Hello doctor, I have bipolar disorder, panic attacks, social and generalized anxiety disorder. I have one to three panic attacks per day, constant anxiety, and fear of leaving the house. No motivation to work, no energy, apathetic, without mood. Right now I am in a depressive episode. I previously tried Valproic acid, Lithium, Carbamazepine, Xanax, Lorazepam, Clonazepam, Rudotel, Lexotanil, Fluoxetine, Sertraline, and Escitalopram. SSRI does not have an effect on me. Right now, I take Lamictal 50 mg daily and Tranxene 5x5 mg daily. Tranxene loses its anxiolytic effects and my anxiety becomes more severe. I am planning to titrate Lamictal 100 mg. However, it should not help with anxiety. What are my treatment options? Benzodiazepines are not an option because I am getting used to them. Two days later I have a consultation with my psychiatrist, but I want to hear possible treatment for my conditions from another option. I have done thyroid, heart function, men hormones, prolactin, kidney and liver function tests. All are normal.
Hello. If your anxiety is not responsive to SSRI's (selective serotonin reuptake inhibitors), then you should consider trying TCA (tricyclic antidepressants) class of antidepressants. They will help with your anxiety and panic attacks. Apart from Tranxene and Benzodiazepines, there are few other options for anxiolysis. If you are specifically looking for something to be added to the TCA such as Propranolol, Buspirone, Tofisopam, Clobazam, Hydroxyzine, and Pregabalin. Also, you can consider Mirtazapine, which will act as an antidepressant and also for anxiolysis. It is a NaSSA (Noradrenergic and specific serotonergic) class of antidepressants.