Dear Doctor, I am suffering from anxiety, restlessness and taking Clonazepam 0.75mg & Mirtazapine 30mg daily. I had depression and panic attacks for the last 7 years relieved by Ativan 1mg and with open angle glaucoma. Need a second opinion.
Hi. Depression, anxiety, restlessness and panic attacks are best respond to a combination of a Selective Serotonin Reuptake Inhibitors (SSRIs) and Benzodiazepines. Mirtazapine is not the most efficient ant depressant and it is not a true SSRI as fluoxetine, paroxetine, citalopram and sertraline are. I recommend 20 to 40mg of Paroxetine (slowly titrated up from 10mg) and 1mg of either clonazepam or ativan (lorazepam) every 8 hours as needed for anxiety. Glaucoma precludes use of any anticholinergics such as hydroxyzine or benadryl (diphenhydramine). SSRIs are also at times likely to make glaucoma worse but a preliminary trial is always worth it. Revert back to a psychiatrist online for further help -->