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Question:

I suffer severely from anxiety/derealization, which is terrifying. I am on Luvox CR for OCD and it's working well. Which booster do you recommend to potentiate the anti-anxiety components of Luvox? I have been tested for seizures, which were ruled out but had excellent, though short-lived, relief from Depakote, Topomax and Lyrica. I have had a trial of 50mg Anafranil. How to reduce my derealization and anxiety?

Answered by: Franklin Schneier

The answer to this question is not simple. Diagnosis is the place to start, and it sounds like there has been a careful effort to rule out seizures. Other unlikely but treatable causes of anxiety, such as thyroid disease, should be ruled out with blood tests.

Anxiety/derealization can often be part of panic disorder. When panic disorder is not effectively treated by Luvox-type medicines, other classes including tricyclics (anafranil is an example) or benzodiazepines like clonazepam (klonopin) can be helpful. Cognitive-behavioral therapy can also be highly effective.

Another potentially important piece of information you give is the "excellent but short-lived relief" from several medications. I would carefully consider whether these medications were given a full try, with adequate dose and duration of treatment.