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How can anxiety be treated?

Q: I am a 26 years old man suffering from severe anxiety for the last 2 years (I get startled by crackers, utensils clanking, even a small pat from behind). During childhood, I used to panic when asked to appear on stage for presentation, elocution, etc. The psychiatrist prescribed Prodep 20 mg for 10 days and then increased the dose to 40 mg, Inderal 10 mg twice a day, Tryptomer 10 mg once a day and B-complex. Now I am facing problems in cognition i.e. reasoning and thinking ability. I am unable to sleep without Tryptomer. If I don't take Inderal then I get stressed/frustrated at the smallest of things. I have also developed a fear of old age, diffidence, lack of motivation and interest in anything and depression. I recently consulted the same doctor who advised me to cut down Inderal to half the dose (retaining the others) and continue it for a month and told me to slowly stop the medication. With this treatment anxiety levels have come down but other problems have started like decreased cognition (without Inderal), decreased sexual interest, lack of motivation, fears, chaos, etc. I am afraid that I might become mentally disordered one day. Please help.

A:Anxiety disorders are one of the more common mental health problems in the modern world. They can present with varied symptomatology and very many times be present along with depressive disorders. What is also important to note is that all medications can have some or the other side effects - not necessarily all individuals develop all the side effects or even of similar severity. Depression either could have been present along with the depressive symptoms or has developed later on or sometimes some kind of depressive symptoms can result as a side effect of certain medications like Propranolol. However the key is recognising and managing the side effects rather than panicking and stopping the medications until unless the side effects are really severe/ unbearable or the side effects are more than the positive effects. There are certain key rules for medication intake:

  1. All medications should be taken under the expert advice of a doctor.
  2. Potential side effects should be discussed with the doctor.
  3. If side effects develop - or become severe there should be a consultation with the doctor.
  4. Medications should be taken as prescribed rather than as and when there is mood to take them
  5. Regularity of medication intake can make the difference in positive response or poor response.
For anxiety disorders we need to realise that the best management strategy would be to take medications as well as undergo behaviour therapy or cognitive behaviour therapy as recommended. Please discuss these concerns at length with your treating psychiatrist and do not hesitate (if required) to take a second opinion from another psychiatrist.

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