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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2253
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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I've had panic attacks since 2005 and starting 2mgs a day of

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I've had panic attacks since 2005 and starting 2mgs a day of ativan since 2007. In January this year, I've had enough and went on Zoloft 25mg and then 50mg and slowing quiting ativan. However for the past month my panic attacks seem to be getting back. Earlier today I had one huge over the bridge, I thought I was going to die. What do I do now ? Increase zoloft or reintroduce ativan which was so hard for me to get rid of ?

Panic disorder / attack are usually a chronic disorder and a patient may experience multiple episodes in future also.

The dose range of Zoloft (Sertraline) is from 50 -150 mg per day and you are currently on the starting dose. Most patients respond well to a dose of 100 mg per day so the first thing to do is to ask your doctor to increase the dose to 100 mg and that should be useful.

Instead of Ativan, you can also ask your doctor to prescribe you a orally disintegrating preparation of Clonazepam (Klonopin) in a low dose strength of either .25 mg or .5 mg to be taken on as and when needed basis. The advantage of using this tablet is that it can provide instantaneous relief due to rapid absorption. Most patients may notice good improvement within minutes to half an hour while having a panic attack and you need not to take it daily also.

Once your dose of Zoloft is increased by your doctor the frequency and severity of panic attack should automatically decrease and you can use the Klonopin tablet on as and when needed basis.

I hope this helps, please feel free to discuss further if you have any other query.

Kind regards

Customer: replied 5 years ago.

Thank you very much for your prompt and interesting reply. what I liked about the dose of 50 mg of Zoloft was that I was not suffering of any side effect (my sexual drive has not been affected). I am very afraid that by doubling my dose, I would start losing libido, gaining weight, losin hairlike like my cousins who take that dose. and what is that upped dose is insufficient in a few months ? also, is Klonopin addictive ? thank uou Dr. Vikas
You are most welcome Charles.

It is very true that patients taking SSRI antidepressants such as Zoloft may experience sexual side effect but it is not a rule and there are many patients also who never noticed any such problem as seen in our clinical practice.

Weight gain and hair loss are rare so you need not to worry about these side effect at all.

In case, if a patient taking Zoloft start experiencing sexual side effect we usually add a low dose of another antidepressant such as Mirtazapine or Bupropion which can effectively counteract the sexual side effect in most cases in addition to augmenting the antidepressant and antianxiety effect of Zoloft. This can be tried in your case also by your doctor.

As I mentioned before, the dose range is from 50-150 mg per day and most patients remain asymptomatic on 100 mg per day. There are maximum chances that you won't be needing an increase in dose but if it does happens your doctor can simply add an augmenting antidepressant in low dose.

Since you will be taking Klonopin only on as and when needed basis so there are no chances of developing dependence on this medicine.
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