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Suggest Treatment For Social Anxiety And Agoraphobia

Posted on Thu, 23 Mar 2017

Question: I have been suffering from agoraphobia and social phobia for many years since I was 20. I've had some psychotherapy sessions, they helped to some extent, but I have never been free from symptoms.Now I am 58, have type 2 diabetes and been in a menopause period now, so it has become worse. I saw a neurologist and he prescribed me citalopram, although I had never taken any medicine, only once when I was young, I took one amitriptyline and had a severe panic attack. Since that time I have always had a fear of taking any medicine for my condition. Now I decided to try it. I am always waiting for worsening of the symptoms as it is said in the instruction, feel sleepy, have difficulty to concentrate, been very slow and feel pressure in my eyes, have blurred vision, sometimes feel agitation. Well, I ´ve always had these symptoms but in a different way, something has changed. And I've been taking citalopram only for 6 days, keep hesitating to continue it or not... When I go out I need to drink some wine otherwise, it is difficult for me to socialise with other people. I work as a teacher for adult people and it's so hard to work when you have these panic attacks when everybody is watching you. I try not to show that but it's like a nightmare. I really don't know if to continue, as yesterday I had a terrible panic attack, but the sensations on citalopram were different from the usual ones...

Answered by Dr. Dr. Ashok Kumar Choudhary (2 hours later)

Brief Answer:
I think you should continue

Detailed Answer:
Hello,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

Considering your suffering over the last four decades and nature of job I feel there is definite need to continue treatment. I understand you had panic attack but it does not mean it was due to medication. I have observed people with extremes fears and noticed that they have tendency of more side effects in initial two weeks before medications starts doing some work.

The extreme worries associated with medication intake probably driving you away from medicine but it does not mean they are harmful.f you compare risk and benefit analysis you will find that benefits clearly outweigh the risks with their use.

I hope this helps you.
If you have more questions I will be glad to assist you further.
If you do not have more questions, please close the discussion and if possible rate the answer for my future patients.

In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

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

Follow up: Dr. Dr. Ashok Kumar Choudhary (2 days later)

Dear Dr. XXXXXXX

Thank you very much for your reply! Well, I'll try to go through these side effects and see what happens in a couple of weeks, probably it will help me and I could lead a normal life and have no problems teaching.
Will it be necessary to increase the dose of the medication? I take Metformin and simvastatin for diabetes, how can it interact with citalopram? Can I drink some wine on this medication?

Thank you in advance and have a nice day!

Answered by Dr. Dr. Ashok Kumar Choudhary (4 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for follow up.

First of all regarding dose increase it may be needed if the current dose fails to give desired results. I am not sure what dose your psychiatrist prescribed for you but most of my patients need citalopram in dose range of 20-40 mgh per day.

There are no significant interactions with simvastatin and metformin with citalopram. It is one of the safe medications when it comes to drug drug interactions.

I will recommend not more than two standard drinks while you are on medication.

I hope this helps you further.
If you have more questions I will be glad to assist you further.
If you do not have more questions, please close the discussion and if possible rate the answer for my future patients.

In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.

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

Follow up: Dr. Dr. Ashok Kumar Choudhary (17 hours later)

Thank you for your answer! And the last question I wanted to ask you: I am on the lowest dose now 10 mg. As you advised, it may be necessary to increase the dose with time, but will it be necessary to take the medication always, I mean, during my whole life, or it will be possible to quit it in some time? Does it make you dependant on it?

Thank you!

Have a nice day!

Answered by Dr. Dr. Ashok Kumar Choudhary (2 hours later)

Brief Answer:
follow up

Detailed Answer:
Hello,
Thanks for follow up.

It neither makes you dependent nor addict.

At the same time it is not necessary to use the medicine for life long.

I hope this clarifies.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Raju A.T