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What Causes Lack Of Concentration, Insomnia, Anxiety, Low Self Esteem And Weight Loss?
Question: I am 32 now, i struggling to find the correct solution to my condition now. struggling with cluster c personality. Shy and anxious most time but it's controllable but if any problem or stress comes in my way i broke down. It happened at 2001 but some how i managed with help of benzos.in my college days it nightmare because there is no benzo available.. but after its peeked in 2007... I can't bear it. My personality is totally crooked.i loose on all study job, relation, friends.I can only find its disorder and antidepressant is the solution at 2011. I took it for 4 years greatly improved. Escitalopram 10 + clonazepam.25. But mirtazapine is the best i found.But I can't concentrate and memorize the subjects so I can't pass on any competitive exam after that. So I stopped the medication to study. But after discontinuation... I am in a hell kind of situation, insomnia, anxiety, shyness, low self esteem, feelings of unworthy,sevear weight loss.. No energy at all... Heavy pain throughout of my spine.. Ulcer... Etc.
So I again started at 2016 with precaution that med should not reduce my memory and concentration... So my doctor after varies types of trials suggest to take trazodon and paroxetine it helped but I'm not motivated and struggle to study. Eventually trazodon can not make me sleep. so this time he gave me trazodon with Fluoxentine. This helped me to alert. But trazodon losses it's seducing capacity. And to the worse.. this medication make me so shy.. So it's so bad compared to me when I'm not talking any medicine... So I stopped again.
So please help me.. Is there a solution for me...i wonder mirtazapine is the great medicine for me in terms of anxiety control, sleep problem.,appetite stimulant.. But one negative is i can't concentrate on study... Which will be suitable for me...
I think some times only clonazepam is enough until I get any job though it has drug tolerance and worst withdrawal effects. And after that I can get a proper treatment...
Thank you...
So I again started at 2016 with precaution that med should not reduce my memory and concentration... So my doctor after varies types of trials suggest to take trazodon and paroxetine it helped but I'm not motivated and struggle to study. Eventually trazodon can not make me sleep. so this time he gave me trazodon with Fluoxentine. This helped me to alert. But trazodon losses it's seducing capacity. And to the worse.. this medication make me so shy.. So it's so bad compared to me when I'm not talking any medicine... So I stopped again.
So please help me.. Is there a solution for me...i wonder mirtazapine is the great medicine for me in terms of anxiety control, sleep problem.,appetite stimulant.. But one negative is i can't concentrate on study... Which will be suitable for me...
I think some times only clonazepam is enough until I get any job though it has drug tolerance and worst withdrawal effects. And after that I can get a proper treatment...
Thank you...
Brief Answer:
miratazapine or SSRI with methylphenidate or mood elevator
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us. I can understand your concern.
You have mentioned clear history.
You have been better with escitalopram and clonazepam as well as with mirtazapine. Your concern is lack of concentration. Many times in people with other disorder (depression or anxiety) diagnosis of attention deficit disorder is missed.
As such no drug affects memory. But due to sedation it is difficult to be alert and person cannot concentrate.
I recommend using escitalopram (or any other SSRI drug)with clonazepam at night or mirtazapine alone at night. This will help in anxiety and sleep. Clonazepam is the least addictive and easy to quit with slow tapering than any other benzodiazepine. You can use it without much concern about withdrawal. If you feel that there is some anxiety with sleep disturbance only, clonazepam alone can be used for short duration for fast relief.
In addition to above for better concentration mehtylphenidate should be added. Other options is adding mood elevator like modafinil or armodafinil to keep you alert in daytime.
Discuss above option with your treating doctor and change the treatment suitable to you.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
miratazapine or SSRI with methylphenidate or mood elevator
Detailed Answer:
Hello XXXXXXX
Thanks for writing to us. I can understand your concern.
You have mentioned clear history.
You have been better with escitalopram and clonazepam as well as with mirtazapine. Your concern is lack of concentration. Many times in people with other disorder (depression or anxiety) diagnosis of attention deficit disorder is missed.
As such no drug affects memory. But due to sedation it is difficult to be alert and person cannot concentrate.
I recommend using escitalopram (or any other SSRI drug)with clonazepam at night or mirtazapine alone at night. This will help in anxiety and sleep. Clonazepam is the least addictive and easy to quit with slow tapering than any other benzodiazepine. You can use it without much concern about withdrawal. If you feel that there is some anxiety with sleep disturbance only, clonazepam alone can be used for short duration for fast relief.
In addition to above for better concentration mehtylphenidate should be added. Other options is adding mood elevator like modafinil or armodafinil to keep you alert in daytime.
Discuss above option with your treating doctor and change the treatment suitable to you.
Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Sir,
thank you. your answer is very helpful. i have few other doubts, please forgive me, its a long list. i cant told all to any doctor, because they all have different opinion about other medical condition. like if said it to a ent doctor(or to a good family doctor) he told me to not take antidepressant.. Because its problematic, natural cure is best etc etc. so i have to told you all. Please help me..
1) after stopping the antidepressants for two years i am feeling no energy some times, can’t stand up. not reality but i feeling that way. Pain all over the spinal area. Unworthy feeling, shyness, nervousness, can’t sleep at night even though i felt tired, only sleeping in the day time.. Clonazepam alone is help with ease up some problems, is that mean i am addicted to clonazepam. Even in clona night sleeping is a problem.
2) is it all happend by low serotonin level? or the ssri i previously used stopped natural production?
Cause when i took ssri after two years i felt very energetic, happy, and good sleep for one week. but again having troubles in sleeping after one week. most of the ssri doing this to me, sleep disturbances..
3)is it my lifelong problem, so cant i stop after some years?
Because i tried to stop many times. Tried many natural ways to control the anxiety and depression and all the symptoms stated above. Nothing helps me in real.
i took 5htp, magnesium, b12, b6, melatonin, inositol,GABA,passion flower,hops,st john's wort,omega 3,vitamin d3,multivitamin,protiens,etc..
i took ayrvedic preparation, siddha preparations..
yoga, breathing ,exercise. i spent over a 100 thousand rupees. just to see if there is any natual way to cure. but sadly non helping completely but they help a little.
so i think there is no way other than life long alopathic medication, i cant stop it and have a normal life? why ? what is wrong with me.
4) is there any hormonal imbalances to check?
============================================================
1) i have three kind of anxiety, anxiety in mind, anxiety in body (nervousness), anxiety in muscles, mostly in facial (shyness). i dont know is there are any three kinds
at a time one or two of the type is happening... but some times im totally free.
2) some medication helps in anxiety but increasing the other type of discomfort.
3) some herbal preparations help me to reduce mind anxiety but increasing somatic anxiety( like brahmi or like neural stimulants, i am afraid modofinil will mostly like that) so i am mostly avoid that kind of stimulants. my somatic anxiety is a very problematic one because if get angry or afraid i cant control my nervousness. its first cause that i have social phobia.
probranol helping me to conquer this problem(but giving me hardness in chest). but the problem is i am having wheezing also..allergical rhinitis’s...deviated nasal septum making it worse, so even though i haven’t have any cold or sputum, my sinus are mostly filled. so congested nose mostly, i cant sleep with.so.that is two different problems, if i take medicine(antihistamine mostly, puff rarely) for wheezing its different i have to take care the nasal path separately(otrivin)... (Mostly it’s under control ,i am cautious about allergens ). i have to decide to operate on the deviated septum..
4) Some medication help to reduce mind and somatic anxiety but increasing the shyness, so its very hard to communicate to any people face to face. Because at that i cannot express my natrual reflexes like i forgot how to give expression to situation. So i have smile my mouth, or shrink or any other expression voluntarily and separately (like mouth, my posture,). it feels i am stubborn. Any one whom i am talking to is noticing my artificial reactions and it feels more irritating to me... i can’t explain it clearly but its also very disappointing problem. Could you explain why this happening and how to deal with problem.
some medication definitely increasing this problem while it reduce the other two anxiety, and somatic.
so trazodon is one of the medicine. some other ssri also do this to me to some extent.(other medicines are valium. some herbal preparation and food definitely do this to me so i have to consciously avoid that kind of thing even thought they are helping my health in other areas.
Some medication clearly helps me that is definitely clonazepam. Alphrazolam also a good medicine for this but it makes me zombie like. So clonazepam is the best medicine i ever had.
5) so even i take some ssri i have to take clonazepam to control the shyness. This is weird and its hard to tell any psychiatrist, who may think that i am not aware of its addiction and other side effects. Who may think i am misuse that medicine. But who can tell them that how hard and how often i tried to get rid of all medication...and fails all the time... if doctor refuses to prescribe it along with it, then its only trouble taking an antidepressant also.
So please tell me is it normal that i still feel the need to use clonazepam while i am using some ssri, or snri..? How long can i take clonazepam..
6) Doctor, are all happening is real trouble with by natural body function or am i addicted or depended to any medicine. Or am I too shy, coward to fight with the normal things that others also facing...
because some doctors confusing me, they told me that" why are you taking antidepressants, i have seen some people who jerked to just see the medical instrument, and they still normally taking that things, why are you taking thinks too serious, take good food and see it all normal". Many other friends and well wisher also told me that you are not look like having trouble, don’t thinking you have it yourself. Do you think that i am lazy and all problems i having are just simple problems.
but i have been struggling since my childhood, since my college days its nightmare to just to the college and do things in front of girls, i am very hard to make friends, cant mingle with all kinds of people. i cant maintain friendship and relationship. Visiting them rarely, even i feel fear to answer their calls. Always feel i am not up to the mark, as they expect, not interesting, not intelligent, not humorous. They feel that I neglect them but in reality i am very interested to make friends but i am struggling... can you help me how to deal with it.
i am sorry that i cant explain in simple... thank you sir.
thank you. your answer is very helpful. i have few other doubts, please forgive me, its a long list. i cant told all to any doctor, because they all have different opinion about other medical condition. like if said it to a ent doctor(or to a good family doctor) he told me to not take antidepressant.. Because its problematic, natural cure is best etc etc. so i have to told you all. Please help me..
1) after stopping the antidepressants for two years i am feeling no energy some times, can’t stand up. not reality but i feeling that way. Pain all over the spinal area. Unworthy feeling, shyness, nervousness, can’t sleep at night even though i felt tired, only sleeping in the day time.. Clonazepam alone is help with ease up some problems, is that mean i am addicted to clonazepam. Even in clona night sleeping is a problem.
2) is it all happend by low serotonin level? or the ssri i previously used stopped natural production?
Cause when i took ssri after two years i felt very energetic, happy, and good sleep for one week. but again having troubles in sleeping after one week. most of the ssri doing this to me, sleep disturbances..
3)is it my lifelong problem, so cant i stop after some years?
Because i tried to stop many times. Tried many natural ways to control the anxiety and depression and all the symptoms stated above. Nothing helps me in real.
i took 5htp, magnesium, b12, b6, melatonin, inositol,GABA,passion flower,hops,st john's wort,omega 3,vitamin d3,multivitamin,protiens,etc..
i took ayrvedic preparation, siddha preparations..
yoga, breathing ,exercise. i spent over a 100 thousand rupees. just to see if there is any natual way to cure. but sadly non helping completely but they help a little.
so i think there is no way other than life long alopathic medication, i cant stop it and have a normal life? why ? what is wrong with me.
4) is there any hormonal imbalances to check?
============================================================
1) i have three kind of anxiety, anxiety in mind, anxiety in body (nervousness), anxiety in muscles, mostly in facial (shyness). i dont know is there are any three kinds
at a time one or two of the type is happening... but some times im totally free.
2) some medication helps in anxiety but increasing the other type of discomfort.
3) some herbal preparations help me to reduce mind anxiety but increasing somatic anxiety( like brahmi or like neural stimulants, i am afraid modofinil will mostly like that) so i am mostly avoid that kind of stimulants. my somatic anxiety is a very problematic one because if get angry or afraid i cant control my nervousness. its first cause that i have social phobia.
probranol helping me to conquer this problem(but giving me hardness in chest). but the problem is i am having wheezing also..allergical rhinitis’s...deviated nasal septum making it worse, so even though i haven’t have any cold or sputum, my sinus are mostly filled. so congested nose mostly, i cant sleep with.so.that is two different problems, if i take medicine(antihistamine mostly, puff rarely) for wheezing its different i have to take care the nasal path separately(otrivin)... (Mostly it’s under control ,i am cautious about allergens ). i have to decide to operate on the deviated septum..
4) Some medication help to reduce mind and somatic anxiety but increasing the shyness, so its very hard to communicate to any people face to face. Because at that i cannot express my natrual reflexes like i forgot how to give expression to situation. So i have smile my mouth, or shrink or any other expression voluntarily and separately (like mouth, my posture,). it feels i am stubborn. Any one whom i am talking to is noticing my artificial reactions and it feels more irritating to me... i can’t explain it clearly but its also very disappointing problem. Could you explain why this happening and how to deal with problem.
some medication definitely increasing this problem while it reduce the other two anxiety, and somatic.
so trazodon is one of the medicine. some other ssri also do this to me to some extent.(other medicines are valium. some herbal preparation and food definitely do this to me so i have to consciously avoid that kind of thing even thought they are helping my health in other areas.
Some medication clearly helps me that is definitely clonazepam. Alphrazolam also a good medicine for this but it makes me zombie like. So clonazepam is the best medicine i ever had.
5) so even i take some ssri i have to take clonazepam to control the shyness. This is weird and its hard to tell any psychiatrist, who may think that i am not aware of its addiction and other side effects. Who may think i am misuse that medicine. But who can tell them that how hard and how often i tried to get rid of all medication...and fails all the time... if doctor refuses to prescribe it along with it, then its only trouble taking an antidepressant also.
So please tell me is it normal that i still feel the need to use clonazepam while i am using some ssri, or snri..? How long can i take clonazepam..
6) Doctor, are all happening is real trouble with by natural body function or am i addicted or depended to any medicine. Or am I too shy, coward to fight with the normal things that others also facing...
because some doctors confusing me, they told me that" why are you taking antidepressants, i have seen some people who jerked to just see the medical instrument, and they still normally taking that things, why are you taking thinks too serious, take good food and see it all normal". Many other friends and well wisher also told me that you are not look like having trouble, don’t thinking you have it yourself. Do you think that i am lazy and all problems i having are just simple problems.
but i have been struggling since my childhood, since my college days its nightmare to just to the college and do things in front of girls, i am very hard to make friends, cant mingle with all kinds of people. i cant maintain friendship and relationship. Visiting them rarely, even i feel fear to answer their calls. Always feel i am not up to the mark, as they expect, not interesting, not intelligent, not humorous. They feel that I neglect them but in reality i am very interested to make friends but i am struggling... can you help me how to deal with it.
i am sorry that i cant explain in simple... thank you sir.
Brief Answer:
you should continue medicines for long
Detailed Answer:
Hi,
Thanks for follow up. Yes your narration is lengthy but I tried to read and understand twice.
1. After 3 episodes of depression according to guidelines it is better to continue medicines for at least 5 years. Whatever the symptoms you have mentioned can be due to your basic problem and also with stopping anti depressant medicines suddenly. Clonazepam is the least addictive drug. And no need to worry much even if you get addicted as it can be easily stopped through tapering.
2. No SSRI has no role in production of serotonin. They just increase the availability of natural serotonin at necessary sites. It can be possible that after stopping the drug your problem reappeared. Like in diabetes or blood pressure when person has to take medicine for lifelong in depression few patients should take the medicines for long to live better life.
3. Considering your history you should continue for at least 10 years from now. Depression is not merely problem of serotonin. Dopamine and noradrenaline are also involved. Continue yoga also. You can go for CBT- cognitive behavior therapy also.
4. Thyroid should be checked if not done yet.
The best answer of your anxiety problem is CBT. You are thinking more about your problem also. In CBT psychiatrist/psychologist helps person to identify his/her automatic thoughts and faulty behavior which would ultimately be modified by person with active efforts and help of therapist. It also includes time management, daily sleep, meals and exercise timing. You can ask your doctor for the same.
You should go for surgery for DNS as soon as possible to avoid such issues with medicines.
Etizolam is one of the anti anxiety drugs I use very frequently. It is almost without sedation and works like clonazepam for anxiety. If somatic anxiety is not addressed with SSRI other options are pregabalin, imipramine or duloxetine. To this you can add flupirtine maleate for muscle relaxation.
You can take clonazepam for long (at least for 15 years without any problem) but you will not need that much. Taking it until yo remain completely stable for 2 years is sufficient then it can be reduced and stopped.
Your problem can be due to your over concern about your depression and anxiety. It means yes your depression and anxiety can be due to you body, psychology and neurotransmitter problem but it is worsening by your attitude towards problem. It is possible that you have personality disorder and that is why this much trouble is there. And to diagnose it very much other information and mental status examination are required. In any case do not believe that only good food can treat you. You need medicines with psychotherapy.
Take care.
you should continue medicines for long
Detailed Answer:
Hi,
Thanks for follow up. Yes your narration is lengthy but I tried to read and understand twice.
1. After 3 episodes of depression according to guidelines it is better to continue medicines for at least 5 years. Whatever the symptoms you have mentioned can be due to your basic problem and also with stopping anti depressant medicines suddenly. Clonazepam is the least addictive drug. And no need to worry much even if you get addicted as it can be easily stopped through tapering.
2. No SSRI has no role in production of serotonin. They just increase the availability of natural serotonin at necessary sites. It can be possible that after stopping the drug your problem reappeared. Like in diabetes or blood pressure when person has to take medicine for lifelong in depression few patients should take the medicines for long to live better life.
3. Considering your history you should continue for at least 10 years from now. Depression is not merely problem of serotonin. Dopamine and noradrenaline are also involved. Continue yoga also. You can go for CBT- cognitive behavior therapy also.
4. Thyroid should be checked if not done yet.
The best answer of your anxiety problem is CBT. You are thinking more about your problem also. In CBT psychiatrist/psychologist helps person to identify his/her automatic thoughts and faulty behavior which would ultimately be modified by person with active efforts and help of therapist. It also includes time management, daily sleep, meals and exercise timing. You can ask your doctor for the same.
You should go for surgery for DNS as soon as possible to avoid such issues with medicines.
Etizolam is one of the anti anxiety drugs I use very frequently. It is almost without sedation and works like clonazepam for anxiety. If somatic anxiety is not addressed with SSRI other options are pregabalin, imipramine or duloxetine. To this you can add flupirtine maleate for muscle relaxation.
You can take clonazepam for long (at least for 15 years without any problem) but you will not need that much. Taking it until yo remain completely stable for 2 years is sufficient then it can be reduced and stopped.
Your problem can be due to your over concern about your depression and anxiety. It means yes your depression and anxiety can be due to you body, psychology and neurotransmitter problem but it is worsening by your attitude towards problem. It is possible that you have personality disorder and that is why this much trouble is there. And to diagnose it very much other information and mental status examination are required. In any case do not believe that only good food can treat you. You need medicines with psychotherapy.
Take care.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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