Panic attacks resume without meds

Dear Dr. Roach: I’ve been on Cymbalta for 16 years. I had had panic attacks, and my doctor suggested it, along with talk therapy. After a year, my therapist told me they weren’t made to be used long term and I should eventually wean myself off them. I did at one point, at which point the panic attacks came back. I started taking them again and am now afraid to stop. They make me feel less than worthy, in the sense that I can’t do well in life without them. I take 10 milligrams every day or five days a week as I forget occasionally. Are there long-term effects taking this drug?

D.M.

Answer: I see a great many people with conditions affecting their mind, especially depression and anxiety, and related conditions like panic attacks. This is a common occurrence, and it can affect people with any level of function. Unfortunately, there is a stigma associated with mental illness, which can keep people from getting the help that they need. I am disappointed that your therapist made what I consider an ill-considered statement.

Both talk therapy and medication are effective treatments for panic attack; however, a great many people continue to need medication long term to keep the condition under control. Just as with conditions like diabetes and high blood pressure, some people can get off medications while others need to continue them.

All medications have the risk of side effects, but for medications like duloxetine (Cymbalta), most of the side effects commonly appear when first taking the medication. Since you have been on this medication for 16 years, it is not likely that new side effects will show up now, especially at the relatively low dose you are taking. One exception may be that, as people get older, these medications are more likely to cause abnormalities of the sodium level. A periodic check of your kidney function and electrolyte levels would be prudent.

When starting a medicine, and even when having a follow-up visit to check on the medicine’s effects, the prescriber should consider the risks of taking or continuing the medicine against the risk of not being on it. In your case, with the panic attacks coming back, I think it is better to continue than to stop.