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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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HI, i am a 60 year male who has recurring episodes of anxiety.

Resolved Question:

HI, i am a 60 year male who has recurring episodes of anxiety. I seem to have all the sympoms of gad and am taking a course from the midwest center for anxiety that includes relaxation, meditation etc. However it seems that my axiety attacks are accompamied with a lot of muscle pains and sensations. I have tried various anxiety meds such as prozac, lexapro, and recently buspar. What is the best way to treat my situation. Thanks, Keith
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year ago.

Hello Sir,

GAD is a chronic anxiety disorder and a patient may experience multiple waxing and waning of symptoms. In a patient who is having long history of GAD, the first and most important thing to do is to take the treatment regularly once started for at least 8-12 months and may be more if there is long history of illness.

Could you please mention all of the medicines you are currently taking along with the dose?

For how long you took Prozac, Lexapro and Buspar and did you noticed any improvement while on these medications?

Thanks

Vikas
Customer: replied 1 year ago.
Hi Vikas, I most recently tried buspar @ 15gm/day but last only 30day as the side effects have made the situation worse. My history has been that when i get these anxious episodes i get muscle spasms in my upper back and neck and get a foggy feeling and many times get the feeling of tiredness, fogginess, muscle pain and irriitable bowel. Them my dr would put me on an anti depressant and would seem to work but with some side effects. The prozac that i was last on made me yawn involuntarily and frequent so i got off off it after taking it maybe 6-9 months. So, i have tried various anti depressants over the years at low dosages and then always got off off the them. I went to my dr yesterday and he recoommended that i get off the buspar and see a therapist like yourself. Do you feel there are some medical tests i should be taking in regards XXXXX XXXXX muscles. It seems i have the symtoms of a thyroid issue bit it tested out fine. My memory doesnt seem to be as good, can this be part of the panic attacks? Look forward to hearing from you. Keith
Expert:  Dr. Vikas replied 1 year ago.
Hello Keith,

Thanks for your reply.

Muscle stiffness,gastric upset, tiredness, heaviness and feeling of weight on shoulder areas (upper back and neck), lack of concentration are typical symptoms reported by anxious patients and your thyroid status is also fine which points more towards the possibility of anxiety disorder in your case. I don't think there are any significant medical test required at present on the basis of symptoms you have mentioned here.

In patients of anxiety disorder including GAD, I personally prefer to use SSRI antidepressants such as either Sertraline (Zoloft) or Escitalopram (Lexapro) in combination with Clonazepam. All SSRI during the initial phase of treatment may worsen the anxiety before controlling the anxiety symptoms and clonazepam can effectively control that anxiety. Once the patient start noticing relief the clonazepam can be withdrawn and can be used on as and when required basis.

I do agree with your doctor that you should consult a psychiatrist for proper evaluation and management. In the mean while till you are able to consult a psychiatrist, you can discuss with your GP / doctor about starting Sertraline 50 mg or Escitalopram (Lexaparo) 10 mg per day to be taken at night in combination with clonazepam. The dose of Clonazepam can be kept either .25 mg twice a day or .5 mg to be taken at night. .25 mg of clonazepam can be used as an extra dose to control any anxiety attack.

By starting this combination you should notice a good improvement within 7-14 days, then your doctor can increase the dose of Lexapro to 15 or 20 mg in divided dose depending on the clinical symptoms.

In addition to medicines, cognitive behavior therapy has also been found useful in patients suffering from anxiety disorder. You can also try free online Cognitive Behavior therapy in addition to the medicines.

MoodGYM

Please let me know your thoughts about this treatment strategy.

Kind regards

Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2207
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
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