instruction: hello doctor I have bipolar disorder panic attacks social and generalized anxiety disorder I have one to three panic attacks per day constant anxiety and fear of leaving the house no motivation to work no energy apathetic without mood right now I am in a depressive episode I previously tried valproic acid lithium carbamazepine xanax lorazepam clonazepam rudotel lexotanil fluoxetine sertraline and escitalopram sari does not have an effect on me right now I take lamictal 50 my daily and tranxene 5x5 my daily tranxene loses its anxiolytic effects and my anxiety becomes more severe I am planning to titrate lamictal 100 my however it should not help with anxiety what are my treatment options benzodiazepine are not an option because I am getting used to them two days later I have a consultation with my psychiatrist but I want to hear possible treatment for my conditions from another option I have done thyearoid heart function men hormones prolactin kidney and liver function tests all are normal
output: hello if your anxiety is not responsive to sari selective serotonin reuptake inhibitors then you should consider trying tea tricyclic antidepressants class of antidepressants they will help with your anxiety and panic attacks apart from tranxene and benzodiazepine there are few other options for anxiolysis if you are specifically looking for something to be added to the tea such as propranolol buspirone tofisopam clobazam hydroxyzine and pregabalin also you can consider mirtazapine which will act as an antidepressant and also for anxiolysis it is a massa noradrenergic and specific serotonergic class of antidepressants