<s>[INST] I have a 56 year old son who suffers from panic attacks and depression and was prescribed Valproate 200mg and Cymbaltra 60mg which he takes every morning after breakfast. He has been on this medication for five years without review and is marginally better in regard to panic attacks but is completely negative about life.  He also has problems concentrating and remembering things.  Are these drugs causing the memory and confusion of his mind? Would he be better on Zoloft ?  He had a professional career but has not been able to return to work at all. He is on a disability pension. I am concerned about any side effects of the drugs he is now taking as well as the fact they do not seem to be productive in results. [/INST] Hello He is on valproate 200 mg and cymbal ta or duloxetine 60 mg for last 5 years without review. He started this medicine for panic attacks and depression. As per my opinion there should be regular consultation from a psychiatrist when patient is given medicines but you didn't consult a Psychiatrist. The dose of valproate is very low considering his age. 200 mg doses daily don't help in controlling mood symptoms and this is a very low dose. He is having memory problem, problems in concentrating, so his symptoms are also not under control. I would advise you to consult a Psychiatrist again and then discuss any change in medicines. There is no use in giving improper doses or medicines without proper psychiatrist cover. Thanks </s>