Hello. Thank you for sharing your concerns so clearly - it's not uncommon to experience some fluctuations in symptoms during the early days of treatment for anxiety and somatic symptom disorders.
You're currently on Day 13 of treatment with Escitalopram 5 mg, Etizolam 0.25 mg, and Petril MD SOS, which is a standard starting regimen. It's important to understand the following:
1. Initial Worsening of Anxiety:
Escitalopram and other SSRIs can initially increase anxiety, restlessness, or sleep disturbances in some individuals. These effects usually subside in 2–4 weeks as your body adjusts.
2. Time to Full Effect:
Escitalopram often takes 3–6 weeks to reach full therapeutic benefit. Early awakening and intermittent panic episodes at this stage don't necessarily mean the treatment is failing.
3. Dose Adjustment:
Your physician’s plan to reassess after 4 weeks is appropriate. The usual therapeutic dose of Escitalopram is 10–20 mg/day, but starting low and going slow helps minimize side effects.
4. Etizolam and Clonazepam (Petril MD):
These are short-term agents to help manage acute symptoms like panic. Over-reliance should be avoided due to dependence risks.
5. BP and Heart Rate Spikes During Panic:
Sudden spikes in BP and HR during panic attacks are typical due to the fight-or-flight response. Headaches and discomfort during such episodes are common but usually not dangerous in a healthy young adult.
Next Steps
a. Continue the current treatment as advised by your doctor unless the symptoms worsen significantly.
b. Avoid self-adjusting doses. Increasing Escitalopram without supervision may lead to more side effects.
c. Consider discussing with your doctor the possible use of non-pharmacological supports, such as CBT (Cognitive Behavioral Therapy), which is highly effective for panic disorder and health anxiety.
Lifestyle measures like regular sleep, avoiding caffeine/stimulants, exercise, and mindfulness can also support recovery.
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