instruction: hello doctor my brother who is 25 years old has been suffering from anxiety for the past four years his doctor put him on effexor and elavil both the medicine has to be taken daily in addition to xanax lately the anxiety has developed into full blown panic attacks two of which resulted in a seizure and passing out briefly in addition we just discovered through a dna test that he has two mthfr mutated genes he seems to be rely more on the xanax now as a safety net or crutch when he feels a spell coming on I am very concerned that he has become too dependent on the xanax and now that he is taking a prescribed vitamin supplement to counter the mthfr it is likely making all the drugs on board more potent than before I have read that the cause of anxiety for some people is the mthfr gene mutation therefore I wonder if he even needs any of the drugs he is on but I realize that he cannot just quit cold turkey he needs opinion he is in a real tough cycle right now where he can hardly function which is not good as he is in final semester of law school please help
output: hello I can understand your concerns from your description it seems that your brother might have become dependent on xanax alprazolam xanax belongs to benzodiazepine group of drugs and is quite notorious for causing dependence if used for a longer period hence when not taken it leads to anxiety like symptoms which can mic a panic attack these are actually the withdrawal symptoms of xanax hence I would suggest you to stop your brother from taking xanax as soon as possible substitute xanax with some other drug with less abusive profile like clonazepam and then gradually taper and stop it besides this effexor venlafaxine is an effective drug for anxiety disorder but we need to adjust the dosage to increase the efficacy you need not give him elavil amitriptyline with effexor however he can continue with the supplements I would also suggest you to take a neurology opinion in view of seizure like episodes that happened previously for further clarification consult a psychiatrist online