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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4507
Experience:  MD Psychiatry
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I have complex PTSD post an rta 3.5 yrs ago. Now seeing a

Customer Question

I have complex PTSD post an rta 3.5 yrs ago. Now seeing a clinical psychologist who wants me to stabilise my mood and help with the severe panic attacks which have begun 2 weeks ago, 6 weeks into therapy. I saw a locum gp who gave me 2md diazepam but that doesn't help. My regular dr is away but he's not keen on benzos understandably. But I'm medical and need something strong now to deal with an attack when it comes. Would Xanax or equivalent be ok for a short time or is there something better? My dr suggests escilatapram longer term which is ok but I need help now. Also j think something from my childhood - emotional abuse, is maybe triggering the extra fear.
Submitted: 1 month ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 month ago.

Greetings.

Welcome to the site.

I am a Psychiatrist and i believe i can help you with your query.

Well, if you want to deal with Panic attacks then you will have to get started on both a long term and short term medications at the same time so that your PTSD and Panic attacks both are properly managed. As a short term and faster acting remedy to control the panic attacks xanax xr ( extended release ) would be more appropriate since this is a longer acting version of the xanax plain or instead a more potent benzo would be klonopin ( clonazepam ). Klonopin works well at twice a day dosing while xanax xr can be taken in 2-3 times a day dosing.

But for longer and lasting effect on PTSD and Panic attacks, use of lexapro ( escitalopram ) or zoloft ( sertraline ) would be essential and it takes roughly 2 weeks for either of the drug to start making significant improvement in your mood and emotions.

I hope this makes sense and gives you insight into what all options you have.

Wish you all the best.

Please kindly leave a POSITIVE RATING if you are satisfied with the answer.

Regards

Customer: replied 1 month ago.
Thank you. My GP has just prescribed escilalpram as you suggest but 5mg for 28 days. I'm concerned this won't be enough as 10ng seems to be the dose suggested (please note I am not a person who usually ever used medication). He is resistant to Xanax but says I can take 6-8mg diazepam in a crisis. But I am concerned it takes too long to kick in and I doubt he will help by extending the 30 2mg diazepam tablets. I'm aware of the issues of benzos but I feel vulnerable currently. Is it reasonable to ask for more help if they run out or to try Xanax instead? Is one less sedating as the diazepam makes my muscles weak for hours without helping the anxiety.
Expert:  Dr. Kaushik replied 1 month ago.
Thanks for the inputs.
Well,i will address the two concerns of yours one by one.
Even though you do not use medications that often, still I feel that 10 mg dose is a good effective dose to start on so as to see POSITIVE benefits early, but If your doctor is not comfortable with this idea of using 10 mg straight away then you can ask him to place you on escitalopram 5 mg for 10 days and then up the dose to 10 mg and use that for 21 days before considering further increment of dose.
As far as your second issue is concerned regarding which benzo to be used , I will suggest that neither xanax nor diazepam shall be used , instead Klonopin ( clonazepam ) at dose of 0.25 - 0.5 mg can be used on PRN basis that is as and when required basis. You see Klonopin is faster acting anti anxiety drug just like xanax and at the same time it is safe too, so I feel this drug shall be approved by your doctor.
I hope this helps.
Wish you all the best.
Please kindly leave a POSITIVE RATING if you are satisfied with the answer.
Regards

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