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Ask Dr. Kaushik Your Own Question
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4672
Experience:  MD Psychiatry
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I would like a different opinion than I have already gotten

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I would like a different opinion than I have already gotten so if I have spoken to you please refer to someone else.
Hello, I am in treatment but can't seem to get to the bottom of a solution for myself. I am pretty sure I have OCD with repetitive thoughts about having a heart attack and I have had a full cardiac workup and I am fine. This is causing panic attacks and I am so deeply frustrated. Please help.

Greetings !

Welcome to the site.

I am Dr. Kaushik and i am a psychiatrist and i believe i can help you with OCD with my many years of experience in dealing with this condition.

While CBT ( ERP Therapy -- Exposure Response Prevention therapy ) is considered to be very effective for OCD, but you see OCD as well as Panic attacks ( both of which are included in anxiety disorders ) is associated with neurochemical imbalance in the brain ( low levels of serotonin ) therefore use of an anti depressant drug which balances out the serotonin levels in the brain is important to overcome OCD and panic attacks.

So i will humbly suggest you to ask your family doctor to start you on an anti depressant drug such as Lexapro ( generic name -- escitalopram ) at dose of 10-20 mg / day or Zoloft ( generic name -- sertraline ) at dose of 50-150 mg / day , any one of the these two drugs shall be used to counter the obsessional thoughts about having a panic attack ( i.e clinically termed as Anticipatory anxiety) plus the underlying panic attacks.

In addition to lexapro or zoloft you shall also ask your doctor to add klonopin ( clonazepam ) at dose of 0.5 mg mainly used PRN that is as and when required at times of overwhelming anxiety / obsessional thoughts.

The drug therapy comprising of lexapro / zoloft + clonazepam ( PRN use ) taken for 4-6 months in combination with CBT shall see through the obsessional thoughts for panic attacks as well cause remission of panic attacks.

So basically speaking CBT alone is not adequate to help you to deal with your problem therefore you should discuss the above mentioned regime with your doctor and get started on the same and you may expect improvement to start within 2-3 weeks but for complete recovery the drug regime needs to be taken for the above mentioned period.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

If there is any further assistance needed please feel free to ask using the reply button.


Customer: replied 4 years ago.

Thank you Dr. Kaushik.

I have been suggested that Zoloft would be helpful. I have been resisting due to my fear of side effects along with the fact that I take a .5 mg of ativan most days of the week and I was fearing any withdrawal with that.

Do you think this thought is stuck because of chemicals or it's something I can break down with therapy. Obviously there is an underlying fear here. Thanks for all your help.

First let me address the side effects which you dread , you see none of the side effects which if at all develop upon use of zoloft or lexapro are permanent plus they only occur in a handful of individuals so why to unnecessary generalize them and apply on yourself before even trying the drug.

Secondly lexapro is a better drug than zoloft because it is faster acting and also associated with less side effects. You may start at a very modest dose of 5 mg of lexapro and after 1 week raise the dose to 10 mg / day and maintain on it and only if the need arises should you raise the dose to the maximum safe dose of 20 mg / day.

You see many doctors tend to overlook the basis due to which anxiety disorders like OCD and panic attacks develop and one of the basic reasons for their development is chemical imbalance which warrant use of drugs as mentioned above.
I will reiterate again that therapy shall not be able to achieve full remission on it's own and you will have to turn to use of one of these drugs.

Thirdly ativan like klonopin can be taken on PRN basis that is occasionally or irregularly when required and this way it onyl seldom develops withdrawal and since you have been managing ativan this way quite well so it is unlikely that you will develop any withdrawal.

In fact you may directly switch over to klonopin from ativan at the same dose of 0.5 mg without having to fear any sort of withdrawal side effects.

I hope this helps.

Wish you all the best.

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