Managing Panic Disorder: Medication Choices and Lifestyle Strategies

Q: Managing Panic Disorder: Medication Choices and Lifestyle Strategies

Hello Ms. <br>Bi： Long-term use of sedatives can lead to dependence, so it is recommended to use them as an adjunct medication. <br>You can start with one capsule of Prozac and half a sedative. <br>If your condition stabilizes, you can reduce the sedative or even stop taking it a

Panic disorder (Paxil, Zoloft)

Hello, doctor.
I have been dealing with panic disorder for eight years now.
For the first seven years, I was taking Effexor, but I experienced significant discomfort during withdrawal (I gradually reduced from 2 capsules of Effexor plus a sedative to half a capsule daily).
When my doctor suggested stopping the medication, I felt very uncomfortable the next day without it.
Therefore, my doctor switched me to a medication with the same active ingredients as Effexor (the doctor mentioned that Effexor is no longer available on the market).
Until last month, I was taking one capsule of the new medication every two days.
After feeling better, I stopped taking it, and it has been a month since then.
During this time, I have only taken vitamin D, B vitamins, garlic extract, fish oil, GABA, and I have been spending half an hour in the sun and doing 15 minutes of aerobic exercise daily to increase serotonin levels and gradually taper off the medication.
However, I have suddenly started feeling unwell again these past few days.

I would like to ask whether it is better to take one capsule of the new medication plus half a sedative daily, or to take two capsules of the new medication without the sedative.
For the past two days, I took one capsule of the new medication plus one sedative in the morning, and today I took one capsule of the new medication plus half a sedative.
I have consulted with the attending physician at a psychosomatic clinic, but I feel that they did not take my concerns seriously.
I inquired whether it was possible to reduce the medication while using some methods, but I did not receive an answer.
Therefore, I would like to seek advice from other doctors.
Currently, I have no intention of stopping the medication because I cannot bear the pain of an episode again.
However, if I can take the medication regularly like a patient with high blood pressure, I would be fine with that.
I hope to continue taking the medication while also exercising.
I do not seek to stop the medication; maintaining a good quality of life is a significant reward for me.
I might also be feeling more anxious because I have been unemployed for two months while looking for a job.
Aside from a small cup of black coffee every morning, I do not have any habits of drinking alcohol or smoking.

Miss Bi, 30~39 year old female. Ask Date: 2023/03/04

Dr. Lin Mianzhang reply Psychiatry

Hello Ms.
Bi: Long-term use of sedatives can lead to dependence, so it is recommended to use them as an adjunct medication.
You can start with one capsule of Prozac and half a sedative.
If your condition stabilizes, you can reduce the sedative or even stop taking it altogether.
If you have been taking Prozac for more than two weeks and still experience panic or anxiety, you should consider increasing the dosage to two capsules.
Ideally, you should only need to take Prozac, using the sedative as a supplementary medication for acute panic or anxiety episodes.
Wishing you peace and health!

Reply Date: 2023/03/04

More Info

Managing panic disorder can be a complex journey, especially when it involves medication adjustments and lifestyle changes. Your experience over the past eight years, particularly with the challenges of medication withdrawal and the search for effective treatment, is not uncommon among individuals dealing with panic disorder.
Firstly, it's important to recognize that panic disorder is a chronic condition that often requires ongoing management. The symptoms can be debilitating, and finding the right balance between medication and lifestyle strategies is crucial for maintaining a good quality of life.
From your description, it seems you have been on a journey of trial and error with various medications, including the transition from a medication like Venlafaxine (Effexor) to alternatives due to side effects and availability issues. The fact that you are considering a combination of medication and lifestyle changes is a positive step.
Medication Choices:
When it comes to medication, it’s essential to work closely with your healthcare provider to find a regimen that minimizes side effects while effectively managing your symptoms. The choice between taking one capsule of your current medication (which appears to be a selective serotonin reuptake inhibitor, or SSRI) along with a half dose of a sedative versus taking two capsules of the SSRI without the sedative depends on several factors:
1. Symptom Control: If you find that taking the combination of one SSRI and a half sedative helps you manage your anxiety and panic symptoms better, it may be worth continuing that regimen. However, if you feel that the sedative is not necessary and you can manage your symptoms with just the SSRI, that might be a preferable option in the long run to avoid dependency on sedatives.

2. Side Effects: Consider the side effects you experience with each option. SSRIs can take several weeks to show their full effect, and it’s common for individuals to experience initial side effects that may diminish over time. If the sedative is causing more issues than it solves, it might be wise to reduce or eliminate it.

3. Long-term Management: Since you mentioned wanting to maintain a stable lifestyle, it’s crucial to find a medication strategy that you can adhere to without feeling overwhelmed by side effects or withdrawal symptoms. Regular follow-ups with your healthcare provider can help adjust your medication as needed.

Lifestyle Strategies:
In addition to medication, your approach to incorporating lifestyle changes is commendable. Engaging in regular aerobic exercise, getting adequate sunlight exposure, and taking supplements like Vitamin D, B vitamins, and Omega-3 fatty acids can all contribute positively to mental health. These strategies can help increase serotonin levels naturally, which is beneficial for mood regulation.

1. Exercise: Aim for at least 30 minutes of moderate exercise most days of the week. This can help reduce anxiety and improve overall mood.

2. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices such as meditation, yoga, or deep-breathing exercises can significantly help manage anxiety levels. These techniques can provide you with tools to cope with panic attacks when they arise.

3. Nutrition: Maintaining a balanced diet can also play a role in managing anxiety. Limiting caffeine and sugar can help reduce anxiety symptoms, while a diet rich in whole foods can support overall mental health.

4. Social Support: Engaging with supportive friends or family members can provide emotional support. Consider joining a support group for individuals with panic disorder or anxiety disorders, as sharing experiences can be therapeutic.

5. Professional Guidance: If you feel that your current healthcare provider is not addressing your concerns adequately, it may be beneficial to seek a second opinion or consult with a mental health professional who specializes in anxiety disorders.
In conclusion, managing panic disorder is a multifaceted approach that includes medication, lifestyle changes, and ongoing support. It’s essential to find a balance that works for you, and it’s perfectly acceptable to prioritize your mental health by continuing medication while also exploring lifestyle strategies. Remember, it’s a journey, and seeking help is a sign of strength.

Similar Q&A

Understanding Panic Disorder: Medications and Treatment Options

Hello, Doctor. Recently, I have been experiencing unexplained tension and increased heart rate while driving or exercising. After an examination, my doctor diagnosed me with panic disorder. Initially, I was prescribed Deanxit and Lowen to take before bed, but I still feel fear wh...

Dr. Song Chengxian reply Psychiatry
Dear Mr. Jian, There are many medication options available in psychiatry for panic disorder. If the current medication is not providing satisfactory results, I recommend discussing this with your psychiatrist as soon as possible. As for non-pharmacological treatment options, su...

Managing Panic Disorder: Treatment Options Without Disrupting Work

My husband has a history of panic disorder due to his family environment since childhood. Although he managed to overcome it for a while, it relapsed four years ago due to work and family stress. He has undergone treatment, but the side effects of the medication, such as drowsine...

Dr. Wu Enliang reply Psychiatry
Online users suggest considering pharmacotherapy (including non-sedative medications), psychotherapy, relaxation training, and brain stimulation techniques. Dr. Wu En-Liang.

Understanding Panic Disorder: Treatment Duration and Recovery Insights

Hello Dr. Zhou, my wife has panic disorder. She is currently taking four medications: Erispan, Rivotril, Venlafaxine, and Inderal. Could you please tell me if panic disorder can improve? How long does she need to take the medication before she can stop? Thank you for your guidanc...

Dr. Zhou Sunyuan reply Psychiatry
"Panic disorder" is treatable, and it is currently recommended to use a combination of medication and cognitive behavioral therapy for optimal results. However, like all diseases, there is a possibility that some individuals may develop a chronic condition. There is con...

Effective Strategies to Cope with Panic Disorder Beyond Medication

Hello Doctor: I would like to ask, aside from seeing a doctor and taking medication for panic disorder, what other methods can help me recover quickly? The medication makes my mind feel blank and forgetful, and I am unable to perform well at work. Are there any alternative method...

Dr. Ke Shengying reply Psychiatry
Dear A-Rong, It seems that you are in a difficult situation. Currently, the treatment for panic disorder primarily relies on medication, supplemented by cognitive behavioral therapy. If you are experiencing uncomfortable side effects from the medication, you should discuss adjus...