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Suggest Treatment For Anxiety And Depression

Posted on Wed, 16 Apr 2014

Question: Hello I recently had my dose of zoloft increased to 200 mg after trying to taper off the medication with poor results. Lately I have had increased anxiety. My psychiatrist placed me on 1-2 mg Klonopin per day as needed for the anxiety. I have been taking .5 mg 2 x per day for three past weeks. I do not want to be on this medication long term because I have read the horror stories of trying to get off the medication but feel that it is needed at this time. I have a few questions. Is it normal to feel increased anxiety well the body adjusts to the increased dosage of zoloft? Is it ok to take 1 mg klonopin per day and for how long? How do I taper off the klonopin once I am stabalized on the zoloft> Thanks

Answered by Dr. Ashish Mittal (13 hours later)

Brief Answer: Current treatment is safe. Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 32 year old male • Known case of anxiety, depression and hypertension • Complaints of: increase anxiety and worry regarding medicine doses. In drug treatment of anxiety and depression two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines (like klonopin) are used for short duration around 4-8 weeks (due to risk of dependence). For long term relief most commonly SSRI (selective serotonin reuptake inhibitors like zoloft) are used. SSRI takes around 3-6 weeks to show its effect, till that time benzodiazepines control the anxiety symptoms. All these medicines are prescription medicine and dose change need supervision of psychiatrist. Effective dose range of Zoloft is 50 and 200mg per day. According to guidelines if patient do not respond in low doses, its doses can be increase to 200mg per day, even higher in some resistant cases. Klonopin contain clonazepam. There is no harm in using it in doses upto 2mg per day, till zoloft start showing effect, under psychiatrist supervision. After that it can tapered 10% doses every 4th day. Apart from this there is need to find out reason for poor response anxiety and depressive symptoms, as concurrent treatment of these issues will bring fast relief. Following are common causes for poor response: -Vitamin deficiency: specially b1, b6 and b12. Healthy balance diet is beneficial in such cases. -Thyroid imbalance: Specially in female. You can get your thyroid profile (T3/T4/TSH) to rule it out. -Excessive use of stimulants (amphetamines, cocaine, caffeine), so stop use if present. Reduce tea, coffee and cola drinks use as these contain caffeine. -Side effect of substance use: Stop smoking and alcohol use (if present). -Anemia (low hemoglobin level) I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Mittal (8 hours later)

Thank you for your response. I am currently under the care of a psychiatrist. Last year I was on 200 mg zoloft with good response. my Pdoc and I decided that it would be ok to try to taper off the medication slowly. Once I got to 50 mg I had relapse of symptoms. My Pdoc put me back up to 200 mg 3 weeks ago. Is it normal to feel increased anxiety when increasing the dosage this much this quickly? From your response it appears that it is ok to take the clonazepam on a daily basis at this point. Currently i have been taking 1 mg daily for 3 weeks with good response. Is it reasonable to continue with the dosing for another 1-2 weeks and then begin the taper? I do not want to get addicted to this medication! So in summary I have had increased anxiety since increasing my dose of zoloft from 50 mg to 200 mg. However the clonazepam at 1 mg per day is providing adequte symptom relief. Questions: 1.) Is it normal to feel increased anxiety until I stabilize on the increased dosage of zoloft? It has been three weeks since the increase 2.) Is it reasonable to continue with the clonazepam for another 1-2 weeks and then begin taper? 3.) With such small pills of clonazepam how do I taper at a 10% dosage reduction? and how severe will the withdrawal symptoms I experience be? Thanks

Answered by Dr. Ashish Mittal (15 hours later)

Brief Answer: You will be well soon. Detailed Answer: Hello again, Thanks for follow up. Dose of zoloft usually increase 50mg mg every 3-5th day. But as you are already on 200mg zoloft for 3 weeks there is no need to worry as sudden increment in doses cause increase anxiety for 7-10 days for that you was already on clonazepam. There is no problem with clonazepam (1mg/day), as it can be tapered after improvement in anxiety without fear of addiction after 2-3 weeks. For tapering you can use 0.25mg clonazepam tablet and make it half (0.125mg means 12.5%), which can be reduced every 4th day. In my opinion, in your case: treatment is going fine, do not fear from clonazepam addiction and you will be well again in 2-3 weeks. Please accept my answer and give feedback in case there is no further query and you found reply helpful. In case of doubt, I am here to help you. Wish you good health. Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar