Taking Clonazepam, Mirtazapine for anxiety and depression, Can you suggest any solution?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Dear Doctor,

I am suffering from anxiety, restlessness and taking Clonazepam 0.75mg & Mirtazapine 30mg daily. I had depression and panic attacks for the last 7 years relieved by Ativan 1mg and with open angle glaucoma.

Need a second opinion.

Answered by Ananth Shanmugam

Education:

MBBS

Professional Bio:

Dr. Ananth Shanmugam is a highly experienced psychiatrist and andrologist with expertise in mental health, psychotherapy, and counseling. He provides compassionate care for conditions such as anxiety, depression, relationship concerns, and men’s health issues. With a focus on holistic well-being, he blends medical expertise with personalized therapy to help patients achieve emotional balance, mental resilience, and healthier relationships.

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Hi,

Welcome to icliniq.com.

Depression, anxiety, restlessness and panic attacks are best respond to a combination of a Selective Serotonin Reuptake Inhibitors (SSRIs) and Benzodiazepines.

Mirtazapine is not the most efficient ant depressant and it is not a true SSRI as fluoxetine, paroxetine, citalopram and sertraline are.

I recommend 20 to 40mg of Paroxetine (slowly titrated up from 10mg) and 1mg of either clonazepam or ativan (lorazepam) every 8 hours as needed for anxiety.

Glaucoma precludes use of any anticholinergics such as hydroxyzine or benadryl (diphenhydramine).

SSRIs are also at times likely to make glaucoma worse but a preliminary trial is always worth it.

Revert back to a psychiatrist online for further help

Medically reviewed by iCliniq medical review team
Published At May 19, 2018
Reviewed At May 7, 2025

Education:

MBBS

Professional Bio:

Dr. Ananth Shanmugam is a highly experienced psychiatrist and andrologist with expertise in mental health, psychotherapy, and counseling. He provides compassionate care for conditions such as anxiety, depression, relationship concerns, and men’s health issues. With a focus on holistic well-being, he blends medical expertise with personalized therapy to help patients achieve emotional balance, mental resilience, and healthier relationships.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Same symptoms don't mean you have the same problem. Consult a doctor now!

Ananth Shanmugam
Ananth Shanmugam

Psychologist/ Counselor

Consult this doctor

Education:

MBBS

Professional Bio:

Dr. Ananth Shanmugam is a highly experienced psychiatrist and andrologist with expertise in mental health, psychotherapy, and counseling. He provides compassionate care for conditions such as anxiety, depression, relationship concerns, and men’s health issues. With a focus on holistic well-being, he blends medical expertise with personalized therapy to help patients achieve emotional balance, mental resilience, and healthier relationships.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality
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