Dear Doctor,
I am male 40 and suffering with GAD/breathlessness/Panic anxiety/Low mood (not depression)/ agoraphobia/loss of libido. Took imipramine 50mg and stelazine 2mg for last 6 years and also took amitriptyline 50mg for months but they are no more effective now. Currently I am taking escitalopram 15mg (tried 20mg also) but with esci only 60% normal. One doc told add bupropion 75 mg to esci or pregabalin 75 thrice to esci or stop all these and start desvenlafaxine. Two days onwards onwards I am taking Pristiq 50mg and esci 5mg, how long does it take to effect, can we add bupropion to pristiq later. Please kindly advise. I am addicted to chewing tobacco. I shall be highly obliged for the help done. Diagnosis: (PNS X-ray result Deviated Septum and PFT result Bronchial Hyper responsiveness and HBA1C 6.4%) (TMT, Echo, TSH, SGPT, Uric Acid, ESR, Chest X-ray, CBC, ECG, Trop-T = all normal) (CT Scan not done).
I shall be highly obliged and grateful for the help done, I am very much effected with this problem Doctor. Kindly help.

This is a matter for your own medical practitioner as they have knowledge of your history and medication.

I am sorry you have these problems, and you consider your doctor to be a 'problem doctor'.

What you might consider is taking all this detailed information on your medications, and book an appointment with another Doctor- I presume you are prescribed these medications by a psychiatrist for the disorders you mentioned.

Having a second opinion, and a new assessment of your situation, might be a good idea.

I think he omitted a crucial comma between problem and doctor.

In a perfect world, you would be tested for medical problems and assessed for psychiatric problems at the same time. I would wonder when and how slowly or suddenly your symptoms started.
A common report of WOMEN with undetected heart disease is a set of symptoms that include panic, GAD, and shortness of breath. Many are sent home with anti-anxiety drugs, and later have a heart attack.
You are male, but have your had a cardiogram?

When did you start to chew tobacco?
If I were you, I would wean myself off tobacco before anything else. Chew nicotine gum or get a nicotine patch from your doctor.
You will save yourself from throat or mouth cancer anyway.

How many doctors do you see that are prescribing you these meds?