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Anxiety and Stress Disorders

Making Medications Decisions

03/13/2006

Question:

Due to a lot of frustration as regards the incompatibility of my wife to my level, I have to compromise every day due to her immature, inconsiderate and childlike behaviour. In my hour of need, there is nobody with whom I can share my feelings. I am mentally disturbed, I remain upset and feel sick. I have lost interest in everything. An element of gusto has vanished. I am also facing stress in my job. I am always out of mood. My nature has become anxious and fearful. Not only that I have become intorvert. My wife is a hypochondriac. She always complains of chest pain and allied symptoms due to as which I remain under tension. Though the doctors have ruled out anything. If I tell her to be cool and calm and not to be panicky, she quarrels with me and a full-fledged debate on my callousness towards her takes place. Now I feel that I am suffering from some panic disorder, OCD or anxiety. I feel like weeping for my fate. When I see my friends and their family, I feel jealous of their happiness. Please help me overcome the symptoms described. I was prescribed Paxil-10 mg and after 12 moths, it was discontinued because I started relief. Again, recently, earlier symptoms relapsed, I am given Escitolopram 10 mg with clonazepam 0.5.I don`t want to go to doctors. I am otherwise a very successful executive, with no vices. I am a non-smoker, non-diabetic, do not take tobacco or alcohol and I live a very straight-forward life in a small town. Kindly guide me. Docotor says this is due to chemical deficiency in the brain. Recently, due to prostrate enlargement, Flomax 0.4 is given to me. Concommittent intake of clonazepam Escitolopram and Flomax make me drowsy. I do not have a sleep disorder. I am told clonazepam is habit forming. Further, recently, due to premature ejaculation problem, my doctor asked me to take paxil 10 mg instead of Escitolopram 10 mg. He says, it will take care of all problems. Please guide me so that I can have print of your answer which I can show it to my doctor, Please help me of problems.

 

Answer:

Both Paxil and Lexapro are antidepressants and anti-anxiety medications in the class called selective serotonin reuptake inhibitors (SSRI).  Others in this class include Zoloft (Sertraline) and Prozac (Fluoxetine).  There are very few studies comparing one SSRI to another, and most experts believe all the SSRIs are generally equivalent.  However, individuals will likely react better to a specific SSRI, but this can only be determined by a person working closely with his or her physician to find the best medication and dosage.

Most people with depression and anxiety begin to show some improvement 2 - 4 weeks after beginning medication.  If there is no improvement, then the dose may need to be increased or the medication may need to be changed.  People with anxiety often need higher doses of medications than people with depression alone before they feel better.

Counseling is also an important part of treatment.  For example, people with anxiety who receive counseling and medication do better than people who receive just counseling or just medication.  If you are not currently receiving counseling, you may want to consider it as an important part of your treatment plan to feel better.

Good Luck.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati