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Anxiety attacks and depression - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Depression
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   Hi
Doctor :  
How can I help you?
User :   hello sir
Doctor :  
Yes
User :   i am a 30 year old male with hypertension and anxiety problem
User :   i am on fluoxetine 60 mg since 2002 and telma R since 2007
User :   i am also trika 0.5 mg and statins for cholestrol level which were high
Doctor :  
Please give me a minute
User :   u there
User :   hello sir
Doctor :  
I am really sorry
Doctor :  
I had an urgent call
Doctor :  
Please proceed
Doctor :  
I am here to help you now
User :   yaa should i copy paste my whole problem
Doctor :  
No need
Doctor :  
you can continue
User :   to help you need understand better
Doctor :  
I went through all the chat about the medicines
Doctor :  
Yes
User :   ok
Doctor :  
If it is descriptive
Doctor :  
it makes me easy
Doctor :  
you can copy past and I shall read it
User :   I am 30 years old male.I am on fluoxetine 60 mg since 2002 for my depression and anxiety condition.I started on alprazolam 0.5 mg since 2007.I am on BP medicines Telmisartan 40 mg + ramipril 5mg since 2007 as my BP was 150/90 and now it remains 125/80.I am on cholestrol lowering drugs lipitpe 10 mg as my triglycerides numbers were high 330.I am on levothyroxine since 2005 as my TSH was slightly elevated i am on 25 mcg..In 2007 i withdrew drug fluoxetine and one night i experinces terrible symptoms like chest pain and burn lightheadedness,feeling of dread and nervousness,tingling and numbness in hands and feet..I experienced similar symptoms 2-3 times after that.After that there is a continuous feeling of tingling in hands and feet especially at night while trying to sleep,chest discomfort,slight lightheadedness,inner shaking and trembling and some time very slow reflexes with anxiety and dreaded thoughts.I underwent all blood tests including Ultrasound,blood tests for thyroid,LFT,KFT,hemogram,lipid profile,echo TMT all were XXXXXXXXl except triglycerides which were high for which i am on medication.My BP is well controlled and so is thyroid.My depression is also controlled. I am not able to understand these vague symptoms.
User :   sir have u gone through?
Doctor :  
Ok
Doctor :  
Yes
Doctor :  
I have gone through
User :   kindly suggest
User :   what should be done
Doctor :  
You mean you had similar complaints thrice in total
Doctor :  
since 2007
Doctor :  
and that too after withdrawl of the fluoxetine
User :   i guess those were panic attacks 3 times but i have these mild symptoms everyday
User :   like persistent
User :   shaking and trembling
Doctor :  
ok
User :   inner body shaking
User :   lightheadedness
User :   chest discomfort and painful spasms in chest for few seconds
User :   and sudden numbness in feet and hands
Doctor :   Ok

User :   with tingling, palpitations are also there like my heart is beating in my head
User :   kindly suggest what is the problem>
Doctor :  
DId you take the consent from your Doctor before stopping the Fluoxetine
User :   no
Doctor :  
Is it done gradually by lowering the dose?
User :   but i am again on fluoxetine since 2007 end
Doctor :  
over a period of year
User :   no abrupt cessation
Doctor :  
Ok,
User :   but symptoms are still persisting
Doctor :  
Are you aware of that Fluoxetine causes withdrawl effects if stopped suddenly
Doctor :  
and without an expert opinion
User :   yes but i started taking it again from 2007
User :   and still on 60 mg
Doctor :  
yes but it takes time to get that desired plasma concentration of fluoxetine inthe blood
User :   but symptoms are still persisting
Doctor :  
If you start on Fluoxetine with the same dose it may not work
User :   its been 2 years now
User :   on 60 mg
User :   what should be done
Doctor :  
It is not acheiving the desired concentration you need to keep the symptoms away
User :   so on how much dose
User :   i should go
Doctor :  
You may need either a higher dose or a different class of antidepressants al togehter
User :   Are my BP and cholestrol medicines fine
Doctor :   Yes they are fine
User :   what drugs of antidepressants i should go for?
Doctor :  
You should know that the BP and cholesterol medicines might interact with the Fluoxetine and can nullify its effect
User :   ok
User :   then what should be done
Doctor :  
Hence you need an immediate review of entire medication from both the treating doctors ( General Physician and Psychiatrist )who can analyse the problem and try to get you proper regimen
Doctor :  
which shall help you
Doctor :   Moreover the antidepressants might need to be started from scratch too.
User :   means a lower dose
User :   or diffrent class
Doctor :  
So it again takes sometime for the Doctor to acheive the proper dosing to keep your symptoms away
Doctor :  
So you have to be little patient
User :   what are the basic reasons of these symptoms?
Doctor :  
and keep following with the Doctor and inform the same thing to your General Physician who has give you BP and Cholesterol medications
User :   are these symptoms of anxiety
Doctor :  
You never had to stop the Fluoxetine that is a mistake you should not have done.
User :   i never knew the possible withdrawl effects
Doctor :   I may be bit frank here but I am trying to explain you that the most common reasons is not following the proper follow up
User :   ok
Doctor :  
So do not be worried
User :   kindly give me a frank feedback
Doctor :  
You will set right with soon
User :   i will be obliged
Doctor :   Yes
User :   doctor are these symptoms of anxiety?
User :   because trika helps me getting relieved of these symptoms
Doctor :   Look they seem to be symptoms of anxiety but I cannot rule out the possibility of low dose of fluoxetine
Doctor :  
Yes for instant relief Doctors prescribe Trika, kind of drugs
User :   doc told me 60 mg is a high dose
Doctor :  
but you should not take a single dose extra or short of the dose without the knowledge of Doctor
User :   and u cant give more than 80 mg a day
Doctor :  
Yes but he can change to the other classes
Doctor :  
depending on the other medicines and the side effects you complain
User :   why i am experiencing chest discomfort
Doctor :  
Anxiety is one of the causes of chest discomfort
User :   and palpitaions along with inner body shaking and trembling
Doctor :  
Yes
User :   do u think there can be a heart problem?
Doctor :  
If the ECG is XXXXXXXXl you can fairly rule out
User :   TMT is also XXXXXXXXl
Doctor :   yes
User :   but can u catch all cases of CAD by TMT
Doctor :  
Most cases
Doctor :  
There is ECHO too
Doctor :  
which can help the Doctor
User :   i also want to know my echo showed mild LVH
Doctor :  
Are you seeing a General Physician
User :   doc says there is no problem with it
Doctor :  
Mild LVH is because of the High BP
User :   and i am ramipril for that
Doctor :  
Yes
User :   is it dangerous LVH?
Doctor :  
Mild LVH is not dangerous
User :   can it be corrected?
Doctor :  
If the BP is not controlled properly it can increse the swelling of the heart
Doctor :  
LVH once formed cannot get back completely
User :   BP is controlled at 124/84
Doctor :  
only thing is to put the BP under control
User :   can i get heart attack due to this?
Doctor :   It should get back to less than 120 / 80

User :   what should be done for LVH?
Doctor :  
The anxiety increases the BP and more anxious you are the more BP and more LVH and chances of heart problem
Doctor :  
Exercise is the common treatment both for BP and Anxiety
User :   ok
Doctor :  
Few medications are also common treatment which you are already taking
User :   in short term is there any danger of LVH
Doctor :  
Not really
User :   should i go for angiography
User :   what do u suggest?
Doctor :  
See the more important problem now is because of your anxiety and not heart problem
User :   ok
Doctor :  
So you have reduce the anxiety with medicines and behavioural therapy
User :   ok
Doctor :  
You do not need to worry about the heart problem
Doctor :  
I am sure you are more worried about the heart changes
User :   doc i have high BP and high triglycerides
User :   and also LVH
User :   that is why i am worrying
Doctor :  
Believe me High BP is a risk factor for heart disease but you are missing that anxiety is increasing the riks
Doctor :  
Triglycerides increase in many situtations
User :   what do u suggest is the best possible treatment option?
Doctor :  
So Total Cholesterol, LDL CHOL and HDL CHOL are more important
User :   they are XXXXXXXXl
User :   except triglycerides
Doctor :  
They you should not worry about the lipid profile
User :   ok
Doctor :  
Concentrate only on reducing the BP and the anxiety
User :   what are the best antianxiety drugs
Doctor :  
This can be done with Exercise, Relaxation therapy and Regular use of medicines
User :   should i continue on trika?
User :   it helps a lot
Doctor :  
Medicines are importnat but Exercise and the Relaxation therapy are important that medicines
User :   ok
Doctor :  
So you need Psychiatrist, Psychologist and General Physician follow ups
User :   i also want to know one more thing doctor
User :   in 2007 i had 4 pegs of vodka and then i had a walk for about 2-3 kinlometres then suddenly i was waiting for a bus and i started feeling that blood is rushing throughtout my body and my legs and feet were numb
User :   i sat down i fainted for about 15 seconds or so
User :   then i regained consciouness and my heart was beating faster
User :   this i have experienced only once
Doctor :  
Look alcohol is completely not suited for you if you are on antidepressants and anti anxiety drugs
User :   so y i experienced this kind of episode
Doctor :  
It is a drop attack
User :   is it common?
Doctor :  
which happens after consumption of alcohol
User :   ok
User :   could it be XXXXXXXX?
Doctor :  
might be
User :   so what do u suggest?
Doctor :  
same as said above
Doctor :  
DO not worry about the drop episode
Doctor :  
What is important now?
User :   but if it is XXXXXXXX,then i may experience stroke!
User :   shortly
Doctor :   Not necessary
User :   so what should be done at the best
Doctor :  
The best way is to get back to your Doctors and say what happned and get a fresh answers from them
Doctor :  
and be a communicator btween them
User :   sir i want to know the area you specialize in?
Doctor :  
or ask them to communicate between themselfve
Doctor :  
I am a General Practioner
User :   MD in which area sir?
Doctor :   Family Medicine
User :   so now should i go to physician
Doctor :   Yes and then ask him to the best Psychiatrist whom he can speak to over phone regarding your case
Doctor :  
and there is a constant follow up with him
User :   doc do u think it can be really a transient ischmeic attack?
Doctor :  
I am not sure
Doctor :  
but might be
User :   how can we diagnose that?
Doctor :  
There are really several reasons to attacks like those
User :   now as it happened in 2007
Doctor :   IT cannot be diagnosed
User :   what are the other reasons
User :   for this kind of experience
User :   besides XXXXXXXX?
Doctor :  
Alcohol intoxication, Nutritional deficiency,Dizziness, Seizure attack
Doctor :  
are few I could think of now
User :   can it be also reaction between medicines and alcohol or drug interactions?
Doctor :  
I do not see a major relevance now
User :   what does major relevance mean?
Doctor :  
Importance
User :   you said that you dont see a major relevance
User :   what does it mean exactly

Doctor :  
For the treatment current problem of symptoms this not much of significance to
Doctor :   this
User :   hello sir
User :   u there
User :   hello
User :   i am back any respected doctors over there
User :   hello
User :   Dr XXXXXXXX u there
User :   hello
Doctor :  
Hi
Doctor :  
I am sorry
Doctor :  
I was on a different call
User :   hi
User :   r u doc XXXXXXXX
Doctor :  
Go ahead
Doctor :  
Yes please go ahead
User :   r u aware of my problems
User :   coz earlier i was chatting to another doc i guess
Doctor :   Yes
Doctor :  
I have gone through the chat
User :   ok
User :   doctor should i be worried about that drop attack episode
Doctor :  
I think the problem now is about your current symptoms
User :   should i undergo carotid angiography?for current problems i will go to my GP
User :   i am young
User :   tht
User :   at is why i am worried
User :   or it might only be a drop attack
Doctor :  
You do not need one I suppose
Doctor :  
because it was a transient episode
Doctor :  
and it was not repeated again
User :   yes it was nearly 3 years ago
Doctor :  
and more over there are no other risk factors which suggest for an indication of carotid angio
User :   but i have high BP and triglycerides for which i am on medications
User :   can it be a hypoglycemic attack also or vasovagal syncope
Doctor :  
Can I say you one thing
User :   yes
Doctor :  
It is this anxiety that is making things worse for you
Doctor :  
You should not worry about the past episode of the drop attack
User :   doc actually i am young and recently married
User :   that is y i am woried
Doctor :  
I understand all of your situation and giving you the right suggestion
Doctor :  
You should not worry about the past attack at all
User :   can i ask you one question
Doctor :  
Concentrate on lessening your anxiety
Doctor :  
Yes please go ahead
Doctor :  
The major problem for you is anxiety and not adhering to the medication
User :   what can be the most possible cause of my drop attack according to your experience?
Doctor :   I can possibly say the cause but not really sure
User :   please say the possible cause
Doctor :  
syncopal attacl
User :   vasovagal that is
User :   i guess
Doctor :  
It is frequently associated with a precipitating circumstance, such as intense pain, emotion (eg, fear)
User :   coz it was after taking alcohol and i experienced sudden rush of blood
User :   in hands leg and head
User :   and sudden fainting
User :   for 15 seconds or so
Doctor :  
yes vasovagal is also a reason
User :   and then faster heart beat
User :   ok
User :   so doc what do u suggest best for me
User :   in current situation
Doctor :  
The best that I can suggest you in current situation is managing your anxiety
User :   ok
User :   i am on trika
User :   0.5 mg
User :   and fluoxetine 60 mg
Doctor :   For which you need counselling by the Psychiatrist and some medicines like trika and antidepressants are useful
User :   telmisartan 40 mg and ramipril 5 mg
User :   and lipitor 40 mg
Doctor :  
I hve seen the chat history and I know you are taking these
User :   ok
Doctor :  
Which city are you in?
User :   NEW DELHI
User :   do u run a clinic
Doctor :  
I do not in New Delhi
Doctor :  
I am based in Bangalore
User :   r u MD in mEDICINE
Doctor :  
If you want I shall refer you to a Good General physician and Psychiatrist in Delhi
Doctor :  
who can help you better
User :   please help me out
User :   in this
Doctor :  
Ok, which area do you stay in Delhi
User :   i stay in west delhi janakpuri
Doctor :  
Ok one of our CRM representatives shall get back to you with the details
Doctor :  
Please confirm the details
User :   doc which area you specialize in ?
Doctor :  
I am a specialist in preventive medicine
Doctor :  
YYYY@YYYY Mobile: 0000
User :   r u MD in preventive medicine?
Doctor :   Yes

User :   yes details are correct
Doctor :  
Till then shall I say some relaxation exercises
User :   doc i more thing i wanna ask you
User :   you said i dont have risk factors so i should not go for carotid angio
Doctor :  
Yes
User :   but i have high BP and high triglyceride number
User :   for which i am on medication
User :   so what are the other risk factors
Doctor :  
Smoking, age more than 50 yrs, recurrent episodes of stroke
User :   ok
User :   so my problem is more of a syncope
User :   rather than XXXXXXXX?
Doctor :  
Yes
User :   ok
Doctor :  
THere are many reasons for syncopal and XXXXXXXX is very uncommon reason
User :   kindly tell me relaxation exercise
User :   ok
Doctor :  
Ok some are breathing and some are muscle relaxatin
User :   doc can i remain in contact with you via e mail
Doctor :   I am sorry AAAAAAA I can only speak to you over chat as it is the company policy

User :   ok
Doctor :  
In relaxation technique, you focus on slowly tensing and then relaxing each muscle group.
User :   ok
Doctor :   This helps you focus on the difference between muscle tension and relaxation.
User :   do u run ur clinic
Doctor :   One method is to start by tensing and relaxing the muscles in your toes and progressively working your way up to your neck and head.
Doctor :   Now do it for two muscle groups while you are chatting with me.
User :   ok
Doctor :   Tense your muscles for at least five seconds and then relax for 30 seconds, and repeat.

User :   ok
User :   i will do them
User :   doc should i switch my antidepressant
User :   from fluoxetine
Doctor :   AAAAAAA you feel that every illness has to do with some medicines and some tests but that is wrong
User :   to some other
Doctor :  
You ailment needs more of behavioural therapy and relaxation techniques along with low dose pills
User :   doc in my previous chat doc told me that fluoxetine reacts with telma R
User :   and it nullify its effect
User :   that is why i am asking
User :   no other reason
Doctor :  
That might be very much true because most of the drugs that you take interact with one another
User :   so what can be done
User :   in this regard
Doctor :  
With the above may experience feelings of emotional discomfort
Doctor :   but it is transient
User :   ok
Doctor :  
You will certainly be benefitted
User :   i am taking these for more than 3 years now
Doctor :  
Ok
Doctor :  
The switching of drugs is better commented by the Doctor who is treating you
User :   and fluoxetine for more than 8 years
Doctor :  
and if there is a need he will do it
User :   ok
User :   does my LVH has to do sumthing with it
Doctor :  
LVH is very common finding in people with High BP
User :   so what is your best possible suggestion now for me?
Doctor :   Meet the Doctor and start with the relaxation techniques I mentioned
User :   ok
User :   can i take trika
Doctor :   It is an anxiolytic but should be taken only on a prescription

User :   it helps me
User :   a lot
Doctor :   Not requred for a long term
Doctor :  
Yes
Doctor :  
But not good to continue that for longer time
User :   taking 0.5 mg since 2008
Doctor :   Ok

Doctor :  
Have you been advised regarding the same?
User :   initially for short term
Doctor :   Ok
User :   but if i stop symptoms appear again
Doctor :  
Yes you have become dependant on that now
User :   should i continue on BP and cholestrol medicines?
Doctor :  
Hence you would be facing that
User :   what do u suggest
Doctor :  
Yes, you need to continue on that
User :   ok
User :   any dangers of LVH
User :   for me
User :   at present
Doctor :   You should not worry on that

User :   ok
User :   TMT was XXXXXXXX
Doctor :   That is fine
User :   any other test required
Doctor :  
TMT is a very good test
User :   ok
Doctor :   and it is quite enough for now

User :   ok
Doctor :   Is there any thing else I can help you with?

User :   so doc final suggestion for me
Doctor :   Try RELAXATION therapy
Doctor :  
That is most important at this stage
User :   what is ur name doc?
Doctor :  
Dr AAAAAAA
User :   thanks for wonderful advice.Nice talking to you.Have a gr8 day ahead...
Doctor :   Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.

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