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Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia?

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Addiction Medicine Specialist
Practicing since : 2002
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When i wake up in the morning, upon standing I feel off balance most of the time, but I feel it throughout the day as well. I am a homebound agoraphobic and have been so cine this past October, so I get panic attacks almost every day as well as high anxiety. But as for the off balance feelings, it feels like I'm tilting one way sometimes or floating like in an elevator. I've never fallen or vomitted from this, but these sensations really scare me. They've been on and off the past 4-5 months. Also, i've had blood work done that came back normal, blood pressure normal as well and also sugar levels normal. Also, these feelings seem to get worse when I'm more anxious or put in a situation that makes me anxious. I've also been depressed at times because of this and have had thoughts of suicide, which seem to be more often now. I wish i wasn't born at times if this is what life is going to be like!
Posted Sat, 8 Mar 2014 in Anxiety and Stress
 
 
Answered by Dr. Preeti Parakh 2 hours later
Brief Answer: Explained below. Detailed Answer: Hi, Welcome to Healthcare Magic! The symptoms of feeling off balance that you have described are not unusual in anxiety. People with anxiety get all types of neurological symptoms like dizziness, loss of balance, numbness, tingling, tremors etc. But when they get themselves tested for any neurological disorders, the clinical examination and tests are all found to be normal. When anxiety is left untreated, the worry and loss of productivity ultimately make people depressed as well. I guess this is what is happening with you too. Anxiety disorders like agoraphobia with panic attacks respond very well to treatment. There are two main strategies of management. One involves the use of medicines like SSRIs (Zoloft, Paxil etc) and people usually show remarkable improvement within four to six weeks of starting treatment. In the initial stages, a benzodiazepine is also prescribed as it helps control the anxiety till the SSRI starts working. The second strategy involves a behavior therapy called systematic desensitization. It is effective in all kinds of phobias and involves repetitive graded exposure to the situations causing anxiety. Gradually the mind gets habituated to the situations and no longer feels anxious. Both the strategies can be combined as well. Whatever strategy is chosen, two things are important: 1) First, stop worrying about your condition. It is not life threatening and can be cured. Worrying will just worsen your anxiety which will aggravate your symptoms. 2) Secondly, try to practice relaxation exercises like progressive muscular relaxation or autogenic relaxation regularly. Detailed instructions are freely available online. These will reduce both anxiety and depression over time. I understand that your anxiety has been very disabling for you. Overcoming it will be difficult and time taking, but is not impossible. Consider it as just like any other disease you might have had or may be like a fracture of leg sustained while playing your favorite game which would have similarly disabled you and get it treated by a competent doctor. While a psychiatrist would be an ideal choice, almost all primary care physicians are able to start SSRIs and manage anxiety reasonably well. I hope this helps you. Please feel free to ask in case you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry
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Follow-up: Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia? 1 hour later
Could the dizziness also be caused by stiffness in the neck and between the shoulders? I find I wake up sore, especially in those areas. Sometimes when I'm highly anxious I feel the back of my neck (behind the ears) muscles get tense as well and I feel sinus pressure around the face (not every time though). When it gets into a full blown panic attack I feel as though I may faint, but have never fainted before in my life. thank you again
 
 
Answered by Dr. Preeti Parakh 11 minutes later
Brief Answer: Yes Detailed Answer: Hi, Yes, dizziness can be caused by stiffness in the neck. Cervical spondylosis is a very common condition in which degenerative changes in the vertebrae in the neck cause the compression of the cervical nerves exiting the vertebrae. This causes dizziness, headache, numbness, tingling etc. An X ray of the neck is enough for a diagnosis. Treatment is with neck exercises. At the same time, anxiety itself can also cause muscle tension and stiffness. But it is unlikely to be present when you just wake up in the morning, as people are not anxious while asleep. However, stiffness due to cervical spondylosis is often present on waking up as use of pillows aggravates it. Feeling that one may faint while having a panic attack is common. Some people also feel as if they are having a heart attack and are going to die. This reduces when one is able to comprehend that what is happening is just a panic attack and will pass off in a few minutes. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by
 
Follow-up: Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia? 7 hours later
Yes, because sometimes I move my head in a certain position (left or right) and I feel the dizziness come, but not always. This leads to more anxiety too.
 
 
Answered by Dr. Preeti Parakh 23 minutes later
Brief Answer: As below. Detailed Answer: Hi, Dizziness can worsen anxiety as people start worrying about what is happening. Staying calm when it happens will prevent the aggravation of anxiety. You should also ask your primary care physician to investigate you for cervical spondylosis. Although you are quite young, you may still be having it. There is no harm in getting an X-ray done of your cervical spine. Two views are taken, antero-posterior and lateral. Once a diagnosis is confirmed, you will know which symptoms are due to neck problems and which are due to anxiety. Please do not hesitate in getting your anxiety treated as well. Best wishes. Dr Preeti Parakh MD Psychiatry
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Follow-up: Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia? 27 minutes later
Could it also be BPPV? I've had a couple people tell me they knew people that had sudden vertigo and went to the doctor who tested them and they had BPPV.
 
 
Answered by Dr. Preeti Parakh 18 minutes later
Brief Answer: It may be. Detailed Answer: Hi, In vertigo, there is a spinning sensation which is often associated with nausea. If you are having vertigo, then BPPV is indeed a possibility. But the neck stiffness suggests that cervical spondylosis is more likely. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by
 
Follow-up: Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia? 58 minutes later
No I don't feel a spinning sensation, but it feels like I'm tilting or leaning sometimes. But to the left and right and even forward, depends though. My vision sometimes feels like you wear new glasses and the eyes need to adjust, especially when very anxious.
 
 
Answered by Dr. Preeti Parakh 11 minutes later
Brief Answer: As below. Detailed Answer: Hi, Both the tilting sensation and the blurred vision suggest that cervical spine pathology is more likely than BPPV. But the relative contribution of anxiety and cervical spine pathology to your problems can only be assessed after certain tests are done and diagnoses confirmed. Anxiety itself can cause muscle tension, imbalance and blurred vision. Best wishes. Dr Preeti Parakh MD Psychiatry
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Follow-up: Treatment for nausea, dizziness, anxiety, and panic attacks due to agoraphobia? 3 hours later
how is cervical spondylosis treated through the doctor's office? Physical therapy and medications?
 
 
Answered by Dr. Preeti Parakh 7 hours later
Brief Answer: Yes. Detailed Answer: Hi, It is managed mainly by medications and physical therapy. Among the medicines, non-steroidal anti-inflammatory analgesics (NSAIDs) like ibuprofen, paracetamol etc and sometimes muscle relaxants are used. Physical therapy mainly consists of isometric neck strengthening exercises, heat application etc. Severe cases are advised neck immobilization with cervical collars, neck traction etc but I do not expect you to need it. Life style modifications like improved posture, a change in pillows, mattresses and chairs, avoiding rapid jerky neck movements etc also help. Best wishes. Dr Preeti Parakh MD Psychiatry
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