HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

Suggest Treatment For Anxiety And Panic Disorder

default
Posted on Fri, 31 Oct 2014
Question: Im in an extreme panic that i have a bald spot where i part my hair in the front and cant calm down. I have no health issues other than anxiety disorder. Should i see a dr???? Its causing major panic attacks and while everyone says im fine they are getting mad at me because i wont stop asking them
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
counseling session by a psychiatrist may be needed

Detailed Answer:
Hi XXXXXXX

Thanks for writing to us.

I read your current as well as previous questions. I saw your pic also.
From narration it seems that you are much over concerned regarding a minor unimportant thing.

Yes, being a young lady you should be concerned regarding your look.But here a tiny bald spot(according to me it is normal) is bothering you, which is not at all of concern from medical point of view.

You have mentioned that you have anxiety disorder. I would like to know from your side,"Is it due to this concern or is it already there before?, If yes, are you taking any treatment in form of pharmacotherapy and/or psychotherapy?"

If you have anxiety disorder already before this, current problem/symptom is just a part of anxiety disorder and you can ask your treating doctor to help you for this by counseling or medicine.

If your anxiety disorder is only due to this current concern and it is not affecting your daily schedule, routine work or social life, it can be relieved by just reading this answer of assurance that you do not have any major problem or just after detail counselling session by a psychiatrist whom you need to consult.

However if this problem is bothering you much and affecting your personal life, I would like to put some differential diagnosis in likely ore first in order.

1. Obsessive Compulsive Disorder: Obsession of having bald spot and compulsion to ask everyone about that.
2. Body dysmorphic Disorder: Persistent unnecessary concern about defect or abnormality in body part or look.
3.Hypochondriasis: constant feeling of having something wrong in the body and treatment of which is not done as doctors are not able to find the cause.

Exact diagnosis can be done after detail history and mental status examination only. In that case also you need consultation of psychiatrist.

Waiting for your reply to help you further,

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Chintan Solanki (1 hour later)
Hi. I am currently on 10mg prozac and 1mg klonopin for anxiety and ocd. I was doing well until my brother got cancer. Im scheduling more frequent appts with my psych dr but currently am just stuck on thinking my stress has caused bald spots. I just want to know im okay and not balding
doctor
Answered by Dr. Chintan Solanki (4 hours later)
Brief Answer:
You are not balding at all

Detailed Answer:
Hi young lady,

Thanks for detail for the medicines.

Stress causes hair loss but not balding like spot, it will be like scattered hair loss and density will decrease. However this stress induced hair loss is completely reversible as soon as stress relieved.

From your photograph I can say you have sufficient hair.Hair density depends upon genetic pattern,hormonal changes,diet and lifestyle. Worrying about that tiny spot make your self more anxious which can cause some stress induce hair loss.So try to relax your self that you do not have any balding pattern.Your current hair loss is normal according to pattern of hair cycle.

Medicines you are taking are good for anxiety disorders.If your thoughts about balding more and you do not have control over it, you can ask your psychiatrist to give klonopin 0.25 mg round clock three times a day temporary for reducing anxiety and excessive thoughts.

In counseling for anxiety disorder, Cognitive Behavior Therapy(CBT) is extremely useful.You can ask your therapist to start with that.In which you should try to following.Stop asking others about your concern.Whenever thought of balding comes in to mind, just assure yourself that," I have consulted doctor online and he had told that there is nothing like baldness there and I am completely ok." By repeatedly responding to your negative thoughts in this positive manner, you are actively facing them and gradually its frequency will be reduced and will stop ultimately.

Continue healthy diet including milk,eggs, vegetables, fruits and coconut water.Make your sleep and exercise schedule regular.This will help you to remain stress free and by that also improving hair density than current status.

Hope this answer would help you, I will be glad if any query is still there.

regards,
Dr.Chintan Solanki.


Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
default
Follow up: Dr. Chintan Solanki (10 hours later)
Thank you for your help. I plan on talking to my therapist as my worrying about this is taking over every minute of my life. Last night i started comoaring the part in ny hair to other puctures to see if its widening. Im not allowed to exercise or do much as i am recovering from a broken foot and my job made cuts so i am not working. I only have time to sit and worry. I dont want to stress myself into hair loss .
doctor
Answered by Dr. Chintan Solanki (8 hours later)
Brief Answer:
Read books or solve puzzles, rozac 20

Detailed Answer:
Hello,

You are not able to go to job that is an important factor.lack of thinking of other activities allows negative thoughts to come out more frequently and you are also giving push to those thoughts by checking persistently. I guess you are now case of OCD in this regard.

CBT would sure help. As your thought has increased , dose of prozac is needed to be increased to 20 mg. In OCD up to mg prozac is needed.
Current stress factor is foot injury and not able to do the job.To tackle that you can read books, solve puzzles-sudoku which will keep your brain working and frequency of negative thought regarding your baldness decreased.I recommend one book "Feeling Good" by XXXXXXX Burn, it is book for depression and anxiety treatment and includes part of CBT also.

So try to be active mentally though not physically and not allow yourself to sit and worry as much as you can.

All the best and Regards,I will be glad to answer if still any confusion.

Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Chintan Solanki (2 hours later)
Hi. Sorry for being so annoying, this is embarassing that ive become a crazy person. I have spent time doing crossword puzzles and crafts. During that time i am distracted. I am however as you may have seen before really worried about my eyebrows and having allopecia. I seem to be looking at every eyebrow i see .
doctor
Answered by Dr. Chintan Solanki (59 minutes later)
Brief Answer:
Avoid checking and try to resist as much possible

Detailed Answer:
Hello Dear,

You are not at all annoying to me. I have seen many patients with such type of complaints. It is my duty to listen you non judgmentally, carefully and patiently.
You can ask me thousand times and I will reply as calmly as I replied in first answer.

Your thoughts of concern about alopecia are obsessions and to check details of eyebrows ,scalp are compulsions. Your OCD seems to be without insight, means your mind is not able to believe that your obsessions are wrong,intrusive and illogical.
Until you keep doing compulsive act of checking hairs , your negative thoughts of alopecia will continue and may increase in frequency.Though you have been distracted during doing puzzles, you must continue efforts to do that, as initially it is difficult but after repeating efforts your mind will be distracted form baldness thoughts.
One think you can do right now: take klonopin 0.25 mg(1/4th of your 1 mg) three times a day, until you can see your doctor in personal. It will reduce your anxiety and thoughts to some degree, however with 0.25 if you are not satisfied you can go for 0.5 three times though it can cause some sedation.

Try to avoid seeing of eyebrow of others as much as you can. Though it is not needed but I think consultation with dermatologist once will be helpful.Discuss about our talk to dermatologist and assurance form dermatologist will clear your all doubts.

You are always welcome for your queries.Never hesitate to ask. I will be happy to help you further.

Wish you early stability,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Chintan Solanki (2 days later)
Hi. Sorry to bother you again. My dr cant see me til next week but said take 80mg of prozac and no klonopin. The prozac jump is making me sick. I nade a dermatologist appt to just calm myself but feel like my eyebrows are getting worse. My husband got so mad he left for a few days and thats my worst nightmare. Can i drop the prozac dose a bit? Ive attached new photos too do yoy see a wosening?? Im so scared
doctor
Answered by Dr. Chintan Solanki (4 hours later)
Brief Answer:
Yes you can reduce prozac, Eyebrow seems normal

Detailed Answer:
Hi dear,

No sorry please.You are always welcome.

In OCD maximum dose of prozac is 80 mg. It is not good to jump to 80 from 10 in short period.It is going to cause uncomfortable side effects as you feel.
In My patients, I generally increase the dose gradually, depending upon severity and response, 20 mg every week to 15 days.

As you were already on 10 mg,each day you can increase 10 mg and reach up to 40 mg and wait for 10 days at least to see effects. if you do not find any change, increment in the dose will be needed.
In my opinion you should continue klonopin as I mentioned before for early symptomatic relief.

Yes I have seen your latest photo.I compared it with previous photos.I did not find any significant difference in between them means not worsening.
Your concern is more about later(outer) side of eyebrow hair. But in my opinion it is normal.Yes hair density is lower than that of medial(inner) side, but that is normal variant.Please send me old(which you feel normal) clear pic to check and opine. otherwise your dermatologist will going to assure you.

Hope I have answered satisfactorily,I will be glad to answer more

Regards,

Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Chintan Solanki (26 minutes later)
Hi thanks for the med advice. I have attached 2 photos where i thibk they look normal, keeping in mind i was not before taking close ups of my brows like you have seen. I have a friend thats in med school and said even though all my thyroid tests were normal i could still be hypothyroid or have a problem absorbing vitamin a or d. This scared me as i didbt have an eyebrow worry when i had thyroid tests. The worry appeared after and i do now know outer brow hair loss is a symptom and am worried my thyroid went bad since the tests in august. My worries are exausting
doctor
Answered by Dr. Chintan Solanki (25 minutes later)
Brief Answer:
Just relax, problem is not significant

Detailed Answer:
Hello XXXXXXX

Thanks for pics. I still believe that there is no significant hair loss from eyebrows that it can be called pathological. In most of the people lateral side eyebrow hair density is less always than that of medial.

Please send your thyroid tests results to check as I could not get clear idea from narration. And remember that hair loss from eyebrow is not the only symptom of hypothyroidism.There will be lethargy,weight gain,constipation etc.

I think due to your anxiety your calorie burnt in thoughts which causes relative nutritional deficiency which ultimately results in stress related hair loss. I suggest to take vitamin and mineral supplement particularity Vitamin B12, Vit D and zinc and magnesium.
Take milk, eggs , high protein diet including pulses specifically soyabin as well as fruits and vegetables.

One normal reason for hair loss is hormonal disturbance.If your menstrual cycles regular, that factor is also ruled out.

I again assure you that , I don't think you have significant pathological hair loss.

Relax and take care.
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
default
Follow up: Dr. Chintan Solanki (35 minutes later)
Hi. I know my tsh was 2.4 (it had been 3.2 in february as i was complaining of difficult wait loss and increased ibs constipation) my T4 was "normal" (dont know the number) and my thyroid antibody test was negative. My constpation from ibs flares up during anxiety periods and is usually fixed quickly with fiber, no dairy and a probiotic. Im also allergic to soy. I have been on the same birth cobtrol pills for 12 years ans no problems there. I DID have a hair panic in 2010 where i went to an endicrinologist and was told i was fine, and was. No eyebrow worries though. The eyebrows are itchy but its so hard to tell if thats just psychosomatic and i dont want to touch them and have anything come out. Even the idea of washing ny face when i wake up tomorrow is scaring me since im afraid of what will happen. I will get no sleep over this until i see im ok
doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
Klonopin will help,Dermatoogist assurance needed

Detailed Answer:
Hi dear,

I can understand your pain and anxiety. But again I would like to mention that you are not in problem. Your thyroid seems to be normal. No hormonal disturbance is there. So only reason is psychosomatic concern.

Please take klonopin as soon as possible to relieve anxiety. 1 to 2 mg of klonopin will help in sleep. You must sleep otherwise your anxiety fetuses will worsen.

Try to avoid see your face and looking at eyebrow and try to say yourself repeatedly,"Amanda you are normal just relax". Do not touch eyebrow.

Have you consulted dermatologist or not? If not just take one seating and find out what is there! Dermatologist assurance will be final. After that we can go for psychosomatic approach if not relieved.

All the best, try to relax your self by deep breathing, medication or soft music.
Feel free to ask if any query is still there.
Regards,
Dr.Chinatn Solanki.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
default
Follow up: Dr. Chintan Solanki (5 hours later)
Thank you. I was able to get a dermatology appointment at the end of the month. I think that will calm me down. I also have a hair cut appt on friday and my hair stylist can probabky calm me also
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
Good. Continue your efforts as discussed

Detailed Answer:
Hello

In this last question you seems to be sound good. I guess if you revise our discussion frequently and try to follow Do's and Don't, you will be relieved much before the appointments.

And yes ask your hair stylist to set hair in the way which look like dense, otherwise you will go into thinking.

Wish you early stability,

Take care.

Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
default
Follow up: Dr. Chintan Solanki (15 hours later)
Hi. I did better anxiety wise today with the klonopin and because i had to focus on a horrible cold and asthms flare up i have come down with. I havent touched or really looked at my brows all day. I didnt ask anyone either. Until now. As i cant sleep from my cold symtoms ans was working on a photo
Project for my sister i found a pic where i feel like mt brows are morw rounded (maybe its just me, photo is attached) and this totally set me off to seeing my brows now as just short lines and that i have lost TONS of area since the photo in 2012 (im on the left in the photo with the white sash ). Sorry i just cant ask my husband to look at the pic. He is at the end of his rope with me
doctor
Answered by Dr. Chintan Solanki (9 hours later)
Brief Answer:
Good going,keep it up, photo is not there

Detailed Answer:
Hello Dear,

Sorry for delayed response.

Thanks for following suggestions. Klonopin will help for sure.

It is really good that you have controlled your urge to see eyebrow though whatever the way. Just keep continue trying to avoid seeing at eyebrow and thinking about it.try to make yourself busy with some stuff as you have done with that project.If you can do it for a week or so, you will not need much medicines.

I can not find any recent photo with white sash in attachment, so I can't comment on that. Please try to re attach the same.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
default
Follow up: Dr. Chintan Solanki (3 hours later)
I hope it attached. Im on the left.
doctor
Answered by Dr. Chintan Solanki (9 minutes later)
Brief Answer:
not much diffrence with current status

Detailed Answer:
Hi XXXXXXX

Yes pic is there with beautiful smile.It is difficult to judge about comparison with current pic in photographs.Someone can give the best opinion by seeing personal. However I found little bit difference that is of no significant. Just relax and try to follow suggestions from our discussion and become stable soon.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
default
Follow up: Dr. Chintan Solanki (29 hours later)
Hi. Sorry again. My therapy session was moved to tuesday so hopefully that will get here soon. In the mean time i have been sick now with bronchits and bad asthma but instead of worrying tons about that i am still stuck on my hair. I washed my hair today after not washing it or combing/messing with it since tuesday from being sick and i was counting over 100 hairs and really panicking. Do you think it could be from just not washing out the hair i normally would daily? My husband got frustrated and left for the weekend so im pretty upset about that too. I dont mean to annoy him im just scared :(
doctor
Answered by Dr. Chintan Solanki (2 hours later)
Brief Answer:
It is totally normal

Detailed Answer:
Hi XXXXXXX

Please do not say sorry.

Our hair grow in cyclic stages. During telophase it is normal to have fall of hair.5 to 10% of total hair normally in this stage at a time in an individual,so this much hair fall after wash is quite normal and happens in most of the people.Because of not able to wash for few days make its quantity more otherwise its quite ok. So relax and try to enjoy weekend.

Take care,

Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Chintan Solanki (4 hours later)
Hi. I am afraid that my stress is ruining me. My husband returned but is not being nice and tonight i saw the yellow thin crusty scales in my eyebrow. I tried to loosen it so it wasnt visible but several eyebrow hairs came out and im just falling apart. I feel like anything else i could hide but if i lose my eyebrows i cant just draw them on. Plus i may end up alone. Im scared, sad, and more than overwhelmed
doctor
Answered by Dr. Chintan Solanki (12 hours later)
Brief Answer:
take klonopin 0.5 mg three times a day

Detailed Answer:
Hi XXXXXXX

Sorry for delayed reply.
I can understand your pain and anxiety.Your husband is not understanding that is also drawback.
You will not lose your eyebrow , just relax. Until you see dermatologist, take klonopin 0.5 mg three times a day to fight with anxiety features. you can take 1 mg at night if sleep disturbance is there with 0.5 mg.
And in next appointment with psychiatrist ask your husband to come also for counseling and make him understand about you so he can understand your situation and support you.

Regards,
Dr Chintan Solanki.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
Dr.
Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest Treatment For Anxiety And Panic Disorder

Brief Answer: counseling session by a psychiatrist may be needed Detailed Answer: Hi XXXXXXX Thanks for writing to us. I read your current as well as previous questions. I saw your pic also. From narration it seems that you are much over concerned regarding a minor unimportant thing. Yes, being a young lady you should be concerned regarding your look.But here a tiny bald spot(according to me it is normal) is bothering you, which is not at all of concern from medical point of view. You have mentioned that you have anxiety disorder. I would like to know from your side,"Is it due to this concern or is it already there before?, If yes, are you taking any treatment in form of pharmacotherapy and/or psychotherapy?" If you have anxiety disorder already before this, current problem/symptom is just a part of anxiety disorder and you can ask your treating doctor to help you for this by counseling or medicine. If your anxiety disorder is only due to this current concern and it is not affecting your daily schedule, routine work or social life, it can be relieved by just reading this answer of assurance that you do not have any major problem or just after detail counselling session by a psychiatrist whom you need to consult. However if this problem is bothering you much and affecting your personal life, I would like to put some differential diagnosis in likely ore first in order. 1. Obsessive Compulsive Disorder: Obsession of having bald spot and compulsion to ask everyone about that. 2. Body dysmorphic Disorder: Persistent unnecessary concern about defect or abnormality in body part or look. 3.Hypochondriasis: constant feeling of having something wrong in the body and treatment of which is not done as doctors are not able to find the cause. Exact diagnosis can be done after detail history and mental status examination only. In that case also you need consultation of psychiatrist. Waiting for your reply to help you further, Regards, Dr.Chintan Solanki.