[Guest]

Dr.,

My Celexa has been raised to 30mg for 3 full weeks today to help wipe out the remaining symptoms of Panic Disorder (which are still rather significant).

Between CBT and Celexa, the following have disappeared or practically disappeared:

- Full panic attacks
- Insomnia
- Fears that I am "losing it"
- eating problems
- Fatigue
- Anxiety in certain situations where attacks occured previously (this one has only responded pretty much in the past few weeks, and the improvement can be spotty)

I am still stuck with muscle tension and general physical anxiety plus worry about the anxiety when it occurs, which probably prolongs it. It is strange, it does not appear to develop in any particular situation or during times of stress, and will build slowly through the morning, peak in the afternoon and fade out at night, and repeat itself for about 2 more days and then, sometimes quite qucikly, fade out to more manageable freuency and duration. I try all my CBT exercises but it doesn't seem to yield to self-talk or behavioral exercises. I fight off my Klonopin most of the time when it occurs (once every few weeks), but am uncomfortable (albeit functional unlike in the past) all day. It is not so much the intensity, just the duration.

The cycle repeats every 3 weeks or so. In between, I suffer the same symptoms, but only 1 day at a time, and usually less problematic (comes and goes during the day, and less intense).

You had mentioned previously that time was probably just as important as additional medication, but even though I am so much more functional then before and the "terror" is gone, this other problem is no fun either and I have increased my medication and my CBT exercises.

What else can I do? I know I could go up again to 40mg., but if 30mg. seems to be the same level of improvement as 20mg., I am not very confident another 10mg. will help and CBT seems to be more effective on the panic portions than this more prolonged and general problem.

I don't want to be free of Panic Disorder just to have it evolve into GAD or something similar. Thanks as always.

P.S. I called my therapist, he will discuss my HAMA score and goals with me, he says I should be encouraged by the improvement, and he wants to see it lower.

[Guest]

Three weeks is a little early to judge. The liklihood of 40 being better than 30 begins to go down, although you never know. You could conceivably try the lowest dose of a benzo available by splitting pills like a 1/4 mg of Klonopin. Xanax at a 1/4 mg every few days is not a problem either. Still, three weeks is a little early to judge. Good luck.
[quote] Dr. ,

My Celexa has been raised to 30mg for 3 full weeks today to help wipe out the remaining symptoms of Panic Disorder (which are still rather significant)... [/quote]