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I have a question for you please? I have a Panic Disorder

Hi, I have a question...
Hi, I have a question for you please? I have a Panic Disorder which I have had for 24 yrs now. As it went undiagnosed for 5 yrs by a country doctor, I was having panic attacks constantly throughout the day, every day for 5 yrs while raising a family of 5 children. I got so bad in the end I was very depressed so ask my doctor for a referral to a psychiatrist. I slept 1 hr each night for 5 yrs and went through hell. The psychiatrist diagnosed me the 1st time I saw him, and after 3 yrs of different tablets I was put on Effexor XR, and 4 mg Clonazepam, which helped enormously.However due to the trauma of the 5 yrs it took me a long time to get back to normal and these tablets help me have a nearly normal life. They said they thought it was irreversible as I had it for so long and that has been the case. My question is now I am 58, all my family has hypertension, as I have also, should I try to go off the Effexor 375mg, just for my Hypertension, my mother has had it since she was 35, and all my sisters before 40. I am concerned that at my age it could harm me re my hypertension.Do you think I should try to go down on it just to see if my Hypertension goes away, which I doubt as it is genetic. It bothers me a lot, is my high blood pressure which is controlled, be a reason for me going off my Effexor or not?? I am now 58, will my Hypertension get worse? I do get a bit more tired than I used to, due to My blood pressure tablets, should I try to get it down to a better level, or leave it?? Am I at risk for any serious diseases by taking the EffexorXR or not? I went down to 225mg once for 12 mths, but had a major neck surgery and nearly died, it really affected me so I went back up to my 375 mg.
I would really appreciate feedback on this. I also have Agrophobia with it and Generalised Anxiety Disorder. I got it out of the blue when I was 32 yrs of age, & now 58. I don't like feeling extra tired due to beta blockers, but should I try and down my medication due to all these reasons?? I do think I have the Disorder for life, will the medication affect me the older I get?? An answer would be really helpful as I am confused as what to do. And yes I have done all CBT therapy yrs ago. It was very good but did not change me having panic attacks 20 hrs of every day. Warm Regards ***** *****
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Answered in 3 minutes by:
4/24/2013
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
Dr Vikas :

Hello

Dr Vikas :

Lyn

Dr Vikas :

are you there?

Customer: Yes I am
Dr Vikas :

OK, You want to stop Effexor because you are much concerned about its effect on Blood pressure?

Dr Vikas :

because it is very true that Hypertension should be controlled prior to initiation of Venlafaxine (Effexor) and should be monitored regularly during treatment. It has a dose dependent effect on increasing blood pressure.

Customer: Well I have read that you should not take Effexor if you have Hypertension, and last year, my blood pressure got up too high only for the first time in 15 yrs, now I am on an extra Tablet, and it is back down. I do not know if it is from the Effexor or not and I do not know if the Effexor is going to affect me the older I get. I would like to be off it of course, they say it is very hard to come off, and if I do and have major panic attacks again, what could I take that would help if I did come off the Effexor, or would dropping it down to 225mg make a big difference in itself??
Dr Vikas :

OK, see in your case there is a simple solution for this problem. It is true that Effexor affect blood pressure and it is comparatively difficult to taper it down when compared to other antidepressant.

Customer: Do you mean if I lowered the dose my blood pressure might lower also??
Dr Vikas :

Your doctor can simply shift you over to a SSRI antidepressant Fluoxetine (Prozac) which is a very effective medicine for controlling panic disorder.

Dr Vikas :

In patients who are experiencing difficulty in tapering down Venlafaxine (Effexor) we simply switch the on Fluoxetine which has a long half life and can be easily taper down later on.

Customer: How can they give me Prozac at the same time as the Effexor?? Or do I go off the Effexor just like that and on to the Prozac?? I have not really heard of it being done like that. Is it possible to change so quickly like that?
Dr Vikas :

In your case, there will be dual advantage of doing this. First of all you will be able to taper down Effexor and secondly Prozac can effectively control your panic attacks without affecting blood pressure.

Dr Vikas :

Your doctor will follow the method of cross tapering in which he will slowly reduce the dose of Effexor and will gradually increase the dose of Prozac.

Customer: Fine, that sounds ok, is Prozac a Tricyclic Anti Depressant?
Dr Vikas :

No, it is a SSRI antidepressant which are the first line medicines for treating Panic disorder.

Dr Vikas :

and I personally prefer SSRI antidepressants over Venlafaxine for controlling Panic disorder.

Customer: Ok, that sounds fine, as I am a bit intolerant of Tricyclics, but Prozac sounds good, and they will down the Effexor while putting me on the Prozac, is that safe to do, I did not know you could crossover medications like that, but it is mainly to Maois isn't it??
Dr Vikas :

Yes, with MAO inhibitors one should be very careful.

Dr Vikas :

Cross tapering is a frequently used method while switching over from one to another antidepressant.

Dr Vikas :

the rate of tapering varies from patient to patient and there is no clear cut guideline for it.

Customer: That sounds really good to me, I was given Prozac for a very short time at first, I don't know why they changed to Effexor.
Customer: what do you think re the Conazepam, keep taking it for a while and taper it down if I feel good on the Prozac?
Dr Vikas :

Clonazepam can be taken on as and when needed basis, specially the mouth dissolving preparation which bypass gastric metabolism and can bring very quick relief.

Dr Vikas :

Prozac may initially slightly worsen anxiety just like all other SSRI antidepressant so during the initiation of treatment it is a good idea to continue Clonazepam by your doctor.

Dr Vikas :

for few weeks, then it can be used as and when needed.

Customer: That sounds really good, as the Hypertension bothers me and the withdrawal symptoms and short half life of Effexor. I think that is very good advice, thank you for that, I will suggest that and get it started.
Dr Vikas :

You are most welcome.

Dr Vikas :

Thanks for coming to JA.

Customer: regards, Lyn
Dr Vikas :

Kind regards

Dr Vikas :

Vikas

Dr Vikas :

If you are satisfied with my answer please rate one of the positive ratings (3,4,5 / smiley faces) as this is the only way how we are compensated for our time and expertise.

Please take a moment to rate the answer.

Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
Experience: MBBS ; M.D Psychiatry, MS. Health Informatics
Verified
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Dr. Vikas
Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2,253
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