Question: I have been suffering from uncontrollable high anxiety from the age 14. I developed this disorder after seeing my father in ICU for heart attack. My father survived but I developed this disorder and was getting tensed for no reason. I get sweat, difficulty breathing, unwanted thoughts which leads to anxiety and I have burning sensation in stomach which increases with anxiety. Its very difficult to socialise and appear in public. Biggest blow was I was not able to attend my exams because of this problem. It used to become highest at exam times. I somehow managed to pass the 10th level exam even with this condition and then began to see a clinical psychologist. I trained relaxation techniques and things got better but after a year anxiety came back in full swing and I couldnt handle. I was afraid to take medication and saw a different psychologist and he trained me advances relaxation with deep breathing, biofeedback etc. It worked for one exam time but after that it never worked but I tried to do that everyday 2 hours without much success.
I thought it is the only thing I can do but it wasnt helping me and I was failing to attend my exams in engineering. Things went like this from 2002 to 2012 with out much success. After a break up in 2012 I was broke completely and I developed depression too. Then I decided to consult a psychiatrist and I was put on 10mg escitalopram (nexito) and it worked wonders for me. It was increased to 20mg and I became normal and managed to complete my engineering. After 1.5 years on 20mg of escitalopram I tried to came off it and the dosage was reduced to 10mg. I was good on 10 mg of lexapro. Then once again I tried to wean it off but my condition relapsed after 1 month. I restarted the med but it didnt work. Then my doc switched me to sertraline 50 with clonazepam 0.25 but I felt weird in sertraline and tried escitalopram again and it started to work again and I became fine on 10 mg escitalopram again. But the escitalopram was making me gain weight and sleepy also I knew that it wont cure the condition and I will have to be on med forever.so I wanted to try therapy which claims long term benefits for a last time before joing my masters in engineering. So I weaned off from the med doing therapy for a month, but the condition relapsed again after stopping the med. I had to restart the med again but it didnt work like the last time. I sarted to use clonazepam 0.25 untill escitalopram kicks in again. After 4 weeks the dosage was increased to 20mg but still its not working. Now I am on 4th week in 20mg and total 8th week after restarting. Still I am not feeling better and I am managing my work and daily life with clonazepam 0.25 2 times. Why is it taking too much time to kick in even in 20 mg? I was alright in 10mg before. Will it work again if I stay on it for more time? Even if I become alright like I was on 10 mg, will I have to be on med for life? Now I feel the weight gain is not a problem anymore and I want to become alright again. Is there any long term problem if I stay on medication forever? Like brain damage/ neuron death liver or kidney failure etc. I used to be smart and intelligent when everything is alright. Will the long term medication affect my intelligence or memory? Now I am not feeling good and managing with clonazepam 0.25 2 times a day with 20 mg escitalopram when will this start to work again? I want to become alright again like I when I was on 10mg. I want to do masters in engineering and I am also concerned about the long term effects of medication. Hope I get suitable replies for all my worries.

Thank you very much for your valuable suggestions. My psychiatrist wont take much time to discuss with him and if I ask anything in detail like weight gain, tolerence, pooping out etc he will deny all those and tell me that you dont need to worry about it andthose are things for experts etc.

Actually the depression was for only short term after that relationship break up after 10 years of this problem. Main problem was anxiety but when both things hit me I decided to take medication and things got better. But when I stop meds relapse is the original condition of anxiety not depression.

The first psychologist I consulted trained me progressive muscle relaxation and guided imagery. That was in the early stages of this problem and it helped me to some extend but when anxiety returned, that therapy didnt work. Thats why I went to another psychologist. He trained me progressive muscle relaxation + diaphragmatic breathing with biofeedback and at the end of the session, self suggestion of some sentances. I didnt know whether it was any type of behavioural therapy. That doctor was against meds and said me it can be cured If I practice it regularly. But the duration of the session was 1 hrs 2 times a day. I was doing engineering and it was very difficult to practice sessions like that and even if I practices I couldnt feel much of an improvement. But when I was hit by depression of the break up + my original anxiety, it was not managable at all and I didnt feel like continuing that therapy and thats how I went for medication.

I have heard about CBT in online and other forums but I dont know whether it is available in XXXXXXX This was my last try to do therapy and to go off the med. But even after 1 month of therapy I couldnt stand against relapse. Earlier when I stopped the med and restarted it, it worked after some time and I was able to become alright with just 10 mg of nexito. But this time I tried for 4 weeks of 10 mg then used clonazepam 0.25 to manage till nexito kick in then it was upped to 20 mg. Now I am on 8th week total and 4th week of 20mg. Will it kick in soon if i stay on it for more time? My original plan was to come to 10mg again when things get alright and stay indefinitely.

Another point to be noticed that when I stopped last time a year ago, I felt escitalopram was not working any more and my doc switched me to sertraline 50 mg. I took it for some time but I felt weird and I came back to escitalopram without consulting with him and it worked again. I have read that in forums that when one ssri doesnt work docs switch to another ssri and when you come back to the previous one, it works again. I dont know whether that was the thing that happened when I used sertraline 50 and switched back to escitalopram 10mg. But when escitalopram 10 mg kicked in, I became alright and felt smart and intelligent again. But I wanted to try therapy again stopping the med before the masters and ended up like this. If my condition becomes alright again on escitalopram, I wont try to come off it again. I am even ready to take it for life or till it is poop out if any. I dont want to experience this feeling again.

I have never tried a complete check up for any other medical condition like thyroid or any vitamin deficiency etc for this problem. Even the psychiatrist didnt advise for any check ups or anything, he straight away prescribed me escitalopram and it worked for me by luck. Do I need to do any other general check ups or scans for any other medical condition which might be causing this disorder?

Hi,
Thank you again for the answers. I had started clonazepam after 2 weeks after restarting escitalopram 10 mg. But after 4 weeks even with clonazepam I felt increase in anxiety and thats how I upped to 20 mg. Then I had stopped clonazepam for few days to check whether escitalopram has kicked in. But my anxiety was more and I was even sweating for no reason. Then I decided to take clonazepam 0.25 till escitalopram 20 mg kick in. In past 2 days I took clonazepam 0.25 2 times and I am feeling improvement now. I dont know whether it is clonazepam or the nexito kicking in. I wanted to go back to nexito 10, in which I was alright and I want to stay on it for long term. The only disvantage with nexito was the weight gain but I think I can manage it with diet and excercise.

Another thing to be noted that I was experiencing pre mature ejaculation before the medication, but when I was on nexito 20 I experienced increase in time before ejaculation. I know people report sexual dysfunction like difficulty achieving orgasm or ejaculation etc. But I feel that it is a +ve thing for me. Is it the lack of serotonin that causes the pre mature ejaculation?

From my previous experiences, I get relapse when I wean it off and after 3-4 weeks of being completely med free. I was alright on nexito 10 so if nexito 20 kicks in, can I go back to 10 mg after some time and stay on it for long term?