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What Is The Cause And Treatment For Anxiety And Panic Attacks?
Question: Symptoms started: 10 Months ago, and getting worse
Reason for Consult:
Constant Vision Problems (Blurry, Haze, Dim). Constant Brain Fog. Detachment and Disassociation as if in a dreamworld. Feeling Spaced Out. Dizzy Spells. Severe Anxiety and Panic. Headaches. Feeling Unco-ordinated and off balance at times. Fatigue. Depression now as well due to long suffering.
Previous resolved symptoms include Numbness and tingling in hands and face, Heart Palpitations, muscle twitching. Strange attacks of Tunnel vision followed by Panic (probably controlled by Clonazepam at this point)
Patient:
41 Years Old. Was Fit, Active. Secure with good life. No sudden changes in life. No history of mental illness. Great Family. Great Friends. Great career.
Suspect Labs:
Brain MRI showing 12 White Matter Lesions.
Higher than normal Cortisol
Igenex Labs tested suspicious for Lyme Disease. Subsequently visited Doctor in New York who started treating me for Lyme Disease, Bartonella and Babesia. However, I find the diagnosis suspect as I tested negative for all of that in Canadian Labs.
History of Problem
Seen Many Doctors. Have had much conflicting information. GP said anxiety disorder. One local Phychiatrist said suspects Biological reason as he suggested it would rare and unusual for someone like to me to suddenly develop a mental illness out of nowhere. Other Psychiatrist suggested bi-Polar to which my Family GP scoffed at citing I show no signs of bi-Polar. MS Specialist ruled out MS. Still have not found cause or reason to brain lesions, but they are of concern to me.
Patient Story:
Last September I had a strong and strange feeling like I was going to faint. This feeling scared me so much it launched me into a panic attack. This was completely out of nowhere. Since then, it has been nothing short of a nightmare as I continue to degrade. Because I am 41 years old, fit, financially secure and have a great family and friends and never had issues with panic or anxiety before, I found it odd that I would suddenly develop an anxiety disorder so I was convinced it was something physical that was triggering the anxiety. I got a brain MRI which showed 12 non-specific lesions. A follow up for MS proved negative. I was tested for Lyme disease, which also came back negative in Canada, but suspicious for Lyme and Bartonella at Igenex in USA. I am currently on clonazepam (Klonopin) 0.5 mg per day. I suffer daiily with constant Vision problems, Feeling surreal as if in a dreamworld, dizzy spells, severe anxiety and feeling detached.
This has completely consumed my life. I am in a constant state of waiting to see other specialist, but wait times for appts are months. And I keep degrading and am losing control of my life and family. I have 2 young children (10 and 8) and I need to find an answer for them. I have reached a point of desperation and despair and truly need to reach out for some other help.
I would like to specifically find out if these symptoms could indeed be solely psychological? I would think anxiety would come and go, yet I remain in a constant state of discomfort, with constant visual disturbances, and constantly feel in a fog, and at times completely surreal.
I feel that perhaps there is one of 3 things going on
1. Something Biological triggering these symptoms and also creating anxiety and panic
2. I had an abrupt Panic attack, which I ruminated and fed every single day in my quest to "FIX" myself, that it has made me look inward so long that I now suffer from severe anxiety and depression that affects my perception, my vision and more.
3. A combination of having had an abrupt panic attack, but now having bad reaction to the drugs being on and off and on and off. Perhaps Benzodiazepene and SSRI discontinuation syndrome?
I have been told a few times that my symptoms do not match that of solely an anxiety disorder, hence my persistent search. The symptoms that seems the most perplexing to local professionals is the constant blurred vision and brain fog. Can Anxiety really create that for several months every single day?
Reason for Consult:
Constant Vision Problems (Blurry, Haze, Dim). Constant Brain Fog. Detachment and Disassociation as if in a dreamworld. Feeling Spaced Out. Dizzy Spells. Severe Anxiety and Panic. Headaches. Feeling Unco-ordinated and off balance at times. Fatigue. Depression now as well due to long suffering.
Previous resolved symptoms include Numbness and tingling in hands and face, Heart Palpitations, muscle twitching. Strange attacks of Tunnel vision followed by Panic (probably controlled by Clonazepam at this point)
Patient:
41 Years Old. Was Fit, Active. Secure with good life. No sudden changes in life. No history of mental illness. Great Family. Great Friends. Great career.
Suspect Labs:
Brain MRI showing 12 White Matter Lesions.
Higher than normal Cortisol
Igenex Labs tested suspicious for Lyme Disease. Subsequently visited Doctor in New York who started treating me for Lyme Disease, Bartonella and Babesia. However, I find the diagnosis suspect as I tested negative for all of that in Canadian Labs.
History of Problem
Seen Many Doctors. Have had much conflicting information. GP said anxiety disorder. One local Phychiatrist said suspects Biological reason as he suggested it would rare and unusual for someone like to me to suddenly develop a mental illness out of nowhere. Other Psychiatrist suggested bi-Polar to which my Family GP scoffed at citing I show no signs of bi-Polar. MS Specialist ruled out MS. Still have not found cause or reason to brain lesions, but they are of concern to me.
Patient Story:
Last September I had a strong and strange feeling like I was going to faint. This feeling scared me so much it launched me into a panic attack. This was completely out of nowhere. Since then, it has been nothing short of a nightmare as I continue to degrade. Because I am 41 years old, fit, financially secure and have a great family and friends and never had issues with panic or anxiety before, I found it odd that I would suddenly develop an anxiety disorder so I was convinced it was something physical that was triggering the anxiety. I got a brain MRI which showed 12 non-specific lesions. A follow up for MS proved negative. I was tested for Lyme disease, which also came back negative in Canada, but suspicious for Lyme and Bartonella at Igenex in USA. I am currently on clonazepam (Klonopin) 0.5 mg per day. I suffer daiily with constant Vision problems, Feeling surreal as if in a dreamworld, dizzy spells, severe anxiety and feeling detached.
This has completely consumed my life. I am in a constant state of waiting to see other specialist, but wait times for appts are months. And I keep degrading and am losing control of my life and family. I have 2 young children (10 and 8) and I need to find an answer for them. I have reached a point of desperation and despair and truly need to reach out for some other help.
I would like to specifically find out if these symptoms could indeed be solely psychological? I would think anxiety would come and go, yet I remain in a constant state of discomfort, with constant visual disturbances, and constantly feel in a fog, and at times completely surreal.
I feel that perhaps there is one of 3 things going on
1. Something Biological triggering these symptoms and also creating anxiety and panic
2. I had an abrupt Panic attack, which I ruminated and fed every single day in my quest to "FIX" myself, that it has made me look inward so long that I now suffer from severe anxiety and depression that affects my perception, my vision and more.
3. A combination of having had an abrupt panic attack, but now having bad reaction to the drugs being on and off and on and off. Perhaps Benzodiazepene and SSRI discontinuation syndrome?
I have been told a few times that my symptoms do not match that of solely an anxiety disorder, hence my persistent search. The symptoms that seems the most perplexing to local professionals is the constant blurred vision and brain fog. Can Anxiety really create that for several months every single day?
Brief Answer:
It can be due to anxiety
Detailed Answer:
Hi,
I went through you query in detail and can understand the reason for your being excessively concerned regarding your symptoms and still undetermined cause.
Before I go on to answer your question, let me tell you something very important about anxiety. Anxiety is a state/condition which causes multiple symptoms. Then, we start worrying about these symptoms which worsen our anxiety. This leads to even more symptoms or worsening of the previous symptoms. A vicious cycle hence starts.
All the symptoms that you have mentioned can be manifestations of anxiety. The problem with any psychiatric condition is that it is basically a disease of exclusion. You have to rule out possible organic causes that may cause similar conditions. In your case, although there have been few subtle things detected like white matter lesions on MRI and high cortisol level, but these also can be completely incidental and insignificant. I would have loved to see the MRI report and also a neurologist's opinion regarding it.
As I said, all your symptoms can be purely psychological. Even your constant blurred vision can be due to anxiety. Anxiety, as you said can come and go. But it can also cause a constant state of symptoms and can worsen further with more worrying. But it is important to rule out any organic cause. Getting an ophthalmologist evaluation will help do that. Of course, I mentioned neurologist's take on the white matter lesions. Even if any of your symptoms might have been due to an underlying organic cause, your constant worry is definitely leading to anxiety and that has to be treated for you to become symptomatically better.
You have mentioned about trying cipralex, paxil and prestiq for you problems. I would have liked to know the dosage and duration that you were on each individual drug and any kind of relief that you perceived with the same.
For now, I would suggest the following course of action. Stop trying a lot to find meaning into your symptoms.The more you worry, worse your symptoms will be. Let us for some time assume that it is completely psychological and initiate treatment accordingly. You are currently only on clonazepam. I would suggest addition of another agent like another SSRI (selective serotonin reuptake inhibitor) or venlafaxine to treat the syndrome of anxiety. Clonazepam will just help symptomatically and won't treat the underlying disorder. Start exercising daily. Discuss with close someone about what is going on in your life (not about your symptoms) on a daily basis. Try to defocus from your symptoms. With adequate management of anxiety, I am petty sure, you will be able to get rid of your symptoms.
I do hope that I was able to answer your query. please let me know if you have any further query. I will be glad to help.
Best wishes,
Dr. Sunil Gupta
It can be due to anxiety
Detailed Answer:
Hi,
I went through you query in detail and can understand the reason for your being excessively concerned regarding your symptoms and still undetermined cause.
Before I go on to answer your question, let me tell you something very important about anxiety. Anxiety is a state/condition which causes multiple symptoms. Then, we start worrying about these symptoms which worsen our anxiety. This leads to even more symptoms or worsening of the previous symptoms. A vicious cycle hence starts.
All the symptoms that you have mentioned can be manifestations of anxiety. The problem with any psychiatric condition is that it is basically a disease of exclusion. You have to rule out possible organic causes that may cause similar conditions. In your case, although there have been few subtle things detected like white matter lesions on MRI and high cortisol level, but these also can be completely incidental and insignificant. I would have loved to see the MRI report and also a neurologist's opinion regarding it.
As I said, all your symptoms can be purely psychological. Even your constant blurred vision can be due to anxiety. Anxiety, as you said can come and go. But it can also cause a constant state of symptoms and can worsen further with more worrying. But it is important to rule out any organic cause. Getting an ophthalmologist evaluation will help do that. Of course, I mentioned neurologist's take on the white matter lesions. Even if any of your symptoms might have been due to an underlying organic cause, your constant worry is definitely leading to anxiety and that has to be treated for you to become symptomatically better.
You have mentioned about trying cipralex, paxil and prestiq for you problems. I would have liked to know the dosage and duration that you were on each individual drug and any kind of relief that you perceived with the same.
For now, I would suggest the following course of action. Stop trying a lot to find meaning into your symptoms.The more you worry, worse your symptoms will be. Let us for some time assume that it is completely psychological and initiate treatment accordingly. You are currently only on clonazepam. I would suggest addition of another agent like another SSRI (selective serotonin reuptake inhibitor) or venlafaxine to treat the syndrome of anxiety. Clonazepam will just help symptomatically and won't treat the underlying disorder. Start exercising daily. Discuss with close someone about what is going on in your life (not about your symptoms) on a daily basis. Try to defocus from your symptoms. With adequate management of anxiety, I am petty sure, you will be able to get rid of your symptoms.
I do hope that I was able to answer your query. please let me know if you have any further query. I will be glad to help.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your concern and reply.
I too have thought it could all perhaps be anxiety. But is it really possible to go from a perfectly happy, active and fit 40 year old family man with financial security and great friends and hobbies to suddenly develop such severe anxiety that it has debilitated my life? That's where I struggle to understand. Nothing was wrong in my life.
The MRI report is attached in the reports I attached. It's the document called imageing.pdf
I had an MS specialist look at the MRI as well and she did not give any further explanation for the lesions. Perhaps this is because she did not feel they were significant but 12 lesions to me seems a lot.
As for my medications here is what I have tried
Cipralex at 10mg for 7 weeks. Felt a decrease in anxiety but felt like a zombie. Was taken off because it caused severe depression.
Pristiq only lasted 10 days and I was extremely ill.
Paxil I stayed in for 8 weeks. There were no benefits at all to this but I was left with many lasting side effects such as muscle twitching etc.
I often wonder if perhaps many of my symptoms are caused by the constant abrupt discontinuation of these drugs and how they are reacting in my body.
I also know from the moment this happened I have been relentless in searching for a cause. I have spent countless hours and dollars searching for a biological reason as I could not understand how I could abruptly develop a disorder. But if you have seen this before then it I would like to know.
If indeed all these very serious physical symptoms are caused by anxiety, then I have undoubtedly been going about it all wrong. I am reluctant to try another ssri as I have yet to find relief. I do have a prescription for cymbalta that I have yet to get filled that I could try. What would be your suggestion on that?
Lastly. Do people recover from this? My business and family are truly suffering.
Thank you so much for your time.
I too have thought it could all perhaps be anxiety. But is it really possible to go from a perfectly happy, active and fit 40 year old family man with financial security and great friends and hobbies to suddenly develop such severe anxiety that it has debilitated my life? That's where I struggle to understand. Nothing was wrong in my life.
The MRI report is attached in the reports I attached. It's the document called imageing.pdf
I had an MS specialist look at the MRI as well and she did not give any further explanation for the lesions. Perhaps this is because she did not feel they were significant but 12 lesions to me seems a lot.
As for my medications here is what I have tried
Cipralex at 10mg for 7 weeks. Felt a decrease in anxiety but felt like a zombie. Was taken off because it caused severe depression.
Pristiq only lasted 10 days and I was extremely ill.
Paxil I stayed in for 8 weeks. There were no benefits at all to this but I was left with many lasting side effects such as muscle twitching etc.
I often wonder if perhaps many of my symptoms are caused by the constant abrupt discontinuation of these drugs and how they are reacting in my body.
I also know from the moment this happened I have been relentless in searching for a cause. I have spent countless hours and dollars searching for a biological reason as I could not understand how I could abruptly develop a disorder. But if you have seen this before then it I would like to know.
If indeed all these very serious physical symptoms are caused by anxiety, then I have undoubtedly been going about it all wrong. I am reluctant to try another ssri as I have yet to find relief. I do have a prescription for cymbalta that I have yet to get filled that I could try. What would be your suggestion on that?
Lastly. Do people recover from this? My business and family are truly suffering.
Thank you so much for your time.
Brief Answer:
Please see details below
Detailed Answer:
Dear XXXXXXX
Thanks for following up and updating me with further information.
It is very much possible for such symptoms to start suddenly. In fact, most cases associated with panic attacks do start out of nowhere. It is not related to any specific financial or emotional issue. We just have to accept it and do the best to get rid of it as soon as possible.
I saw the MRI report and I do feel that it may be completely insignificant. As you said, probably your MS specialist did not give any further explanation because she felt they were insignificant. I understand that one becomes concerned looking at 12 lesions but that is possible.
Regarding medications, any of them should not be discontinued abruptly, and if done it will definitely cause increased symptoms. I can understand when you say that you don't want to try another SSRI. But every SSRI has a different effect for that matter and can be tried. Cymbalta is also an effective agent. If you already have a prescription, you can definitely try it (my first choices will still be SSRIs and venlafaxine). You have to remember that any of these agents will take time to show response. So, you will have to be patient about the same. More so, some symptoms that you consider "side effects" can be very well be due to anxiety itself.
With adequate and proper treatment, mots people respond very well. I know how hard it must have been for you and your family. But, as I said in mys last response, just de-focus from your symptoms. Accept that you have this problem. The more you resist it, more will it bother you. Start treatment earnestly and maintain a healthy life style. I am pretty sure you will do wonderfully well.
I do hope that I was able to offer at least some help. Please let me know if you have any more doubts/queries. I will try my best to help you out with them. In case, you decide to close the discussion, please do rate the answer.
Wishing you a very speedy recovery,
Dr. Sunil Gupta
Please see details below
Detailed Answer:
Dear XXXXXXX
Thanks for following up and updating me with further information.
It is very much possible for such symptoms to start suddenly. In fact, most cases associated with panic attacks do start out of nowhere. It is not related to any specific financial or emotional issue. We just have to accept it and do the best to get rid of it as soon as possible.
I saw the MRI report and I do feel that it may be completely insignificant. As you said, probably your MS specialist did not give any further explanation because she felt they were insignificant. I understand that one becomes concerned looking at 12 lesions but that is possible.
Regarding medications, any of them should not be discontinued abruptly, and if done it will definitely cause increased symptoms. I can understand when you say that you don't want to try another SSRI. But every SSRI has a different effect for that matter and can be tried. Cymbalta is also an effective agent. If you already have a prescription, you can definitely try it (my first choices will still be SSRIs and venlafaxine). You have to remember that any of these agents will take time to show response. So, you will have to be patient about the same. More so, some symptoms that you consider "side effects" can be very well be due to anxiety itself.
With adequate and proper treatment, mots people respond very well. I know how hard it must have been for you and your family. But, as I said in mys last response, just de-focus from your symptoms. Accept that you have this problem. The more you resist it, more will it bother you. Start treatment earnestly and maintain a healthy life style. I am pretty sure you will do wonderfully well.
I do hope that I was able to offer at least some help. Please let me know if you have any more doubts/queries. I will try my best to help you out with them. In case, you decide to close the discussion, please do rate the answer.
Wishing you a very speedy recovery,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I truly thank you for your response.
You have helped me realize that perhaps I have spent 10 months making this anxiety worse by focusing too much on finding the reason and a cure. Maybe, as you say, it really is all just anxiety and I need to find a way to cope with it until I can hopefully recover fully. I will speak with my doctor about another SSRI. One last question please. Is there any natural ways I could work towards a recovery? Or would you definitely see the need to prescribe the SSRI?
Thanks again Dr XXXXXXX I have found this discussion very helpful and would rate you highly.
XXXX
You have helped me realize that perhaps I have spent 10 months making this anxiety worse by focusing too much on finding the reason and a cure. Maybe, as you say, it really is all just anxiety and I need to find a way to cope with it until I can hopefully recover fully. I will speak with my doctor about another SSRI. One last question please. Is there any natural ways I could work towards a recovery? Or would you definitely see the need to prescribe the SSRI?
Thanks again Dr XXXXXXX I have found this discussion very helpful and would rate you highly.
XXXX
Brief Answer:
Medications should be part of Rx at this stage
Detailed Answer:
Dear XXXXXXX
Thanks for you kind words of appreciation. I am glad to note that you have decided to work on finding a solution to anxiety rather than focusing on the cause and symptoms. That's a great 1st step.
Regarding natural ways, you can opt for psychotherapy. But, you have been already tried CBT. You can plan for restarting it though. Currently, I feel the symptoms severity is too high to be taken care of without medications. So, it will benefit to initiate medications. I would actually consider using both, medications as well as CBT simultaneously so as to maximize the response. Both together woks in a complementary way.
You can also help you cause by maintaining a healthy life style:
>> daily exercise (simple jogging can do wonders)
>> regular sleep wake cycle
>> avoid caffeine/ alcohol/ tobacco in any form and in any amount
>> balanced diet
>> give yourself some relaxation time daily; can include simple things like listening to music, spending time with children and taking them to park, etc.
>> ventilate your emotions rather than holding on to them
Just be patient and work on the solution. You will be really fine and do wonderfully well. I will be there whenever you fell you need help. You can contact me at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
Wishing you a great and healthy life ahead,
Dr. Sunil Gupta
Medications should be part of Rx at this stage
Detailed Answer:
Dear XXXXXXX
Thanks for you kind words of appreciation. I am glad to note that you have decided to work on finding a solution to anxiety rather than focusing on the cause and symptoms. That's a great 1st step.
Regarding natural ways, you can opt for psychotherapy. But, you have been already tried CBT. You can plan for restarting it though. Currently, I feel the symptoms severity is too high to be taken care of without medications. So, it will benefit to initiate medications. I would actually consider using both, medications as well as CBT simultaneously so as to maximize the response. Both together woks in a complementary way.
You can also help you cause by maintaining a healthy life style:
>> daily exercise (simple jogging can do wonders)
>> regular sleep wake cycle
>> avoid caffeine/ alcohol/ tobacco in any form and in any amount
>> balanced diet
>> give yourself some relaxation time daily; can include simple things like listening to music, spending time with children and taking them to park, etc.
>> ventilate your emotions rather than holding on to them
Just be patient and work on the solution. You will be really fine and do wonderfully well. I will be there whenever you fell you need help. You can contact me at:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657
Wishing you a great and healthy life ahead,
Dr. Sunil Gupta
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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