CAN ANYTHING BE DONE WITH MY ANXIETY? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
CAN ANYTHING BE DONE WITH MY ANXIETY? 
Question: I am a fifty year old male. I have had anxiety attacks and GAD since I was seventeen. I was first treated for it in 1996 with Paxil which helped but side effects were terrible — bad panic attacks all night the first week, weight gain, brain zaps. Since then I have tried Lexapro and Zoloft and Klonopin which keeps the panic attacks away. Klonopin is all I’m taking right now but the GAD is bad and I would have to take a lot of Klonopin to overcome it…I now only take .5 mg 2 x a day. I tried BuSpar for a few days but felt weird. I’m going to have to try something else can you suggest anything? I was put on disability last year because I could not longer work. I’d like to get well enough to go back to work and lead a “normal” life….almost forgot what that is. Dr. Heller’s Answer: When I’m presented with a problem like this, PTSD (post traumatic stress disorder) is usually the culprit. BuSpar (buspirone) often makes the PTSD worse. Patients I see with similar complaints have a number of “imbalances” within the serotonin system making it difficult for any one medication to work well, and most medications seem to make the problem worse. There is no “mental health pill.” It’s important for BuSpar (buspirone) to be taken with a meal and to avoid grapefruit juice. BuSpar (buspirone) works primarily for the “cognitive” GAD – genetic worry. It is NOT a tranquilizer, but a unique medication that seems to turn off the genetic “worry” gene. These individuals are “cave guarders” – always on alert for danger. Sequencing of medications can sometimes be as important as the actual medications themselves. Remeron (mirtazapine) helps enormously with the PTSD, including preventing the worsening of PTSD caused by BuSpar (buspirone). When I see this combination I frequently begin the Remeron (mirtazapine) at 30mg nightly (lowering the dose if needed for next day grogginess) and then start with a low dose of BuSpar (buspirone) and go up slowly. An example would be 2.5mg nightly for two weeks, then 5mg nightly for two weeks, then continue the 5mg nightly and add the 2.5mg in the daytime, etc. until 15mg twice daily is reached. This works for over 95% of my patients with this problem. 5% can’t tolerate BuSpar (buspirone) no matter what is tried, but the vast majority succeed with this. Once the individual is on an effective dose of BuSpar, an SSRI can and should be added for the panic disorder. If the borderline personality disorder (BPD) and/or genetic depression are present, Prozac (fluoxetine) is the best option. If not, I usually prefer Lexapro due to its reduced sexual side effect profile. 
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