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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4645
Experience:  MD Psychiatry
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I'm a 29 years old man, that suffers of general anxiety

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Good morning doctor, i'm a 29 years old man, that suffers of general anxiety disorder from 2006. I've been treated with cipralex, with increasing doses until we reached 20mg in 2010, and after three years of good health, with my psychiatrist, we decided to decrease the doses and suspend it. This happened in august 2013. During these three years i attended BCT. In september I had another crisis, so we decided to re-introduce cipralex. I was very bad for 5 weeks, during which i felt also depressed due to the situation. My doctor introduced duloxetine, 30mg and raised cipralex to 25mg. Starting from the 6th week of therapy things went better, until now: after three weeks of good shape, last tuesday i felt again anxiety, probably because (according to what my psychiatrist said) i was exposed to a situation stronger than i could face, because even if it's true that i was better, i was not completely restored, and this complete restorement needs more than three weeks. So, in conclusion, he raised cipralex again, to 30mg a day. What is your opinion? I know you can't know every detail of my history, but i'd like to know if is a good theory the one my doctor explained me about the fact that a complete restorement needs many time, and even if i felt very better in the last three weeks, on the "inside", my body and mind were still working to repair the damages of the anxiety attack of september. Thanks Sorry for my english, i'm italian. :)

Greetings !
Welcome to the site.
I am Dr. Kaushik and i am a psychiatrist and i believe i can help you with your problem.
Well you see your doctor is right to some extent as far as his theory goes as full recovery from anxiety would require longer than 3 weeks more so when the stressful situation this time around was way more than ever before so his comment on you taking more time to overcome this anxiety completely is right however i have a problem with the choice of medications that he has been using for your condition because first of all cipralex has a maximum safe dose of 20 mg / day, any dose above this dose shall not provide any extra benefit plus it may lead to side effects owing to an overdose.
Secondly the use of duloxetine with cipralex is risky because their combination has the potential to precipitate a serious life threatening condition called as Serotonin syndrome due to excess of serotonin levels in the brain brought about by these two drugs when used together.
So to summarize i will say that,
-- Your doctor's theory about slight delay in recovery this time around is mostly correct and can be accepted.
-- However i will like you to discuss with him his strategy of using an overdose of cipralex and duloxetine as an addition which may lead to a serious condition like Serotonin syndrome. A much safer and effective drug to add to cipralex is Buspar ( buspirone) at dose of 10 mg twice a day or Klonopin ( clonazepam) at dose of 0.5 mg twice a day. Either of these drugs can be used as a replacement of duloxetine for augmenting and potentating the action of cipralex without the need to raise the dose of cipralex to 30 mg which is an overdose, so ask your doctor to choose any one of these drugs for use with cipralex which shall not be increased to a dose more than 20 mg/ day.
I hope this makes sense and gives you a sense of direction to move in.
Wish you all the best.
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Customer: replied 3 years ago.

Thank you doctor, I really appreciate your answer.

Anyway i really trust my doctor, he knows me since 2006. I know (he explained me) that maximum safe dose of cipralex is 20, in fact i did an electrocardiogram to check Qtc time (I don't know if it's the same in english language, but i'm sure you understand what i mean) and it is all ok.

The raising to 25 and then 30 is temporary. My doctor also said that in the past he used doses up to 40 mg without any problem. His target is to return to 20mg that is a dose that kept me good for three years, before gradually suspending it, but he said that in case of suspension and a successive re-taking of a drug, sometimes it happens that you need higher doses because the body develop a sort of resistence to the drug.

I'm also aware of the Serotonine syndrome, but am I wrong thinking that in case it would have been happened soon after using the both of them together? Now it's quite a month and we did non have any problem.

Anyway his intention is to remove duloxetine as soon as possible (he gave me this drug because of a secondary depression situation caused by the re-happening of the anxious-panic state). We also tried venlafaxine before duloxetine, but it gave me disturbing side effects so we changed to that drug.

My concern were more on the first part of your answer, and i'm happy you agree in the statement that after six weeks of very bad feelings, three weeks of goodness are not enough to consider the situation closed, so a little step back is possible and i don't have to have too much fear of it.

By the way, if the situation does not solve, when i'll see again my doctor i'll ask him about these other two drugs you suggested.

Thank you again

Customer: replied 3 years ago.
Relist: Other.
I'd like another consult

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