Hi.

Not sure if this belongs in the anxiety/panic d/o forum or the BP forum but…

I have bipolar II and panic disorder. I've been on lithium for 5 or 6 years. I'm currently at a .8 lithium blood level taking 1200mg a day (600 in the a.m., 600 in the p.m.)

I also take seroquel 200 at night for sleep.

About 4 months ago I quit marijuana and it has been a positive change. However when I quit, my anxiety and panic went through the roof. I had severe level 10 panic attacks and terrible anxiety. This persisted and lead to several hospitalizations. One time for 11 days.

My psychiatrist who I see regularly got me stabilized on standing doses of Klonopin (real low dose, .25 twice daily) The panic and anxiety largely stopped for the most part.

This leads me to today. I am doing pretty well on:
• Lithium 1200
• Seroquel 200
• Klonopin .25 x 2 daily

Here's where I need your help and input. My doctor never intended for the Klonopin to be a long-term solution. And now he is suggesting starting either Prozac, Zoloft, or Lexapro (for long term anxiety and panic control) and then to titrate me off the klonopin.

1) Which of those three SSRIs would be best to augment my lithium, and provide the best anxiety and panic relief?
2) Should I be concerned with combining both lithium and an SSRI? I've read about dangers there involving Serotonin Syndrome. But also that its rare, and combining these two drugs is relatively commonplace and safe.

What do you think? Prozac, Zoloft, or Lexapro? And is it safe with the lithium?

Thanks for your input.