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Question
Posted by: Angela | 2018/10/18

Anxiety Meds

I was diagnosed in 2013 with GAD by my GP. Been on lots of meds ( lexamil, serdep, urbanol, 0.25 mg alzams. In 2016 I started using 50 mg of exsira then went up to 100 mg. Stayed on the meds till October 2017 - when I stopped using them as I could'nt afford them. Since April this year I started with bad panic attacks again. I started again using 50 mg Exsira. that was for the month of june and july. My ex husband paid for my meds. Aug & Sep I never had them. I went to my GP in October and got prescribed 50 mg of Espiride and 20 mg Paxil. I thought I was going to die. I was sweating, light headed, vomiting. After day 2 i gave up. Contacted my dr and told her the meds made me sick and if she could pls give me a script for my Exsira. I started it 13 days ago and I am battling to get it into my system. I have small panic attacks. I then take one or two 0.25 mg alzams. It feels as if I am getting "shocking" pains across my chest. Light headed. Why is my body rejecting these meds ?? I was given a script for 20 mg Zytomel to try. I'm at my wits ends now. I just want to feel normal again. I have a 3 year old daughter who needs me, and I cannot look after her proporly with these horrid panic attacks. My question is what other meds can I try?

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Our expert says:
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- 2018/10/19

Hello Angela,
Sorry to hear about these problems. Here's some thoughts.  I'm shocked to hear that you've had such a long, complex and alarming time, for some 5 years, with a complex range of symptoms and treatments,  apparently treated only by a GP ? He may be a great GP, but complex problems, and one that is not responding well to orthodox treatment, should be referred to a specialist psychiatrist.   It sounds like it'd be a good idea for you to see a psychiatrist for a fresh review of diagnosis and treatment.
Although sedative tranquillizers like Urbanol ( Clobazam ) and Alzam (Alprazolam) can be used for their capacity to produce a quick sense of relaxation, it is not recommended that they be used for more than a couple of months, as there is a significant risk of becoming dependent on them. We do NOT recommend that they be used for a year or more, 
Drugs also used to treat depression, such as Lexamil ( Escitalopram ), Serdep (Sertraline ) and MANY alternatives, are more strongly recommended by experts for treating anxiety and panic. 
Exsira (Desvenlafaxine) i a more recent antidepressant , though most of what I've heard about it from patients has been concerns about it's high price. I am not aware of strong evidence to convince me that it is far more effective than cheaper alternatives, especially in treating anxiety and panic.
Some doctors like prescribing "the latest" drug ; some of us prefer to look for convincing evidence of claims made.
I'm also concerned about the use of Espiride, a drug which seems to be over-used in SA, esspecially among older GPs.  It is not really an antidepressant, and not a recognized treatment for anxiety ad panic disorders. Actually, it is an antipsychotic, an old drug, and I don't think it's approved for use in the USA, UK, or Australia.  I have never prescribed it ; and I don't know whether it is wise to combine it with some of these other drugs.
I get the impression that part of your problems may have been from stopping and starting various drugs, singly or in combinations : it's common that when such drugs are stopped abruptly rather than by a planned reduction of doses, this in itself can cause unpleasant symptom including anxiety
Overall, I'd like to know you have seen a good local psychiatrist for a second opinion, a re-assessment of diagnosis and a discussion of your treatment options : and remember not to think solely in terms of drugs, a pychological treatment like CBT can also be very useful.



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