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Dr. Ravoof
Dr. Ravoof, Doctor
Category: Medical
Satisfied Customers: 5968
Experience:  Experienced Physician in the field of Medicine and Surgery.
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I suffer from general anxiety and panic accacks particularly

Customer Question

I suffer from general anxiety and panic accacks particularly following an endoscopy when the sedative did not work and they held me down and carried on when I could feel everything. I now dread going to any medical procedure when I have to still and have instruments/people near my face. This makes it very difficult for going to dentist, opticians etc. I have become quite depressed about my anxieties and my Gps have prescribed Fluoxitine 20mg and when I suggested beta blockers for ocassions when I was going to extra worried they would not prescribe them.
In previous years folowing my husband's heart attack when I was very stresed the GP gave me beta blockers to be used "as and when required". I would prefer to be on beta blockers for general anxiety etc rather than the antidepressants. What do you think is most appropriate, I need to go to optician and dentist soon.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Ravoof replied 4 years ago.
Dear customer,

Thanks for your question.

In fact fluoxetine is the first line treatment for anxiety and panic disorders. It belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs), which work by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

However paradoxical increased anxiety during initial treatment of panic disorder is seen on treatment with fluoxetine. This however is a temporary phenomenon and on continued treatment with fluoxetine it will reduce your anxiety.

Also the advantage of this medication is that it does not cause serious physiologic dependency problems.

However there is a 2- to 4-week delay before fluoexetine takes effect. Therefore if you need to go to a dentist or optician soon then you can consult your doctor about benzodiazepines which will relieve your anxiety and these medications may be taken for a short duration. You can ask your doctor about a sublingual dose of alprazolam (0.5–1 mg) which is often effective for urgent treatment of panic attacks. Beta-blockers such as propranolol are also beneficial and will help reduce peripheral somatic symptoms of anxiety and panic attacks. Beta blockers will block symptoms mediated by sympathetic stimulation such as awareness of heart beat.

In addition to medications you also need cognitive behavioral approaches which have been shown to be effective in treatment of panic disorders. Please also read the below mentioned book which will help you in dealing with this condition:

Take care.