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How Can Anxiety Be Treated?

Posted on Thu, 19 Apr 2018

Question: Good evening Dr,
I had sent you a question regarding my generalized anxiety disorder trouble on same portal around 24 days ago, where you helped me with your valuable feedback.

Just to refresh, I am taking medicines since April 2016 with the dosage details below. Even then I feel that I am not out of this illness or I have forgot how its like to live without this illness and negative thoughts. Everyday is difficult for me with fear and "ghabrahat" and on some days, like today, I feel like I'll loose control of my mind, consistently checking if I am doing things right, questioning my existence, abilities and actions.

I need your guidance to set up a schedule for me so that I can track my improvement and overcome hurdles one by one as I want come out of this illness strong and happy. I feel my deep and excessive thinking combined with emotional nature is a reason for this trouble.

My age is not that much and I want to live and happy and positive live. I also believe that the there is a positive life outside this cage of negative thoughts which unfortunately I am unable to access now. It's like I am living a virtual world where I am not able to realize all my capabilities.

Thanks again for your help! Good day
- XXXX

Answered by Dr. Seikhoo Bishnoi (9 hours later)

Brief Answer:
Day to day activities and thoughts should be altered.

Detailed Answer:
Hello thanks for asking again

I am sorry for replying late. Last time we discussed about reducing the dose of Escitalopram from 20 to 15 mg and to make Clonazepam on SOS basis. Currently you are on 25 mg dose and this is a high dose. This adds to side effects more than therapeutic benefits. This could increase the sexual side effects too.

Apart from medicines other psychological methods you have to follow in order to come out of depression. We already talked about the supplements and dietary modifications.

You have to find out what kind of thoughts are affecting you most. In day to day life a lot of thoughts we come across which should be ignored but in patients of depression these thoughts are not suppressed. Maximising a normal negative thought, minimising a positive thing, generalising a trivial issue on whole life, disqualifying positive etc are the common distortions in thoughts.

For example if in day to day activity someone close to you in normal talks says that "you never do work properly" or "you don't know how to drive" or any other minor thing. In normal euthymic mood a person tends to ignore these thoughts but in patients of depression even such minor thing is given importance. They will take these as "I never do work properly" or "I never drove right" etc. I hope you are understanding what I am trying to say.

Try to focus on these things and if possible improve the thoughts. Make a list of thoughts which are bothering you most and then find out which are the thoughts which can be altered in order to live better.

Thanks, please don't hesitate to ask follow up doubts.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (6 hours later)

Thanks for your reply Dr.

I have reduced Clonazepam and i don’t remember taking it since last 2 weeks.

I generally have moderate to high anxiety between 10:30am to around 6pm. However, I see sometimes it reduces after 6:30pm. In office, I try very hard to convince myself that I am fine and nothing will happen to me, these are just negative thoughts.

The thoughts and circumstances I face are:
- Dizziness, blurred vision, unable to focus
- Consistent self-questioning
What I am doing?
Why I am doing this?
What is life?
How are we able to live long, sleep and then wake up every day? More easy would have been to die and start new.

Basically, useless questions but the pattern indicates like I have confused myself with basic fundamentals of life and human being’s existence and its capabilities. This is in turn affecting my capability, confidence in work. I am more confused about life then focused. Somehow am unable to convince myself and bring focus back to life. I remember couple of years back I read book "Many Lives Many Masters" to improve my understanding of life and overcome my fear of death but it went the other way and I think rather than benefiting for it I confused myself more.

Since my childhood days I was more into philosophical thinking and till today inclined towards religious text. I have been an emotional person where before my gain i think about others loos and that’s my am unable to make progress and material gains. Because of very thought that one day we all die so what is the need to living and struggling so much in life. Why do we have to do all this when we will die? Questions like these restrict my professional growth and make it difficult to live a happy day to say life. I see I am missing the acceptance of What is life and so unable to lead it happily. Because of this also I am unable to come out of this illness.

"I wish to make changes to way l think, like rewiring my brain"

Thanks, XXXX

Answered by Dr. Seikhoo Bishnoi (6 hours later)

Brief Answer:
Life style changes should be made.

Detailed Answer:
Hello again

In day time when you are in office, mostly at that time you have anxiety and depressive symptoms. This could be related to work stress too. Even if there is no evident work stress even then that might be due to some unconscious stress. This could be the reason for the worsening of symptoms. When you are at home then you might be at ease and at that time you feel better.

Do you have worsening of symptoms in day time in weekends too?

Intrusive thought about death or repetitive suicide ideas are due to severe depression. Medicines will help to reduce these symptoms but you have to work hard to improve your lifestyle too. Psychosocial methods will also help in this.

Better lifestyle should include fixing time to go to sleep, sleeping at least 8 hours a day, exercising daily, taking balanced diet rich in proteins and complex carbs while low in fats, taking Omega fatty acids rich diet like walnuts, salmon or sardine fish etc, high B12 containing foods like curd, milk, cheese, paneer, animal foods, eggs etc.

All these things will surely help in improving your symptoms. Exercising will help you in focussing your goals. At time of exercise a person focus on himself only. In depression anger turned towards self and exercise will help you in improving the mood.

Thanks. Just don't loose your hope, you will definitely come out of depression.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (22 hours later)

Hello Doctor,

Yes, during weekends I have different symptoms like what to do next, I generally become restless and confused what should I do and result is I get sellpy feeling and when I am in bed i think about this illness and try to improve my thoughts by thinking that I have been surviving this since XXXXXXX 2016 so I'll ve fine. Yesterday evening I went to movie and initially I wanted to run out of the theatre and today I planned to go out with family but I want feeling uneasy and confused so I slept in the noon.

I feel little happy when i am taking care of my aquarium.

Sometimes I feel its not possible to get out of this as i am thinking about this all day. Not sure how can i change my thought process and persue things differently.

Thanks, XXXX

Answered by Dr. Seikhoo Bishnoi (11 hours later)

Brief Answer:
Try to come out of indecisiveness.

Detailed Answer:
Hello again

Indecisiveness or difficulty in taking decisions are also part of depression. Like the episodes you mentioned, you wanted to go for a movie and then didn't go and remained on bed on Sunday. This is part of depression.

To come out of these things you have to start taking decisions. You have to come out of the depressed thoughts. If you start to take a firm decision on a small thing then that will boost your confidence and you will feel better. Try to keep yourself busy and spend more time in outdoors and you will definitely get benefit.

THanks

Above answer was peer-reviewed by : Dr. Yogesh D