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. Vikas Your Own Question

Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
4079050
Type Your Mental Health Question Here...
Dr. Vikas is online now
A new question is answered every 9 seconds

Hi, I have a question for you please? I have a Panic Disorder

Resolved Question:

Hi, I have a question for you please? I have a Panic Disorder which I have had for 24 yrs now. As it went undiagnosed for 5 yrs by a country doctor, I was having panic attacks constantly throughout the day, every day for 5 yrs while raising a family of 5 children. I got so bad in the end I was very depressed so ask my doctor for a referral to a psychiatrist. I slept 1 hr each night for 5 yrs and went through hell. The psychiatrist diagnosed me the 1st time I saw him, and after 3 yrs of different tablets I was put on Effexor XR, and 4 mg Clonazepam, which helped enormously.However due to the trauma of the 5 yrs it took me a long time to get back to normal and these tablets help me have a nearly normal life. They said they thought it was irreversible as I had it for so long and that has been the case. My question is now I am 58, all my family has hypertension, as I have also, should I try to go off the Effexor 375mg, just for my Hypertension, my mother has had it since she was 35, and all my sisters before 40. I am concerned that at my age it could harm me re my hypertension.Do you think I should try to go down on it just to see if my Hypertension goes away, which I doubt as it is genetic. It bothers me a lot, is my high blood pressure which is controlled, be a reason for me going off my Effexor or not?? I am now 58, will my Hypertension get worse? I do get a bit more tired than I used to, due to My blood pressure tablets, should I try to get it down to a better level, or leave it?? Am I at risk for any serious diseases by taking the EffexorXR or not? I went down to 225mg once for 12 mths, but had a major neck surgery and nearly died, it really affected me so I went back up to my 375 mg.
I would really appreciate feedback on this. I also have Agrophobia with it and Generalised Anxiety Disorder. I got it out of the blue when I was 32 yrs of age, & now 58. I don't like feeling extra tired due to beta blockers, but should I try and down my medication due to all these reasons?? I do think I have the Disorder for life, will the medication affect me the older I get?? An answer would be really helpful as I am confused as what to do. And yes I have done all CBT therapy yrs ago. It was very good but did not change me having panic attacks 20 hrs of every day. Warm Regards XXXXX XXXXX
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Vikas replied 1 year ago.

Dr Vikas :

Hello

Dr Vikas :

Lyn

Dr Vikas :

are you there?

Customer: Yes I am
Dr Vikas :

OK, You want to stop Effexor because you are much concerned about its effect on Blood pressure?

Dr Vikas :

because it is very true that Hypertension should be controlled prior to initiation of Venlafaxine (Effexor) and should be monitored regularly during treatment. It has a dose dependent effect on increasing blood pressure.

Customer: Well I have read that you should not take Effexor if you have Hypertension, and last year, my blood pressure got up too high only for the first time in 15 yrs, now I am on an extra Tablet, and it is back down. I do not know if it is from the Effexor or not and I do not know if the Effexor is going to affect me the older I get. I would like to be off it of course, they say it is very hard to come off, and if I do and have major panic attacks again, what could I take that would help if I did come off the Effexor, or would dropping it down to 225mg make a big difference in itself??
Dr Vikas :

OK, see in your case there is a simple solution for this problem. It is true that Effexor affect blood pressure and it is comparatively difficult to taper it down when compared to other antidepressant.

Customer: Do you mean if I lowered the dose my blood pressure might lower also??
Dr Vikas :

Your doctor can simply shift you over to a SSRI antidepressant Fluoxetine (Prozac) which is a very effective medicine for controlling panic disorder.

Dr Vikas :

In patients who are experiencing difficulty in tapering down Venlafaxine (Effexor) we simply switch the on Fluoxetine which has a long half life and can be easily taper down later on.

Customer: How can they give me Prozac at the same time as the Effexor?? Or do I go off the Effexor just like that and on to the Prozac?? I have not really heard of it being done like that. Is it possible to change so quickly like that?
Dr Vikas :

In your case, there will be dual advantage of doing this. First of all you will be able to taper down Effexor and secondly Prozac can effectively control your panic attacks without affecting blood pressure.

Dr Vikas :

Your doctor will follow the method of cross tapering in which he will slowly reduce the dose of Effexor and will gradually increase the dose of Prozac.

Customer: Fine, that sounds ok, is Prozac a Tricyclic Anti Depressant?
Dr Vikas :

No, it is a SSRI antidepressant which are the first line medicines for treating Panic disorder.

Dr Vikas :

and I personally prefer SSRI antidepressants over Venlafaxine for controlling Panic disorder.

Customer: Ok, that sounds fine, as I am a bit intolerant of Tricyclics, but Prozac sounds good, and they will down the Effexor while putting me on the Prozac, is that safe to do, I did not know you could crossover medications like that, but it is mainly to Maois isn't it??
Dr Vikas :

Yes, with MAO inhibitors one should be very careful.

Dr Vikas :

Cross tapering is a frequently used method while switching over from one to another antidepressant.

Dr Vikas :

the rate of tapering varies from patient to patient and there is no clear cut guideline for it.

Customer: That sounds really good to me, I was given Prozac for a very short time at first, I don't know why they changed to Effexor.
Customer: what do you think re the Conazepam, keep taking it for a while and taper it down if I feel good on the Prozac?
Dr Vikas :

Clonazepam can be taken on as and when needed basis, specially the mouth dissolving preparation which bypass gastric metabolism and can bring very quick relief.

Dr Vikas :

Prozac may initially slightly worsen anxiety just like all other SSRI antidepressant so during the initiation of treatment it is a good idea to continue Clonazepam by your doctor.

Dr Vikas :

for few weeks, then it can be used as and when needed.

Customer: That sounds really good, as the Hypertension bothers me and the withdrawal symptoms and short half life of Effexor. I think that is very good advice, thank you for that, I will suggest that and get it started.
Dr Vikas :

You are most welcome.

Dr Vikas :

Thanks for coming to JA.

Customer: regards, Lyn
Dr Vikas :

Kind regards

Dr Vikas :

Vikas

Dr Vikas :

If you are satisfied with my answer please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.


Please take a moment to rate the answer.



Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2219
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Dr. Vikas and 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
 
 
 
Chat Now With A Mental Health Professional
Dr. Vikas
Dr. Vikas
Associate Professor
1813 Satisfied Customers
MBBS ; M.D Psychiatry, MS. Health Informatics