Question: i have a long history of panic disorder with agouraphobia. I've been a prozac for 20 years with mostly good years and a few relapses. Each relapse has been treated in roughtly the same way. Double the prozac, add something to sleep, usually trazodone, a short 3 to 4 month course of a benzo and therapy. For the past 7 years I've lived a fun filled panic free life until a majoy relapse 3 months ago. GP sends me to find a psychiatrist and a therapist. Psychiatrist prescribes ambien cr for sleep and 1 mg. of klonopin per day but does nothing to the prozac. (confused me). GP follow up and he says go back and tell him to do something about the antidepressant. "Prozac can cause anxiety, find something less agitatin" (even though ('ve been on it 20 years and am long past side effects) The psychiatrist prescribe celexa. Cross tapper for a week 10 mg of celexa each day, prozac every other day.. week 2 to 4 20 mg. Side efffects sweating, clenched teeth, higher anxiety, anxiety attacks leading to more avoidance. 4 week folllow up and the psychiatrist concerned about the panic attacks added Effexxor 75xr, and Risperdal .25. The pharmacist was the 1st tos show concern about combining the ssri with the snri together. This was not a switch they were to be used together. A doctor on this site also expresses concern so I sought out a 2nd opinion at the center where I go for thereapy and met with their psychiatrist. He llistened to the story a replied "You have too many cooks in the kitchen,, I would never tell your GP what to prescribe for your bllood pressure. And agreed that there was no reason for the risperdal and effexor so soon on the celexa treatment. What he decided to do was raise the celexa dose to 40mg. Which brings my to my questions.
I've now been on the celexa 8 and a half weeks. One week at 10mg. 5 weeks at 20, and 2 and a half at 40. I've seen no major reslults in terms anxiety relief and my avoidance and agouraphobia is high. When I saw him this week he wants to give the celexa 3 more weeks at this dosage. He also hinted at possibly changing back to prozac if thins don't improve.. My concern how isolating I am becoming and the fact that I have to be ready to teach school in 4 weeks. The idea of going through the start up side effects of a new antidressant at the start of a school year frightens me. i have made an appointment to speak with him this week about 2 things. to explain mt concerns and to ask about the possibility of doing the Genesight genetic testing they offer to guide selection the right meds. Have you used the gegnetictesting? Do you think it's a good idea to give the celexa more time? How hare would it be to teach
school wjhile beginning a new antidepressant with alll th stimulation that comes with it?

In what manner would you suggest the switch?

That seems like a rather quick increase in the prozac. The day this relapse began I took 40 mg. and had heart palpitations. Will never know if it was the drug or my anxiety.

Can you think of any other medication that might be effective?

Thank you for your quick response. I will discuss all options with psychiatrist.

Thank you so much for your advice. I will probably get a few other opinions as well.