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I Am Currently Diagnosed With Severe Anxiety And Depression .
Question: I am currently diagnosed with severe anxiety and depression. I have taken several antidepressants over the last 6 months (Paxil, Lexapro, Zoloft, and currently Prozac for four weeks). I have a head tremor right now that is very possibly psychogenic. I also pace erratically and shake my head myself for most of the day. Is this more likely due to side effects from SSRI's or anxiety/depression symptoms. Should I increase or decrease my Prozac dose (currently 20mg)?
I have read that there is impaired ability to make decisions for anxiety/depression but often times my decision-making ability is not just impaired, it is nearly incapacitated. I go back and forth on the same decision for hours when I never did when I was healthy a few months ago.
Are these considered normal presentations of anxiety/depression? I didn't know it was possible that the symptoms would have such a drastic presentation physically and cognitively. Both of the presentation are not even the slightest bit subtle.
If I am unsure if there if the issue is between SSRI side-effects and anxiety/depression symptoms, does it make sense to try a medication treatment that aren't SSRI's like Busiprone? Lorazapam does seem to help, but I know this is not a good long-term solution, plus I seem to get a rebound anxiety effect the next day when I try not to take it.
I have read that there is impaired ability to make decisions for anxiety/depression but often times my decision-making ability is not just impaired, it is nearly incapacitated. I go back and forth on the same decision for hours when I never did when I was healthy a few months ago.
Are these considered normal presentations of anxiety/depression? I didn't know it was possible that the symptoms would have such a drastic presentation physically and cognitively. Both of the presentation are not even the slightest bit subtle.
If I am unsure if there if the issue is between SSRI side-effects and anxiety/depression symptoms, does it make sense to try a medication treatment that aren't SSRI's like Busiprone? Lorazapam does seem to help, but I know this is not a good long-term solution, plus I seem to get a rebound anxiety effect the next day when I try not to take it.
Brief Answer:
Please provide following details
Detailed Answer:
Hello,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Before I proceed to answer you, it is requested to get following details.
1. Your age and gender
2. Current problems experienced by you and duration of each problem
3. Total duration of illness
4. Do you have similar experience in past ? If yes please provide details including treatment
5. Do you have family history of similar illness? If yes details of treatment as well as received diagnosis and symptoms
6. What was the response with other antidepressants? Reason for discontinuation
7. A short video demonstrating tremors as described above. This will help me to make sense of problem whether it is side effect of medication or due to anxiety.
I look forward to assist you.
Thanks again.
Please provide following details
Detailed Answer:
Hello,
Thanks for using Healthcaremagic.
I read your query and understand your concerns.
Before I proceed to answer you, it is requested to get following details.
1. Your age and gender
2. Current problems experienced by you and duration of each problem
3. Total duration of illness
4. Do you have similar experience in past ? If yes please provide details including treatment
5. Do you have family history of similar illness? If yes details of treatment as well as received diagnosis and symptoms
6. What was the response with other antidepressants? Reason for discontinuation
7. A short video demonstrating tremors as described above. This will help me to make sense of problem whether it is side effect of medication or due to anxiety.
I look forward to assist you.
Thanks again.
Above answer was peer-reviewed by :
Dr. Kampana
1. Your age and gender. 45 year old male.
2. Current problems experienced by you and duration of each problem.
Psychomotor agitation / restlessness / akathisia / erratic pacing and movement, lack of concentration, confusion, and inability to make decisions since end of January (three months).
Involuntary head tremors 1.5 months.
3. Total duration of illness
4. Do you have similar experience in past ? If yes please provide details including treatment.
I have had mild anxiety for years, but never anything this serious.
5. Do you have family history of similar illness? If yes details of treatment as well as received diagnosis and symptoms
Not really. My mom's twin sister had a nervous breakdown.
6. What was the response with other antidepressants? Reason for discontinuation
Lexapro gave me sexual side-effects. Paxil seemed to be giving me brain fog, but it could have just been anxiety/depression symptoms, Zoloft seemed to give me head tremors. Head tremors still continuing after I switched to Prozac.
7. A short video demonstrating tremors as described above. This will help me to make sense of problem whether it is side effect of medication or due to anxiety.
If I just try to relax and meditate the entire day, I can reduce all the restlessness, pacing, head tremors, psychogenic movements, but then I don't get anything done. What is priority right now? Relax or seek help to get better? If I do any real thinking, the pacing and head shaking will begin immediately.
2. Current problems experienced by you and duration of each problem.
Psychomotor agitation / restlessness / akathisia / erratic pacing and movement, lack of concentration, confusion, and inability to make decisions since end of January (three months).
Involuntary head tremors 1.5 months.
3. Total duration of illness
4. Do you have similar experience in past ? If yes please provide details including treatment.
I have had mild anxiety for years, but never anything this serious.
5. Do you have family history of similar illness? If yes details of treatment as well as received diagnosis and symptoms
Not really. My mom's twin sister had a nervous breakdown.
6. What was the response with other antidepressants? Reason for discontinuation
Lexapro gave me sexual side-effects. Paxil seemed to be giving me brain fog, but it could have just been anxiety/depression symptoms, Zoloft seemed to give me head tremors. Head tremors still continuing after I switched to Prozac.
7. A short video demonstrating tremors as described above. This will help me to make sense of problem whether it is side effect of medication or due to anxiety.
If I just try to relax and meditate the entire day, I can reduce all the restlessness, pacing, head tremors, psychogenic movements, but then I don't get anything done. What is priority right now? Relax or seek help to get better? If I do any real thinking, the pacing and head shaking will begin immediately.
Brief Answer:
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
With the available details I feel the inadequate response to medication is likely cause for head nodding/tremor rather than medication. Since the relaxing and meditation both helps you in this the possibility of medication causing it as side effect is almost ruled out. This is because meditation and relaxation help in anxiety but does not help in medication induced side effects.
Pacing/shaking head is generally by product of anxiety and it is likely to get help with antianxiety medications.
Although benzodiazepines have the strong side effects but considering the current symptom profile I feel one of them should be part of treatment for few weeks. Most cases need 3-4 weeks of benzodiazepines to control anxiety. Personally I feel low dose Ativan (1mg) on needed basis can be used after consulting your treating doctor. In regard to rebound effects they are likely to stay for few weeks till the Prozac or any other medication starts working to full extent.
Buspirone is one another option but it does not help in depression. In addition it takes time like other anti anxiety and anti depressant medications.
In case SSRI medication does not help I feel the SNRI medication can be used such as Pristiq.
I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Hello,
Thanks for follow up.
With the available details I feel the inadequate response to medication is likely cause for head nodding/tremor rather than medication. Since the relaxing and meditation both helps you in this the possibility of medication causing it as side effect is almost ruled out. This is because meditation and relaxation help in anxiety but does not help in medication induced side effects.
Pacing/shaking head is generally by product of anxiety and it is likely to get help with antianxiety medications.
Although benzodiazepines have the strong side effects but considering the current symptom profile I feel one of them should be part of treatment for few weeks. Most cases need 3-4 weeks of benzodiazepines to control anxiety. Personally I feel low dose Ativan (1mg) on needed basis can be used after consulting your treating doctor. In regard to rebound effects they are likely to stay for few weeks till the Prozac or any other medication starts working to full extent.
Buspirone is one another option but it does not help in depression. In addition it takes time like other anti anxiety and anti depressant medications.
In case SSRI medication does not help I feel the SNRI medication can be used such as Pristiq.
I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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