place..


I hope this helps..


Wish you all the best..




Customer: replied 4 years ago.
thank you doctor for the information. The information is about the medicine that I can only bring up to my doctor on next appointment.

what should I do till then? (that's actually my question - how to proceed from here)

for now, should i double up the lexapro and reduce valdoxan dosage? since now I am having acid reflux after meal.

most importantly how do I cope with any anxiety attack at night? which is my greatest problem. if they don't come, I am fine, if they do, what do I do? my sister suggested taking naps in the day (since i have less problem sleeping in the day) so that I could sleep less at night and stay awake, something like 4~5hrs sleep at night and 2 half-hr naps in the day. I don't know if that's a good idea from your pt. of view?

I have also tried to ignore the anxiety sensations and relax my muscle and mind to fall asleep, but then I would wake up an hour later by a sudden grinding of teeth or twitching of muscle.

Your answer is already very good. But I still feel helpless. if you were the patient, how do you cope? any practical tips.
Expert:  Dr. Kaushik replied 4 years ago.

Till your next meeting with your doctor .. i would suggest the following changes to adopt to..

1) well, ideally you should raise the dose of lexapro to 10 mg / day , in two divided doses of 5 mg dose in the morning and 5 mg dose of lexapro in the evening , but , since you do not have approval from your doctor till your next meeting , so i think this will not be right to proceed onto..


2) So, what you can do here is that you shall stop valdoxan ... and instead if you have enough xanax , you can take xanax 0.25 mg in the morning and 0.5 mg xanax at bedtime ...This will take care of your anxiety along with morning dose of 5 mg lexapro and also it will induce sleep thereby managing your insomnia .


This shall see you through the time till you meet your doctor next..


3) you stay off valdoxan since you have acid reflux and it will only exaggerate with the use of this drug..


4) well, you may take naps but just fpor 15 minutes twice till afternoon , but 2 hrs of naps would only further create problems in your daily schedule and once you become accustomed to this schedule you will find difficulty in coming back to normal schedule once your doctor puts you on the suggested changes..



I hope this helps..


Wish you all the best..




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