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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5088
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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hello...i have been struggling with panic and anxiety for 18

Resolved Question:

hello...i have been struggling with panic and anxiety for 18 months....very upsetting and frustrating. I have seen a therapist...helped a little. For the last three months I have been seeing a psych doctor. She put me on celexa which I take at 20 mg. They tried 30 but I could not tolerate it. I also have been taking .875 mg of xanax a day for two months. I take .375 mg in the morning, .25 around 4 p.m. and .25 at bedtime. I do not have panic attacks any more which is good. I do have plenty of generalized anxiety which peaks in the morning, midday and around 4 p.m. After six o'clock at night, I am fine. I obsess about how I feel constantly. Never stops. I also have this down, nervous sick feeling after these anxiety rushes at those times of the day. My anxiety is so predictable and I am aware of it. The pscy doc talked to me last week and says we have the panic taken care of, we have to work on the anxiety. She suggested we will have to readjust my meds when I go in next week. I have a feeling she'll take me off the xanax and try another benzo. What other benzos are there? I tried klonopin once and it made me depressed. Would valium be a good choice ? or another ssri? I can tolerate the celexa....I am so scared of taking a benzo because of dependence. The xanax just isn't cutting it. Any opinions on what I can do? Thanks
Submitted: 11 months ago.
Category: Mental Health
Expert:  Dr. Z replied 11 months ago.

Dr. Z :

Hello I believe i can help you with your concern

Dr. Z :

I am so sorry that you have been having this issue with the anxiety, I can imagine how frustrating this must be for you.

Dr. Z :

So the good news about your Xanax dosage is that it is a low dose, which means that your dependency on it will not be great, so it will be easier for you to wean off of it

Customer:

yes...it sucks...just very frustrated and upset. Cannot put it out of my mind...very scared that nothing seems to be helping me...although panic is gone. Many life alterning things have happened to me and I just couldn't cope hence all of the anxiety, etc.

Dr. Z :

As for other SSRI medications to take, I would recommend Lexapro (Escitalopram) which is similar to the Celexa, but there are less incident reports of side effects and also the medication is more effective for anxiety symptoms then the Celexa

Customer:

can you just switch to lexapro from celexa?

Dr. Z :

If you wanted to take another benzodiazepine, Valium has a longer half-life and it is longer acting, so the dependency issues are even less.

Dr. Z :

Yes you can switch with no problem

Customer:

I wish she had put me on the valium in the first place...do you think that would be a good switch and keep the celexa? Really how long does it take for these things to kick in

Dr. Z :

Well the Valium may not be as effective as the Xanax though because Xanax works very fast, while Valium does not...which is why it is easier to wean of Valium.

Customer:

but it lasts longer which is what I need....can you just switch from xanax to valium?

Dr. Z :

Yes at your dosage you should be able to switch to Valium from the Xanax with no difficulties. The Valium has a halflife of around 20-100 hours which is why it stays in your system longer, but if you needed quick relief from anxiety (e.g. panic attack) Valium would not be good for that

Customer:

well, I am not having panic attacks any more....what can I do about obsessing about this over and over. I used to be so nornal and happy until life kicked me in the you know what....I lost my brother from cancer at the age of 47, got divorced, got remarried and my new husband had horrible health issues. He is fine now. My mother has altzheimers too and I take care of her. This anxiety has taken over my life and I just want to be me. I've done everything I'm supposed to do....don't know why. Also why is my anxiety so predictable? I think I am afraid of being anxious at those times so it happens/

Dr. Z :

It is called anticipatory anxiety, and it very common. You can also add a low dose of Abilify (5mg) to your Celexa dosage and this will increase the effectiveness of the Celexa, so that can be an option. Also I would like to ask are you currently in therapy at all? Studies show that a combination of therapy and the medication are the most effective in relieving anxiety

Customer:

no and I know I should be...but just don't want to rehash all of this crap over and over again. Just want to be comfortable after all of this time.

Customer:

I did have a therapist for a year...it was the same thing over and over again. Well, breathing, etc, relaxation tapes did nothing

Dr. Z :

Well I have a different therapy in mind, it is called Cognitive Behavioral Therapy (CBT). CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen. CBT also only focuses on the present and does not focus on the past, so you will not have to re-hash what you went through over and over. And it does not focus on breathing or relaxation techniques. I can show you some CBT techniques if you like

Customer:

that would be great

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help you keep track of any negative thoughts you have. You put the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want you to come up with an alternative thought for the situation (more objective and plausible). This will help you change your way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

Dr. Z :

In addition, these two worksheets are very good at helping lessen anxiety symptoms. It can help you focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with severe anxiety have a poor coping mechanism, so this worksheet will help you develop a better coping strategy to manage your symptoms better.

Customer:

i do obsess about the past a lot...the mistakes I've made...

Dr. Z :


These two books are also really effective in helping manage anxiety as well.


Dr. Z :

Yeah the negative thought process does lead to anxiety, especially anticipatory anxiety, this is why CBT is so effective in changing your thought process and lessening your symptoms

Customer:

my new husband's illnesses put me over the edge....we were even seperated at one point....but we are now together. I felt as if I made an enourmous mistake getting married again.

Dr. Z :

I am sorry, I can imagine how that feeling you may have made a mistake can cause you stress. Would you also like me to find some good CBT therapists in your area too?

Customer:

yes that would be great....i live in finleyville pa 15332

Dr. Z :

Okay, give me a few minutes to compile a list for you

Customer:

ok great....

Customer:

can you believe that I feel so much anxiety on Saturdays? It's because I used to consider it such a fun day. I also have empty nest and miss my kids so much. They are 22 and 25 and are doing well but I miss them being little

Dr. Z :

I am sorry, I know how that can be tough for you sometimes. CBT is very effective in managing your anxiety, but like all therapy it is a gradual approach and takes time to be effective (after all you are retraining your brain's thought process and that takes time).

Dr. Z :

Here are a list of good CBT therapists in your area that specialize in treating anxiety disorders

Customer:

wow thank you so very much.....

Dr. Z :

Anytime, I am always happy to help

Customer:

it takes time to overcome so much trauma....

Dr. Z :

It does take time, but it will happen with the right treatment

Customer:

well...thanks so much you have been helpful. I will print out my worksheets, read the books and look for a good therapist in my area.

Customer:

I thought the meds would be a magic pill...put too much hope into that I think...they are not really.

Dr. Z :

The medications are good at lessening the symptoms, but they do not cure you. Only therapy can cure your anxiety.

Dr. Z :

I am just happy to help. I wish you the best of luck with everything and I hope your anxiety lessens swiftly. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

you are right....I'm so glad I talked to you tonight. You made me realize I need a good therapist.

Customer:

I will...have a good night!

Dr. Z :

I am just happy to help, I hope it all works out well for you :)

Dr. Z :

You have a good night too

Customer:

:) it will!

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5088
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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