instruction: hi doctor I am a 42 years old male I had low mood with anxiety problem around two years back I was on desvenlafaxine 50 my er tablet prescribed by go I took it for around eight months and felt better then I consulted my psychiatrist and told that I have only anxiety so he prescribed clonazepam my and alprazolam 5 my in the morning and nitrazepam 10 my and clonazepam my in the night and stopped desvenlafaxine 50 my er tablet I slowly tapered from first month itself to finally in around one year I was on 25 my clonazepam in the morning and 5 my nitrazepam in the night which I felt has same effect as I started later I tried to come out of it without any medication but I was feeling anxious actually I felt better with desvenlafaxine 50 my er tablet compared to other anti anxiety medicines so I asked my psychiatrist and he said start taking desvenlafaxine 50 my er tablet but I do not have the same effect as I felt earlier now it is almost seven weeks I am taking 5 my nitrazepam in the night and occasionally clonazepam 5 my or alprazolam 25 my or 50 my when I feel more anxious so I want to be only on desvenlafaxine 50 my er tablet as earlier should I wait for some more time or should I increase dose to 75 my or 100 my I really appreciate your help by the way I feel more anxious only at traffic signal or sometimes waiting in line at grocery store or sometime anticipatory fear in going far from my home thank you very much for your help
output: hi I can understand your concern desvenlafaxine is a good antidepressant and anti anxiety drug the drug should be continued for long time to see its full effects drugs like benzodiazepine clonazepam alprazolam or nitrazepam can help to control anxiety symptoms immediately but these drugs are not the definite treatment of anxiety high risk of tolerance and increased abuse potential are the main reasons that these drugs should not be taken regularly for more than four weeks it is good that you have started taking desvenlafaxine again and the drug will help you to come out of the symptoms currently you are on 50 my dose and in my opinion the dose should be increased to 100 my per day to see more effects and to get better control of symptoms so you can increase the dose of the drug without worries keep other drugs like clonazepam and alprazolam for use on sos basis only as and when necessary you continue nitrazepam for some days and then gradually reduce the dose and stop the drug completely wait for at least four more weeks to see the effect for further information consult a psychiatrist online