Brief Answer:
SSRI and
clonazepam will bring relief.
Detailed Answer:
Hi XXXX,
Welcome to Healthcare Magic!
I understand that you are on dosulepin 75 mg per day but have not found relief in anxiety. In my opinion, the dose of dosulepin that you are taking can be hiked further for better symptom control. If the current dose has given you some relief, you can discuss with your doctor regarding gradually hiking the dose to around 100 to 150 mg per day. However, this dosage may be associated with some adverse effects like
constipation, sedation, dizziness etc.
If, however, you have found no improvement with dosulepin and are willing to consider a change of medicine, then I think there are better options available for you. Dosulepin works in low level anxiety, but it is not a first line agent for people with significant anxiety. I prefer to treat people with anxiety with medications belonging to the SSRI class (
sertraline,
paroxetine, escitalopram etc.) along with a
benzodiazepine like clonazepam. For you, I would have preferred paroxetine controlled release preparation, which gives excellent results even in low dosages like 12.5 to 25 mg per day. Since paroxetine and other similar agents take a few weeks to become fully effective, till that time clonazepam can be used to supplement the action of paroxetine. After one to two months, clonazepam can be tapered off. Please discuss with your
psychiatrist if you can be started on this regimen.
Apart from a change of medicine, relaxation exercises can also give you good results. In my experience, patients who were unwilling to take medicines, have also improved a lot solely from doing relaxation exercises like deep breathing and progressive muscular relaxation. Please try and see whether these work for you.
There is one more thing you need to ensure. Many times thyroid and
heart disease may also present as anxiety. I hope your doctor has thoroughly evaluated you and ruled these out before diagnosing an anxiety disorder. If not, please ask him to do so.
Hope this helps you. Please feel free to ask if you need any clarifications.
Best wishes.
Dr Preeti Parakh
MD Psychiatry