Brief Answer:
Please see details below.

Detailed Answer:
Hi,

I can understand your concern regarding feeling over medicated with tofranil (impiramine). Imipramine is a tri-cyclic anti-depressant which can cause sedation as a side effect.

20 mg is a low dose, but it can cause sedation, more so considering your age. The decision regarding decreasing the dose can be taken by taking into account whether imipramine is able to help with your anxiety or not. In case, you are feeling better after starting imipramine, you can consider decreasing the dose to 15 mg initially. If you are able to tolerate 15 mg, then slowly it can be increased 5 mg at a time depending on response and side effects.

If however, there is no relief in your anxiety, there is no point in continuing it as you are not able to tolerate even this dose. You an consider alternative agents. you have mentioned that you can't take SSRIs. I assume that this means you were not able to tolerate them either. I would recommend Bupropion as an alternative which is a non sedating drug. The usual starting dose is 150 mg taken in the morning. You can discuss regarding this with your treating physician.

In addition you can consider learning relaxation exercises like deep breathing and progressive muscular relaxation which can help you overcome your anxiety.

I hope that I was able to answer your query. Please feel free to ask any follow up query that you might have.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Buspirone is an effective anti anxiety agent

Detailed Answer:
Hi,

Thanks for following up.

I understand your concerns regarding side effects of all medicines. Let me reassure you that it is not necessary that if one person is having a side effect, another will have it too. The same medicine can have terrible side effect for one person and completely safe for another. You will never know its effect until you try it. The more you worry about side effects, more will be your anxiety.

Buspirone is an effective anti-anxiety medicine. It can be taken in your condition. The sedation is definitely much less than imipramine. You can definitely try it if you feel comfortable about it.

I generally don't prefer lamictal (lamotrigine) in case of anxiety disorders. It is generally used either in resistant cases to augment the effect of other drugs or in bipolar depression and epilepsy. I will recommend it only if you are not able to tolerate any other agent.

I will again reiterate that sometimes being excessively anxious about side effects leads to problems. You just have to start the medicine, at the lowest possible dose and then see the effect.

I do hope that I was able to answer your query. In case of any further query, please feel free to ask.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
It would better if Tofranil is tapered and stopped

Detailed Answer:
Hi,

Thanks for following up.

If you want to shift from taking tofranil to buspar, you can start tapering down tofranil. You can bring it down to 10 mg/day initially. Simultaneously, you can start taking Buspar. The recommended dose for Buspar ranges between 15-60 mg/day. 15 mg/day is the usual starting dose taken in 2 -3 divided dosage.

Since you are quite apprehensive about the side effects, I would recommend that initially you take 5 mg for a day. If you are fine with. it, you can increase the dose to 5 mg three times a day over 2-3 days. You will have to wait for few days on 15 mg/day dose to see the effect on your anxiety and accordingly decision to increment the dose can be taken.

Tofranil can be continued at 10 mg/day for 4-5 days and thereafter stopped.

I do hope that the information provided was helpful. I would recommend that the medications that you want to try must be taken under supervision of a psychiatrist, both for assessing response to the drugs and for monitoring side effects.

In case of any further query, please don't hesitate to ask. I will be glad to help you further.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
Please see details below.

Detailed Answer:
Hi,

Thanks for following up. I am glad you feel that I was of some help.

You can start taking buspar 5 mg on first day, preferably at night time. If you are fine with the medicine, on second day increase it to 5 mg twice a day (morning and night). Wait for a couple of days and increase it further to 5 mg three times a day.

Usually, it can be started at 5 mg thrice a day straight away. However, in your case, I am suggesting you to go slow as you have had side effects with other medicines and feel anxious about it.

It can be continued at 5 mg three times a day for 1-2 weeks and thereafter decision to increments the dose can be taken depending on response. In your case, the increment can be done slowly 5 mg at a time.

Hope that answers you query. Please don't hesitate to ask any further query. I would be glad to help.

Best wishes,

Dr. Sunil Gupta

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Brief Answer:
It is safe

Detailed Answer:
Hello,

Thanks for following up. I would want to mention that your question did put a smile on my face.

Yes, Buspar is a very safe drug and most of the patients whom I have prescribed Buspar have reported no side effects and have tolerated it well. But I will also like to admit it here that Buspar is not my first choice drug for anxiety disorders. I usually prefer SSRIs like escitalopram and sertraline.

You can call me lucky that most of my patients have responded well to the drugs without much side effects. Usually, if there is some initial adverse events, they are mild like increase in anxiety and they go off with continuing the drug.

In your case, I would just recommend that you stop worrying about the side effects. I understand that you have had bad experiences with most of the medications in the past. But, you will have to try this one and hopefully it will be effective for you without any problems.

Hope you do really well on Buspar and it is able to take care of your symptoms effectively. I am right here for you whenever you have any doubt.

Best wishes,

Dr. Sunil Gupta

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