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.

My main reason for posting this is i scared when I researched SSRIs and Lithium. There is a warning about a rare but potentially fatal drug interaction causing Serotonin Syndrome. I wonder how common is this and will I be safe taking an SSRI with Lithium. Obviously my doctor is prescribing and wouldn't do something that could kill me. I just worry because the internet said its a potentially fatal combo.

Thoughts anyone?

[BeyondtheRainbow]

Serotonin syndrome is real but it is rare. The truth is that many of the med combinations we need to take could cause it but it is usually considered an acceptable risk. You'd have to talk to your doctor about your particular risk but I doubt they'd prescribe something they were really concerned about. And my understanding is that if you get treatment if you start feeling bad and having scary side effects that you'll catch the serotonin syndrome in time. Again, I'm not a doctor and I think you need to talk to your about your concerns but I think it is generally safe.

[Wander]

I have been on both without getting serotonin syndrome. The problem for me is that SSRI's can trigger hypomania or mixed states. Everyone reacts differently. I would discuss your concerns with your pdoc and take it from there.

Guys thanks so much. I see my pdoc this coming Monday and will let you know how it goes. I was wondering what the best SSRI for panic and anxiety would be. Prozac and Zoloft seem to be good answers. As well as Lexapro or celeza. I just know he is going to remove the klonopin soon and when he does I don't wanna experience the horrible attacks I used to get. Thanks all for your posts.