Brief Answer:
Take one more opinion

Detailed Answer:
Hello Welcome to HCM

She is 20 years old and consulted health centre for anxiety and panic attacks. She has been prescribed 300 mg Bupropion, 150 mg Sertraline, 25 mg Amitriptyline and Clonazepam 2 mg on SOS basis. Although you have not mentioned her symptoms in detail and I can't see her, still as per my opinion she has been overprescribed a little. She has been given bupropion along with Sertraline (SSRI antidepressant) and Amitriptyline (TCA drug antidepressant).

As per available guidelines multiple drugs can be used in depression and anxiety but only under the situations when mono therapy fails or patient is having severe conditions. Using Bupropion along with SSRI and TCA lowers seizure threshold and it increases risk of seizures. Even prescribing Sertraline alone or along with Bupropion will help in controlling anxiety.

Using these drugs together can precipitate serotonin syndrome which occur due to excess serotonin transmission in brain.

Also 2 mg Clonazepam at her age is very high dose and it will cause sedation to her. The drug is having abuse potential and should be take under proper prescription only.

So as per my opinion you can take her to health centre again for reevaluation or you can take one more opinion.

Hope this helps you, if you have more questions you can ask again

Thanks

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Brief Answer:
Seizure threshold decreases with sleep deprivation

Detailed Answer:
Hello again

Over all we can't predict that risk of seizure is high in sleep or in awake state with drugs but theoretically risk is high in awake state than in sleep. As she has not taken anti-depressant medications earlier so I will advise you that before starting medicines consult her doctor again.

Thanks, you can ask again if you have more doubts.

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