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khagihara, Doctor
Category: Medical
Satisfied Customers: 6590
Experience:  Trained in the multiple medical fields for many years.
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I have been experiencing often severe anxiety since the

Customer Question

I have been experiencing often severe anxiety since the death of my oldest son. I often wake up to the sound of a gunshot, and I have has severe sleep disturbance since that time. What can you do to help/
JA: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?
Customer: Work stress, and trying to work appropriately with my remaining 3 children has be - children very difficult
JA: Anything else in your medical history you think the doctor should know?
Customer: I am in the healthcare industry, and would like to find a dosage of alprazolam that is effective - I may start up wtih Mirtazapine and lamotrigine as well, these have worked well in the past - no signigicant medical issues - allergic to penicillin
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. Mo replied 11 months ago.

Hi Dr. Ashori here.

What dose of alprazolam have you tried in the past?

Expert:  Dr. Mo replied 11 months ago.

Both mirtaz and lamotrigine are quite effective medications.

I'm sorry for your loss. How long has it been since the incident?

Customer: replied 11 months ago.
My son Tyler took his life on Jan 9, 2012. For about 2 years, I awoke to the sound of a gunshot (he used a gun to commit suicide. About a month later, his fiance took the same gun and tool her life as well. They left a 8 month old son - her parents and my wife and I share custody of Jackson.
For about 2 years, my lowest dose has been 4 mg/day, but as high as 8 mg/day
Expert:  Dr. Mo replied 11 months ago.

Thank you for sharing that.

Alprazolam can help, especially at night, you might need somewhere in the 0.5-1mg range for it to be effective.

Expert:  Dr. Mo replied 11 months ago.

Mirtazepine for nighttime is a very good medication, it can prevent those sudden bouts of night terrors.

Customer: replied 11 months ago.
I tried to work with those doses, and although they helped somewhat with sleep, they did not help with my social and personal anxiety issues. I'm looking for a doctor that can help me legally and possibly long term.
Expert:  Dr. Mo replied 11 months ago.

I think a good psychiatrist should be well-versed enough in those medications. I realize it isn't easy to find a good local doctor that you feel comfortable with but perhaps asking around might be a good idea.

Expert:  Dr. Mo replied 11 months ago.

You may have to add on another medication such as wellbutrin or sertraline.

Expert:  Dr. Mo replied 11 months ago.

I think increasing the dosages even further for the lamotrigine and the mirtazepine would be a good idea.

Customer: replied 11 months ago.
I work in the mental health field for 30 years, and I just concluded 3+ years of psychotherapy - i thought your service could perform medication management at a price that I can afford!
Thanks for your time!
Let me know if you can help - what dosage do you think might be appropropriate?
Expert:  Dr. Mo replied 11 months ago.

I don't recommend alprazolam at those high doses, they build up in your system too much but don't last long enough.

You would be better served with lorazepam starting at 1mg and increasing slowly to 2mg. The dosages with the different benzodiazepines aren't equivalent. So 8pm mg of alprazolam would be the same as 4mg of lorazepam.

Expert:  khagihara replied 11 months ago.

You seem to have post traumatic stress disorder. The treatment is a trauma-focused cognitive-behavioral therapy (CBT), medication (a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI)), or a combination of both modalities. The first-line treatment of PTSD is a trauma-focused CBT over medication . An SSRI or SNRI can be used for first-line treatment in patients who prefer medication to psychotherapy, or when CBT is not available. As an example, paroxetine can be started at 20 mg/day orally and increased up to 60 mg/day. For patients with PTSD who show minimal response to two trials of SSRIs or SNRIs, we suggest second-line treatment with quetiapine as monotherapy. Start quetiapine 25 mg orally, increase one week later if the response is inadequate up to 50 mg/day, and then in weekly 50 mg increments up to 400 mg/day. For patients with PTSD who show a partial response to an SSRI or SNRI, we suggest adjunctive treatment withquetiapine or risperidone. As an example, start risperidone at 0.5mg orally, increase after five to seven days if the response is inadequate up to 4 mg/day. If no clinical benefit is seen after two to three weeks of treatment at the maximal tolerated dose, gradually discontinue the medication. For patients with PTSD who achieve a partial clinical response to pharmacotherapy, we suggest trauma-focused CBT as an adjunctive treatment. We suggest treatment with prazosin for patients with PTSD who experience sleep disruption or nightmares or other PTSD symptoms. This medication can be used alone or as an adjunct to an SSRI or SNRI. You should not take alprazolam for a long time because it is tolerant and addictive. You should stop alrazolam slowly under the supervision of your psychiatrist so that you have minimal withdrawal symptoms.

Expert:  khagihara replied 11 months ago.

Any questions about my answer?