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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am 50 years old and have suffered from depression and anxiety

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I am 50 years old and have suffered from depression and anxiety since I was 17 years old. I have tried everything from Prozac, Effexor, Bupropione, Lexapro, Citalopram, and Hydroxyzine HCL 25mg 6 times a day. I have been having very severe anxiety attacks for over 4 months now. I feel to the point I may pass out and I can hardly breathe. My anxiety is mostly job and social related. I work in customer service taking over 100 phone calls a day with over 50% of them complaints from swearing angry and threatening customers. I work the overnight shift and the Hydroxyzine is making me too sleepy. I will soon be fired if I can't get over these attacks. We are not allowed to stop taking calls and I am having to do that because I cannot breathe, my heart pounds, I sweat, get dizzy, stomach ache and feel faint. What is something else that you would recommend?

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am so sorry that you are suffering from these severe anxiety/panic attacks that you have described

Dr. Z :

Typically the best medications for panic attacks would be a benzodiazepine (e.g. Xanax, Ativan, Klonopin). These are the most effective anti-anxiety medications out there, but the problem is that they are very physically addicting so once you decide to stop them you must slowly taper off of them.

Dr. Z :

Now these medications also do have a sedative effect and I would not want you to be tired during work so it is important to start off at a lower dosage to allow your body to get used to the medication

Dr. Z :

Also Klonopin has a very long half-life (18-50 hours) so you can take it the night before and the beneficial effects can carry over to the next day without the sedation side effects.

Customer:

I have been seeing the same family physician for over 25 years and they have never prescribed a benzodiazepine. How do I request this? I also have an appointment with a psychiatrist on Dec. 5, but I need something now.

Dr. Z :

Well the psychiatrist will definitely give you the benzodiazepine based on your medication history and a psychiatrist is more trained to monitor you so that you do not abuse the medication (this medication is frequently abused). You can ask your family physician that you are suffering from these panic attacks for so long and the antidepressants are not effective and you are afraid of losing your job, so you would like a prescription for a benzodiazepine. The Xanax, Ativan, and Klonopin are the most effective, but also the most frequently abused, so your family doctor may be willing to prescribe Valium which is one of the least abused of the benzodiazepines.

Customer:

They have insisted that the Hydroxyine HCL should work well, but it hasn't. It just makes me sleepy. Thank you for the above information. I will speak with my doctor tomorrow.

Dr. Z :

If you family physician still refuses you can ask for Gabapentin which works in a similar fashion as the benzodiazepine, but not nearly as effective, or Buspar, which is an SSRI type medication with antianxiety effects like Xanax, but not as strong.

Dr. Z :

The Hydroxyine HCL is an antihistamine and its sedation effects are supposed to calm you down, but is better for generalized anxiety disorders and not panic attacks.

Customer:

This is a start. I have been waiting for over a month already to get into the psychiatrist, so I can wait a few more weeks but I need my job as I am recently divorced and have full custody of a 14 year old daughter has migraines, vertigo and cyclic vomiting syndrome, so I need to get well.

Dr. Z :

I definitely agree that you need to get better and the benzodiazepines are fast acting, usually it takes 1 hour to get the beneficial effects.

Customer:

I will contact my doctor tomorrow and share this information. Your information was helpful. Thank you.

Dr. Z :

Anytime, I am happy that I was able to help you and I wish you the best with your continued treatment, and I hope that your symptoms lessen very soon for you. 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. Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Dr. Z :

Oh and also when you finish rating me, this chat will be sent as a link to your email, if it has not already, so you can always use it for future reference. In addition, this chat will be saved in your JA account under My Questions so you can always go back to it when you need to

Customer:

Ok I have rated this below and clicked submit, but it isn't doing anything. Just saying loading data.

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