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Suggest Treatment For Panic Disorder

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Posted on Mon, 12 Oct 2015
Question: first off, I am 24 year old male, I have no pre existing medical conditions. I stay active, I have had zero stress or major life changes. I have never had ANY anxiety issues. my family has no history of anxiety or panic attacks. this may be a bit long, but I feel the events are prevalent to whatever is happening to me. 5 days ago I was sitting in a class I have to take (electrician apprenticeship program), watching a safety video. when out of no where I felt an immediate black out type feeling, my face tingling and throat almost had a swelling shut feeling. it was a difficult feeling to explain. I turned to the guy sitting next to me and said....I think I am having an allergic reaction to something, I asked him to go outside with me. once outside I went to one knee as the feeling intensified. then my heart started racing , I had control of my breathing, noting that I was not hyperventilating. the instructer came outside to investigate , told me that he has panic attacks and that is what this was. I was willing to accept this, confused as to why I would be having one though. I walked around a bit with someone next to me trying to get some fresh air, but the feeling only worsened. the aggressive and intense tingling was now in my hands and I had someone drive me to the emergency room. (in 24 yrs I have never set foot in one, I am not a hypochondriac type) once at the emergency room things got very intense. my lips and roof of my mouth where tingling so intensly I stated to panic. my entire arms and legs were shaking and very very ...well tingling, like a loss of feeling. I needed help getting to the room. once admitted my blood pressure was 183/90 something, oxygen was fine and heart rate was 77. again I never noticed any hyperventaliting. they kept telling me that's why I was feeling what I was, but I felt I always had proper oxygen exchange. anyway here was where something weird happened. while in this intense episode the cna took my blood pressure, and when the sleeve pumped up, my arm from the sleeve down felt an extreme pain, my fingers locked up 100 percent, and when the sleeve released I felt everything slowly go back to normal. almost simultaneous with the blood flow returning to my arm. I deffianlty wasn't fully feeling normal, I still felt dizzy, and had a little bit of trouble processing and speaking. although I was answering everything correct it was more the labor of talking that felt werid. they then gave me some atavan though iv. there took some blood, did a urine analysis and an ekg. I was not anemic, nor diabetic, ekg looked normal and urine was clean. they told me panic attack, gave me a script for 6, 1mg atavan in case I felt it happening again. I was unsure of the diagnosis because of how it came on and with no history of any such things but I am no doctor. so I went back to class after getting my script. I felt out of it but I figured it was the atavan. however hours later by the time the atavan should have worn off I still just felt off, like having no equilibrium. i never took any atavan that was given to me despite having this constant drunk like feeling. the whole next day there was several time where i would suddenly feel like i had to focus on breathing, like i would pass out if i didn't breath properly, quite a scary feeling. but i got through the day trying no to think about it. the morning after that while walking into the training center , right in the middle of a conversation with a friend, i had that same instant intense feeling like i was having some sort of a reaction, almost blacking out. knot in my throat and tingling face. i then took my first atavan immediately it never spiraled into a full episode like it had the last time. that afternoon i went to an express care clinic because this feeling had not gone away since the fist "attack", after telling my story and what i was feeling, i had peeked there interest and had two doctors in a room examining me. they re-took my blood and urine and everything was fine. all vitals as well, they were going to do a ct scan on my head but decided to give me anxiety medication and more atavan first, to try out for a week and if it never went away they would further investigate. they performed many motor skill tests on me and determined a ct was not justified yet. this is day 5 since i was in the er. and day 3 since the second doctor visit. i have spent every hour of the last 3 days in my house, and have been taking atavan and the aniety medication (paroxetine 10 mg) on schedual , and yet constantly have this feeling like i am about to slip into whatever happened to me the first day. there are moments where i will be standing and have to sit down quickly and breath deep cause i will feel my face start to tingle and throat start to get tight and i loss a sense of what is going on around me, it passes in about 15 min but this is happeneing ALL THE TIME. I have done my own research and i agree that it does have very similar symptoms to aniety and panic attacks. i am not being niave. but i have many doubts that that is what is happening. the frequency of these episodes and the fact that i have not for one minute felt myself since that first attack is what brings me looking for somone who has a theory of what else it could be. i have lived a perfectly normal healthy life until that attack and i feel krippled sense then, please ....any idea ?
doctor
Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Consultation

Detailed Answer:
Hi XXXXXXX

I understand that this is a very concerning experience you are having. Fortunately, I can tell you with certainty what is going on, and I can tell you further that this condition can be completely and fully treated.

This is definitely panic disorder, and is indeed a classic case of it. Panic disorder does not require a family history, usually starts in a person's early 20s, and does not require a major stressor in order to be provoked. It is a biological condition in which the amygdala, a structure in the brain, is overactive, provoking a fight-or-flight response. Every symptom you describe above is consistent with this disorder. This includes the constant worrying about having another attack, creating between-attack anxiety which makes it seem like nothing has returned to normal after your first one. In young people, these symptoms are rarely associated with some other condition, such as drug (cocaine, amphetamine) abuse, or a heart condition, but a normal urine test and a normal EKG confirm what is already very like, that you have panic disorder.

This is a very, very treatable condition. In the short term, doctors will use benzodiazepines such as Ativan to help keep you calm when an attack starts. The long-term treatment is an antidepressant such as paroxetine which you have already started. It can take 4-6 weeks for antidepressants to take full effect because of the way they work in the brain. Even if paroxetine doesn't work, there are a dozen other antidepressants which can be tried. When on the correct medication, you can expect complete relief from these attacks happening again.

While this is terrifying right now, I can tell you with full confidence that this is panic disorder and that it can be treated with medication.

For a more comprehensive evaluation and answer, ask me on HealthCareMagic at the private link below: tinyurl.com/DrSheppeAnswers
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
Dr.
Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2236 Questions

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Suggest Treatment For Panic Disorder

Brief Answer: Consultation Detailed Answer: Hi XXXXXXX I understand that this is a very concerning experience you are having. Fortunately, I can tell you with certainty what is going on, and I can tell you further that this condition can be completely and fully treated. This is definitely panic disorder, and is indeed a classic case of it. Panic disorder does not require a family history, usually starts in a person's early 20s, and does not require a major stressor in order to be provoked. It is a biological condition in which the amygdala, a structure in the brain, is overactive, provoking a fight-or-flight response. Every symptom you describe above is consistent with this disorder. This includes the constant worrying about having another attack, creating between-attack anxiety which makes it seem like nothing has returned to normal after your first one. In young people, these symptoms are rarely associated with some other condition, such as drug (cocaine, amphetamine) abuse, or a heart condition, but a normal urine test and a normal EKG confirm what is already very like, that you have panic disorder. This is a very, very treatable condition. In the short term, doctors will use benzodiazepines such as Ativan to help keep you calm when an attack starts. The long-term treatment is an antidepressant such as paroxetine which you have already started. It can take 4-6 weeks for antidepressants to take full effect because of the way they work in the brain. Even if paroxetine doesn't work, there are a dozen other antidepressants which can be tried. When on the correct medication, you can expect complete relief from these attacks happening again. While this is terrifying right now, I can tell you with full confidence that this is panic disorder and that it can be treated with medication. For a more comprehensive evaluation and answer, ask me on HealthCareMagic at the private link below: tinyurl.com/DrSheppeAnswers