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What Causes Hot Flashes, Nervousness And Trembling Hands?
Question: Hello. I have not felt well for a couple of years and the symptoms seem to have become worse over the past 6 months. It seems like every morning between 8 and 11 am. my face, head and neck get very hot and I get extremely shaky, nervous. My hands tremble and it feels like my body (both inside and outside) trembles as well. My head feels "funny" all of the time. Kind of a lightheaded feeling like I'm not actually inside my head. Moist days, this "hot" feeling subsides and sometimes comes back much lighter later in the day. I have had a CT scan of my head and everything appears to be normal. My doctor feels I have severe anxiety and I do not disagree, but is there some type of physical ailment that could be causing these feelings? I feel anxious 99% of the time and it has caused a great fear that I'm dying. I know that sounds extreme, but it is how I feel.
Brief Answer:
Consultation
Detailed Answer:
Hi XXXXXXX XXXX, thanks for asking form HCM.
I can understand your symptoms. It seems that you are coping with so much stress due to all these symptoms. I agree with you and your doctor that these symptoms can be due to anxiety panic disorder. I understand your point regarding possibility of any physical ailment that could be causing these anxiety symptoms. And you are right that there are few physical(organic) diseases which can cause anxiety. These causes must be suspected if
1 Onset of anxiety symptoms after the age of 35 - NO in your case
2 Lack of personal or family history of an anxiety disorder - let me know
3 Lack of childhood history of significant anxiety, phobias, or separation anxiety - let me know
4 Absence of significant life events generating or exacerbating the anxiety symptoms - let me know
5 Lack of avoidance behaviour - let me know
6 Poor response to anxiolytic agents - let me know
I have mentioned few points. You can tell me as either yes or no for 2. - 6. points. It will help me making some conclusion and suspecting organic cause.
The diseases which need to ruled out are
1 Hypo- or hyperthyroidism
2 Vestibular dysfunction
3 Heart disease like Congestive heart failure, cardiac arrhythmia
4 Lung disease like Chronic obstructive pulmonary disease
5 Hyperventilation
6 Vitamin B12 deficiency
7 Neoplasms
8 Encephalitis
9 Pheochromocytoma or hyperadrenalism
These need to be ruled out if suspecting organs disease. I will describe you how to rule them out, after finding about number of positive points in you.
Hope you have got my point. If any doubt, do let me know.
Thanks. Take care.
Consultation
Detailed Answer:
Hi XXXXXXX XXXX, thanks for asking form HCM.
I can understand your symptoms. It seems that you are coping with so much stress due to all these symptoms. I agree with you and your doctor that these symptoms can be due to anxiety panic disorder. I understand your point regarding possibility of any physical ailment that could be causing these anxiety symptoms. And you are right that there are few physical(organic) diseases which can cause anxiety. These causes must be suspected if
1 Onset of anxiety symptoms after the age of 35 - NO in your case
2 Lack of personal or family history of an anxiety disorder - let me know
3 Lack of childhood history of significant anxiety, phobias, or separation anxiety - let me know
4 Absence of significant life events generating or exacerbating the anxiety symptoms - let me know
5 Lack of avoidance behaviour - let me know
6 Poor response to anxiolytic agents - let me know
I have mentioned few points. You can tell me as either yes or no for 2. - 6. points. It will help me making some conclusion and suspecting organic cause.
The diseases which need to ruled out are
1 Hypo- or hyperthyroidism
2 Vestibular dysfunction
3 Heart disease like Congestive heart failure, cardiac arrhythmia
4 Lung disease like Chronic obstructive pulmonary disease
5 Hyperventilation
6 Vitamin B12 deficiency
7 Neoplasms
8 Encephalitis
9 Pheochromocytoma or hyperadrenalism
These need to be ruled out if suspecting organs disease. I will describe you how to rule them out, after finding about number of positive points in you.
Hope you have got my point. If any doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for your reply doctor. Here are answers to your questions:
2. Yes. My father suffered from anxiety/depression and was put on medication, which helped a lot.
3. My recollection is that I started to feel anxiety/depression in high school and it has remained much of my adult life.
4. My father passed away unexpectedly just over 3 years ago. My girlfriend moved into my house approximately 6 months ago.
5. Yes. At some point late in high school, I started to "pull away" from events where I would be tested (ex. my sports, schoolwork, etc).
6. I have been put Paxil, but it made me want to sleep all of the time. I was also on Brintellix and it may have helped some of the symptoms, but not all.
I just got recent blood work back and my thyroid was tested and the results were that my thyroid is fine. My C-Reactive protein test came back good as well (<.29).
I am very frustrated/sad because I just don't feel well and I can't put my finger on it. It's not like I cam point to one are of my body and say that's where I don't feel well. it's an overall feeling of not feeling well and I deal with it every day.
2. Yes. My father suffered from anxiety/depression and was put on medication, which helped a lot.
3. My recollection is that I started to feel anxiety/depression in high school and it has remained much of my adult life.
4. My father passed away unexpectedly just over 3 years ago. My girlfriend moved into my house approximately 6 months ago.
5. Yes. At some point late in high school, I started to "pull away" from events where I would be tested (ex. my sports, schoolwork, etc).
6. I have been put Paxil, but it made me want to sleep all of the time. I was also on Brintellix and it may have helped some of the symptoms, but not all.
I just got recent blood work back and my thyroid was tested and the results were that my thyroid is fine. My C-Reactive protein test came back good as well (<.29).
I am very frustrated/sad because I just don't feel well and I can't put my finger on it. It's not like I cam point to one are of my body and say that's where I don't feel well. it's an overall feeling of not feeling well and I deal with it every day.
Brief Answer:
Consultation
Detailed Answer:
Hi XXXXXXX xXXX, welcome back.
I have read your question carefully. From your description and answers of all points, it strongly appears that cause of anxiety is not organic. You have almost all points suggestive of familial inheritance of psychological anxiety. So there is no need to get unnecessary blood investigations.
Now coming to the treatment of anxiety, you can follow few tips to control it
: You are taking good antidepressants (Paxil and Brintellix). You should ask your doctor to prescribe you newer anxiolytics like mouth dissolving clonazepam. It will help you in controlling symptoms.
: Start Yoga and meditation on daily basis. You will be able to control your nerves and thus all symptoms.
: Consult psychiatrist for "Behavioural therapy".
: Try to indulge yourself in some hobby or extracurricular activity like singing, painting, sketching, playing, swimming etc.
: Avoid alcohol, excessive coffee/tea, spicy food.
: Whenever developing such symptoms, try to take deep breath and count 1-10. It helps in controlling nerves. It is a very common practice.
: Discuss your problems with family or friends. Do not take too much tension.
: Try to identify those trigger factors which can cause anxiety. You should avoid those factors.
: You can enrol yourself in psychotherapy group. There people discuss about their problems and help each other in overcoming anxiety.
: Adopt healthy habits like daily 8-9 hours sleep, eating healthy balanced diet.
Hope it will help you in reducing drug intake and controlling your symptoms. If still in doubt, do let me know.
Thanks. Take care.
Consultation
Detailed Answer:
Hi XXXXXXX xXXX, welcome back.
I have read your question carefully. From your description and answers of all points, it strongly appears that cause of anxiety is not organic. You have almost all points suggestive of familial inheritance of psychological anxiety. So there is no need to get unnecessary blood investigations.
Now coming to the treatment of anxiety, you can follow few tips to control it
: You are taking good antidepressants (Paxil and Brintellix). You should ask your doctor to prescribe you newer anxiolytics like mouth dissolving clonazepam. It will help you in controlling symptoms.
: Start Yoga and meditation on daily basis. You will be able to control your nerves and thus all symptoms.
: Consult psychiatrist for "Behavioural therapy".
: Try to indulge yourself in some hobby or extracurricular activity like singing, painting, sketching, playing, swimming etc.
: Avoid alcohol, excessive coffee/tea, spicy food.
: Whenever developing such symptoms, try to take deep breath and count 1-10. It helps in controlling nerves. It is a very common practice.
: Discuss your problems with family or friends. Do not take too much tension.
: Try to identify those trigger factors which can cause anxiety. You should avoid those factors.
: You can enrol yourself in psychotherapy group. There people discuss about their problems and help each other in overcoming anxiety.
: Adopt healthy habits like daily 8-9 hours sleep, eating healthy balanced diet.
Hope it will help you in reducing drug intake and controlling your symptoms. If still in doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you very much doctor. I do not disagree with you at all, but I have never felt like I have the past few months with the "funny" feeling in my head, the overall body shakiness, the clamminess, the nausea, etc. I assume that severe anxiety can cause all of these type of symptoms?
Also....My doctor does not currently have me on any anti-depressants. He took me off of the Paxil (because it made me want to sleep all of the time) and the Brintelix (because it didn't help a great deal). I know you aren't my primary care physician, but, based on my severe symptoms, are there any anti-depressant's/anti-anxiety medications you suggest that I can discuss with my doctor?
I recently saw a neurologist, but he did no tests. He gave me a physical exam where he tested my strength and had me follow his finger with my eyes and that was about it. He didn't feel like he needed to see me again. I'm not doubting him, but these "tremors" cause me concern. It seems as though my body "quivers" a lot during the day and night.
I try to relax, but my symptoms are so strong that all I think about is my health and it's affected many areas of my life.
Also....My doctor does not currently have me on any anti-depressants. He took me off of the Paxil (because it made me want to sleep all of the time) and the Brintelix (because it didn't help a great deal). I know you aren't my primary care physician, but, based on my severe symptoms, are there any anti-depressant's/anti-anxiety medications you suggest that I can discuss with my doctor?
I recently saw a neurologist, but he did no tests. He gave me a physical exam where he tested my strength and had me follow his finger with my eyes and that was about it. He didn't feel like he needed to see me again. I'm not doubting him, but these "tremors" cause me concern. It seems as though my body "quivers" a lot during the day and night.
I try to relax, but my symptoms are so strong that all I think about is my health and it's affected many areas of my life.
Brief Answer:
Consultation
Detailed Answer:
Hi XXXXXXX XXXXX, welcome back.
I got your point. I will answer your questions one by one.
1st answer - Yes, anxiety can cause such severe symptoms. Severe anxiety can cause rise in pulse upto 140 - 200/min, arrhythmia, cardiac arrest.
2nd answer - You can ask your doctor about anxiolytics like benzodiazepine group of drugs. It includes alprazolam, clonazepam, lorazepam. Regarding antidepressants, I think you will be fine with anxiolytics and there will be no need of antidepressants. You can also discuss about Zolpidem for lack of sleep. Along with it, follow all measures mentioned in previous answer. For tremors, you can take tablet Propranolol after discussing it with doctor.
3rd answer - The neurologist must have evaluated your cerebellar and vestibular function to find the cause. As he found it to be normal and your CT head was also normal, the cause of tremors is either anxiety or essential tremor. This type of tremor responds to anxiolytics and Propranolol medication.
Hope I have cleared your queries. Still in doubt, do let me know. I will be happy to help you.
Thanks. Take care.
Consultation
Detailed Answer:
Hi XXXXXXX XXXXX, welcome back.
I got your point. I will answer your questions one by one.
1st answer - Yes, anxiety can cause such severe symptoms. Severe anxiety can cause rise in pulse upto 140 - 200/min, arrhythmia, cardiac arrest.
2nd answer - You can ask your doctor about anxiolytics like benzodiazepine group of drugs. It includes alprazolam, clonazepam, lorazepam. Regarding antidepressants, I think you will be fine with anxiolytics and there will be no need of antidepressants. You can also discuss about Zolpidem for lack of sleep. Along with it, follow all measures mentioned in previous answer. For tremors, you can take tablet Propranolol after discussing it with doctor.
3rd answer - The neurologist must have evaluated your cerebellar and vestibular function to find the cause. As he found it to be normal and your CT head was also normal, the cause of tremors is either anxiety or essential tremor. This type of tremor responds to anxiolytics and Propranolol medication.
Hope I have cleared your queries. Still in doubt, do let me know. I will be happy to help you.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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