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Suggest Treatment For Anxiety And Panic Attacks
Question: Hello I am 34 and in the past generally considered myself in good health. Period I was diagnosed with fibromyalgia three years ago and never took anything for it but have lived with the pain and headaches since then. In December, I had what I felt may have been a mild panic attack. I felt nervous and my heart felt like it was racing and pounding out of the blue as I was getting ready for bed one evening. Since then I feel like I have all kinds of crazy symptoms heart racing up to 175 bpm, mild chest pain digestive issues but most disturbing is the constant floaty dizziness. This mild chest pain digestive issues but most disturbing is the constant floaty dizziness. This has gone on now for two months. My physician sent me to a cardiologist has gone on now for two months. My physician sent me to a cardiologist who did a stress test two EKGs and echocardiogram a 24 hour and a seven day holter monitor test and is on the fence whether it is sinus tachycardia or SVT. My ENT has cleared any issues with my ears and my neurologist called for a IAC Proto call MRI and it was also clear. I also find myself all over nervous I shake and have other classic anxiety symptoms however I feel that most of my anxiety is caused by physical symptoms. I also visited with a therapist with intentions of starting treatment for anxiety who told me to continue to pursue a physiological cause. I have been awaiting a follow up with my neurologist for two weeks for a game plan and in the meantime made an appointment with my physician who is still convinced that my dizziness stems from a cardiology issue and will not prescribe any long-term anxiety meds. I have begun taking holy XXXXXXX and also a magnesium supplement out of desperation. I am a mess and I feel like I am missing out on my life at this point because I feel so poorly. Any help is appreciated!
Brief Answer:
rule out cardiac cause and do jpmr for anxiety
Detailed Answer:
Hello,
I have read your query and from that it is evident that-
The panic attack that you had for the first time was more likely related to cardiac status. This is almost supported by the fact that ekg and other heart tests seems abnormal. Perhaps you may upload the reports to a cardiologist here on this platform. .
--Whenever there is any health issue there is some anxiety certain to develop in all individuals. But in order to relate a symptom it directly to anxiety : there must be a temporal evidence of relationship between the anxiety and symptoms of dizziness.
As a psychiatrist, we always try to rule out organicity as a first priority. Symptoms which may be related to heart or any major organ, take priority over symptoms of psychological origin as they can be life threatening if ignored.
Because of the above reasons your psychiatrist must have asked you to look into cardiac area first.
- Another reason for considering a cardiac cause is your present diagnosis of fibromyalgia. Dizziness is a common symptom in these patients. As far as two third patients of fibromyalgia suffer from dizziness and it is a common cause of referral to ER.
The things which can help you presently are--
-- Low blood pressure can also be the cause of dizziness. Timely recording of blood pressure three times a day both in sitting and lying down position can help in this. You may visit a GP for the same.
-- Your psychiatrist is right in avoiding any long term anti anxiety pills in your situation. It may however be taken on PNR basis.
-- You may try to do breathing exercises to control anxiety and other stressful symptoms. A deep breathing exercise even improves pain tolerance of fibromyalgia. You can learn it and practice it three to four times daily for 10-20min.
-- There is another scientifically researched technique jpmr- you may learn it from internet or someone who knows it. It is a procedure of 45-50min and when done properly and is deeply relaxing and rejuvinating. I have tried it in patients of various painful conditions and very commonly in difficult anxiety patients with very good results.
You can discuss the above points with your treating team.
Wish you good luck.
Please feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
rule out cardiac cause and do jpmr for anxiety
Detailed Answer:
Hello,
I have read your query and from that it is evident that-
The panic attack that you had for the first time was more likely related to cardiac status. This is almost supported by the fact that ekg and other heart tests seems abnormal. Perhaps you may upload the reports to a cardiologist here on this platform. .
--Whenever there is any health issue there is some anxiety certain to develop in all individuals. But in order to relate a symptom it directly to anxiety : there must be a temporal evidence of relationship between the anxiety and symptoms of dizziness.
As a psychiatrist, we always try to rule out organicity as a first priority. Symptoms which may be related to heart or any major organ, take priority over symptoms of psychological origin as they can be life threatening if ignored.
Because of the above reasons your psychiatrist must have asked you to look into cardiac area first.
- Another reason for considering a cardiac cause is your present diagnosis of fibromyalgia. Dizziness is a common symptom in these patients. As far as two third patients of fibromyalgia suffer from dizziness and it is a common cause of referral to ER.
The things which can help you presently are--
-- Low blood pressure can also be the cause of dizziness. Timely recording of blood pressure three times a day both in sitting and lying down position can help in this. You may visit a GP for the same.
-- Your psychiatrist is right in avoiding any long term anti anxiety pills in your situation. It may however be taken on PNR basis.
-- You may try to do breathing exercises to control anxiety and other stressful symptoms. A deep breathing exercise even improves pain tolerance of fibromyalgia. You can learn it and practice it three to four times daily for 10-20min.
-- There is another scientifically researched technique jpmr- you may learn it from internet or someone who knows it. It is a procedure of 45-50min and when done properly and is deeply relaxing and rejuvinating. I have tried it in patients of various painful conditions and very commonly in difficult anxiety patients with very good results.
You can discuss the above points with your treating team.
Wish you good luck.
Please feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Prasad
I have scheduled an appointment with an EP doctor to confirm whether my reports show evidence of SVT. Would SVT cause this dizzy/floaty that I have had 24/7 for two months? I also experience a lot of tension headaches. My dentist recently confirmed evidence on the surface of my teeth of clenching/grinding. I am looking into getting a nighttime mouth guard for this problem.
I also spoke to my neurologist today who recommended that I follow up with the EP first and also mentioned vestibular therapy.
I just am doubtful that occasional issues with possible SVT would cause this type of dizzy sensation...is this a commonly occurring connection?
I also spoke to my neurologist today who recommended that I follow up with the EP first and also mentioned vestibular therapy.
I just am doubtful that occasional issues with possible SVT would cause this type of dizzy sensation...is this a commonly occurring connection?
Brief Answer:
check BP, relaxation helps teeth& confirm SVT
Detailed Answer:
Hello,
SVT can cause dizziness, rapid breathing, papitation, loss of consciousness etc. These can be see commonly and may last for few minutes to whole day. This can be precipitated with any physical and emotional stress.
You should visit your EP for the same to confirm it.
Another cause for long periods of dizziness can be vestibular system. Due to disturbance in fluid in ear there can be constant state of dizziness...espically when one moves. It is frequently associated with nausea and vomiting.
Tension headaches can be related to cardiac event also or may be due to psychological stress of having these symptoms for so long. Get your blood pressure checked and if its normal you can take any cardio safe pain killer.
The grinding of teeth during sleep is frequetly seen in people who have anxiety. Taking a nap in daytime and having relaxed time helps this significantly. Using mouth guard is also recommended many times to prevent the teeth damage and pain in mouth next day.
Hope the reply helps.
Feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
check BP, relaxation helps teeth& confirm SVT
Detailed Answer:
Hello,
SVT can cause dizziness, rapid breathing, papitation, loss of consciousness etc. These can be see commonly and may last for few minutes to whole day. This can be precipitated with any physical and emotional stress.
You should visit your EP for the same to confirm it.
Another cause for long periods of dizziness can be vestibular system. Due to disturbance in fluid in ear there can be constant state of dizziness...espically when one moves. It is frequently associated with nausea and vomiting.
Tension headaches can be related to cardiac event also or may be due to psychological stress of having these symptoms for so long. Get your blood pressure checked and if its normal you can take any cardio safe pain killer.
The grinding of teeth during sleep is frequetly seen in people who have anxiety. Taking a nap in daytime and having relaxed time helps this significantly. Using mouth guard is also recommended many times to prevent the teeth damage and pain in mouth next day.
Hope the reply helps.
Feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, I have been checking BP at home since December...especially during peak times of us wellness. While I will occasionally have higher number, my BP is generally well within normal range.
Would a vestibular concern still be a possible cause if my ent doctor has ruled out any issues with my ears?
Would a vestibular concern still be a possible cause if my ent doctor has ruled out any issues with my ears?
Brief Answer:
yes, it should be ruled out propely
Detailed Answer:
Hello,
The high blood pressure as a cause is almost ruled out as your bp is within normal limit most of the time. Occasional fluctuations can be related to simple anxiety.
The common clinical causes of constant dizziness are - high BP; vestibular system disease; cervical spondylosis or cardiac problem.
An infrequent cause can be due to cerebellum of brain ( cerebellum is a part of brain involved in maintaining balance and eqillibrium).
You dont have any other feature of cervical spondylosis, like neck or shoulder pain..so that is out.
As far as brain is concerned you dont have other cerebellar signs ( as your neurologist has tested you throughly and he must have done those tests on you), so this is also out (and i didnt mention that initially for the same reason).
We are left with cardiac and vestibular reasons. And simple ent testing might not include vestibular tests, thats why you should get them done.
.
If at all, all of these come out to be normal, then only anxiety is left as a possible cause of this dizziness. Psychological event is almost always taken as a cause when every other potential organicity is ruled out. This is a protocol which is usually followed.
so,there is no harm in getting the vestibular testing done and ruling it out completely.
Hope the reply helps you and clarifies the situation. Feel free to ask any more queries if you have . I will try my best to help.
Dr. Manisha Gopal
MD Neuropsychiatry
yes, it should be ruled out propely
Detailed Answer:
Hello,
The high blood pressure as a cause is almost ruled out as your bp is within normal limit most of the time. Occasional fluctuations can be related to simple anxiety.
The common clinical causes of constant dizziness are - high BP; vestibular system disease; cervical spondylosis or cardiac problem.
An infrequent cause can be due to cerebellum of brain ( cerebellum is a part of brain involved in maintaining balance and eqillibrium).
You dont have any other feature of cervical spondylosis, like neck or shoulder pain..so that is out.
As far as brain is concerned you dont have other cerebellar signs ( as your neurologist has tested you throughly and he must have done those tests on you), so this is also out (and i didnt mention that initially for the same reason).
We are left with cardiac and vestibular reasons. And simple ent testing might not include vestibular tests, thats why you should get them done.
.
If at all, all of these come out to be normal, then only anxiety is left as a possible cause of this dizziness. Psychological event is almost always taken as a cause when every other potential organicity is ruled out. This is a protocol which is usually followed.
so,there is no harm in getting the vestibular testing done and ruling it out completely.
Hope the reply helps you and clarifies the situation. Feel free to ask any more queries if you have . I will try my best to help.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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