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What Causes Tremors, Twitching, Lethargy, Insomnia, Feeling Nervous And Tensed?
Question: HI,
I have been having some symptoms of what seems to be Anxiety Disorder for a pretty long time, around 6 years or so.
Symptoms include:
1. Pressure on one side of the head which extends from the top of the head to the forehead and down the right side of my face.
2. Strange sensation in the right nostril of my nose. Its more like a constant pressure build up in the nose almost like something is lodged up in nostril.
3. Also pressure in the right cheek (actually not the whole cheek but closer to the edge of the nose , more like in the sinus cavity)
4. the right side of my arm feels tense and tingly.
5. tension and tingling in the neck, back and shoulder (again on the right side)
6. feelings of nervousness for no apparent reason.
7. the right side of my upper lip feels numb( like there is some pressure on it).
8. The most embarrassing symptom however is the uncontrollable shaking (head, neck,hands,legs, etc ) in social situations.
(even if i try to type on a keyboard my fingers shake or hold a glass or things like that. ) Extremely noticible tremors.
9. also because of the pressure on the face, sometimes facial ticks and eye twitches occur and it also affects my speech.
10. feelings of tiredness and lethargy too are quite commonplace.
11. I also suffer from Insomia. I'm not sure if its related to the rest but insomia has troubled me for as long as i can remember.
The above symptoms are really making it difficult for me to go about my day to day activities in peace. Simple things like going to meet friends and chatting with people is posing to be a problem.
I originally assumed that most of these problems were tied to a sinus infection, however over the years the symptoms just kept increasing exponentially. One doctor said that i may have "trigeminal neuralgia", but that diagnosis was probably based on the fact that i only mentioned a few symptoms like the head pressure and so on.
A brief about me : I'm a Male , 28 years old.
I have been having some symptoms of what seems to be Anxiety Disorder for a pretty long time, around 6 years or so.
Symptoms include:
1. Pressure on one side of the head which extends from the top of the head to the forehead and down the right side of my face.
2. Strange sensation in the right nostril of my nose. Its more like a constant pressure build up in the nose almost like something is lodged up in nostril.
3. Also pressure in the right cheek (actually not the whole cheek but closer to the edge of the nose , more like in the sinus cavity)
4. the right side of my arm feels tense and tingly.
5. tension and tingling in the neck, back and shoulder (again on the right side)
6. feelings of nervousness for no apparent reason.
7. the right side of my upper lip feels numb( like there is some pressure on it).
8. The most embarrassing symptom however is the uncontrollable shaking (head, neck,hands,legs, etc ) in social situations.
(even if i try to type on a keyboard my fingers shake or hold a glass or things like that. ) Extremely noticible tremors.
9. also because of the pressure on the face, sometimes facial ticks and eye twitches occur and it also affects my speech.
10. feelings of tiredness and lethargy too are quite commonplace.
11. I also suffer from Insomia. I'm not sure if its related to the rest but insomia has troubled me for as long as i can remember.
The above symptoms are really making it difficult for me to go about my day to day activities in peace. Simple things like going to meet friends and chatting with people is posing to be a problem.
I originally assumed that most of these problems were tied to a sinus infection, however over the years the symptoms just kept increasing exponentially. One doctor said that i may have "trigeminal neuralgia", but that diagnosis was probably based on the fact that i only mentioned a few symptoms like the head pressure and so on.
A brief about me : I'm a Male , 28 years old.
Brief Answer:
Suggestive of anxiety and somatoform disorder
Detailed Answer:
Hi,
I read your query in detail and can understand the distress that your symptoms would be causing.
From what you have mentioned, it seems that you are definitely suffering from anxiety disorder. The symptoms that points towards anxiety disorder include tremors, twitching, feeling tired or lethargic, insomnia, feeling nervous and tensed without any apparent reason. To specifically name the type of anxiety disorder would need further information and evaluation. In case your anxiety is only in social situations, it might be social phobia. In case, you worry a lot about almost everything around you, it can be generalised anxiety disorder.
From your query, it seemed that you seemingly are much more concerned regarding the physical symptoms like pressure or strange sensations in nose, cheeks, face and head. It is common place in anxiety and stress related disorders. It is possible that in addition to anxiety disorder, you also are suffering from an entity called somatoform disorder. In this condition, a person has multiple physical symptoms without any underlying detectable cause which can be ascribed to stress.
Considering the distress that you are having due to your symptoms, it is high time adequate management of your condition is started. I would suggest that you seek a psychiatric consultation.
Had I been your psychiatrist, I would have ordered some blood investigations like complete blood counts (to rule out anaemia), and thyroid function tests as thyroid disorders can also give rise to anxiety. Treatment with selective serotonin reuptake inhibitors like escitalopram or sertraline could be initiated. Short term course of benzodiazepines like clonazepam could be added initially to take care on insomnia and reduce anxiety.
I would also advice you to start exercising daily. Relaxation exercises like deep breathing and progressive muscular relaxation are also very effective in controlling anxiety.
I do hope that you found this information helpful. In case of any further query, please feel free to ask.
Best wishes,
Dr. Sunil Gupta
Suggestive of anxiety and somatoform disorder
Detailed Answer:
Hi,
I read your query in detail and can understand the distress that your symptoms would be causing.
From what you have mentioned, it seems that you are definitely suffering from anxiety disorder. The symptoms that points towards anxiety disorder include tremors, twitching, feeling tired or lethargic, insomnia, feeling nervous and tensed without any apparent reason. To specifically name the type of anxiety disorder would need further information and evaluation. In case your anxiety is only in social situations, it might be social phobia. In case, you worry a lot about almost everything around you, it can be generalised anxiety disorder.
From your query, it seemed that you seemingly are much more concerned regarding the physical symptoms like pressure or strange sensations in nose, cheeks, face and head. It is common place in anxiety and stress related disorders. It is possible that in addition to anxiety disorder, you also are suffering from an entity called somatoform disorder. In this condition, a person has multiple physical symptoms without any underlying detectable cause which can be ascribed to stress.
Considering the distress that you are having due to your symptoms, it is high time adequate management of your condition is started. I would suggest that you seek a psychiatric consultation.
Had I been your psychiatrist, I would have ordered some blood investigations like complete blood counts (to rule out anaemia), and thyroid function tests as thyroid disorders can also give rise to anxiety. Treatment with selective serotonin reuptake inhibitors like escitalopram or sertraline could be initiated. Short term course of benzodiazepines like clonazepam could be added initially to take care on insomnia and reduce anxiety.
I would also advice you to start exercising daily. Relaxation exercises like deep breathing and progressive muscular relaxation are also very effective in controlling anxiety.
I do hope that you found this information helpful. In case of any further query, please feel free to ask.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
HI Dr. XXXXXXX
Thank you for such a prompt reply. It was very helpful.
I'm sorry i forgot to mention earlier that i had suspected that it might have been a thyroid problem so i did a thyroid test and everything turned out to be normal.
I was also working with HDFC bank so before joining it was mandatory to do a full medical checkup as per their joining formalities. So there was lots of blood work and things like that involved as part of the medical checkup. Everything turned out to be perfectly fine there too.
Also i used these tablets called stresnil for like three or four days. I saw some positives in it. I guess it had sedating properties. just made me feel a little drowsy . but definetly helped. It seemed to have the same effect as alcohol had. If i had to have a beer or two the symptoms seemed to vanish. But thats not a very permanent solution as with the tablets.
Also i do lead quite an active life. I do walk alot. recently the insomia hasnt been bad. Been getting an okay nights sleep. Can you recommend some over the counter medication maybe?
Thank you for such a prompt reply. It was very helpful.
I'm sorry i forgot to mention earlier that i had suspected that it might have been a thyroid problem so i did a thyroid test and everything turned out to be normal.
I was also working with HDFC bank so before joining it was mandatory to do a full medical checkup as per their joining formalities. So there was lots of blood work and things like that involved as part of the medical checkup. Everything turned out to be perfectly fine there too.
Also i used these tablets called stresnil for like three or four days. I saw some positives in it. I guess it had sedating properties. just made me feel a little drowsy . but definetly helped. It seemed to have the same effect as alcohol had. If i had to have a beer or two the symptoms seemed to vanish. But thats not a very permanent solution as with the tablets.
Also i do lead quite an active life. I do walk alot. recently the insomia hasnt been bad. Been getting an okay nights sleep. Can you recommend some over the counter medication maybe?
Brief Answer:
Please see details below.
Detailed Answer:
Hi,
Thanks for following up. I am glad that you found my response helpful.
Its good that you have had blood check-ups including thyroid function already done and you don't need them done again.
That brings us to medications for your condition. The medications that would be required for your problems are psychotropics which are not available over the counter. So, you will need to consult a physician in person for the same. In any case, I would want you to get over your problem and not think of any stop-gap arrangement. So, it would be much better that you seek a psychiatric consultation for starting treatment so that medications can be prescribed and then its effects and side effects monitored.
Stresnil is alprazolam which is a benzodiazepine. It is used as a sedative and as adjunct in treating anxiety. That would be the reason that you felt better when you took it. However, taking a sedative alone is not recommended in your condition as it will just treat the symptoms without taking care of the reason for it. It will be like in case of malaria, you are just taking paracetamol without taking any medications to treat malaria. Moreover, there is a high chance that you will become dependent on it if taken unsupervised.
The medications would include either sertraline or escitalopram (as mentioned in last reply). Sedatives would be required in the initial period. However, my choice would be clonazepam rather than alprazolam (stresnil). It has better anti-anxiety effect and will be easier to taper when the need arises.
In addition, make sure you start exercising daily.
I do hope that helped. In case of any further queries, please feel free to ask. In case you don't have any, you can close the discussion and rate the answer.
Best wishes for speedy recovery,
Dr. Sunil Gupta
Please see details below.
Detailed Answer:
Hi,
Thanks for following up. I am glad that you found my response helpful.
Its good that you have had blood check-ups including thyroid function already done and you don't need them done again.
That brings us to medications for your condition. The medications that would be required for your problems are psychotropics which are not available over the counter. So, you will need to consult a physician in person for the same. In any case, I would want you to get over your problem and not think of any stop-gap arrangement. So, it would be much better that you seek a psychiatric consultation for starting treatment so that medications can be prescribed and then its effects and side effects monitored.
Stresnil is alprazolam which is a benzodiazepine. It is used as a sedative and as adjunct in treating anxiety. That would be the reason that you felt better when you took it. However, taking a sedative alone is not recommended in your condition as it will just treat the symptoms without taking care of the reason for it. It will be like in case of malaria, you are just taking paracetamol without taking any medications to treat malaria. Moreover, there is a high chance that you will become dependent on it if taken unsupervised.
The medications would include either sertraline or escitalopram (as mentioned in last reply). Sedatives would be required in the initial period. However, my choice would be clonazepam rather than alprazolam (stresnil). It has better anti-anxiety effect and will be easier to taper when the need arises.
In addition, make sure you start exercising daily.
I do hope that helped. In case of any further queries, please feel free to ask. In case you don't have any, you can close the discussion and rate the answer.
Best wishes for speedy recovery,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. XXXXXXX
This has truly been great. The info was very helpful. The next time i go to the doc i would be better informed and can bring up these suggestions that you have made.
I just have a few more simple questions. Is there anything that i could do at home to help with the anxiety - especially the tingling and tremors? You mentioned exercise earlier. WHat about maybe follow a particular diet or i read somewhere that a certain kind of tea helps?
Besides anxiety could it be a problem with my spine or something like spondilitis?
Besides a the prescription rendered medication are there any kind of herbal supliments i could use.
okay cant think of any more questions right now ...
You have been very helpful. thank you .. have a good day!
This has truly been great. The info was very helpful. The next time i go to the doc i would be better informed and can bring up these suggestions that you have made.
I just have a few more simple questions. Is there anything that i could do at home to help with the anxiety - especially the tingling and tremors? You mentioned exercise earlier. WHat about maybe follow a particular diet or i read somewhere that a certain kind of tea helps?
Besides anxiety could it be a problem with my spine or something like spondilitis?
Besides a the prescription rendered medication are there any kind of herbal supliments i could use.
okay cant think of any more questions right now ...
You have been very helpful. thank you .. have a good day!
Brief Answer:
Please see details below
Detailed Answer:
Hi,
Thanks for following up and many more thanks for you kind words of appreciation.
Regarding diet, my advise would be to follow a simple balanced diet with lots of green vegetables, fruits and high fibre content. Keep the content of fats (oil, butter, ghee, etc.) on the minimum possible level. Drink adequate amount of water. I would suggest not to go for any designer products as they are mostly show off with out any proven efficacy.
Try to keep the intake of caffeine/ tea to a minimum level. In at all you want to drink tea, green tea should be preferred. Frankly, it doesn't have any specific effect on anxiety, but is considered better in general as it contains anti-oxidants.
From your history, I really don't feel that your symptoms are due to spondylitis. Spondylitis does't lead to anxiety as such. It can cause back pain with associated radiating neuropathic pain only in the area involved. So, I feel you can feel relaxed on that part.
One last piece of advise. Anxiety is a condition which gets aggravated if you remain more preoccupied by it. You will have to start ignoring few symptoms. More you think about it, higher will be the level of anxiety. So just try to relax and distract yourself and I am sure you will be able to overcome your symptoms.
I hope that the information provided was helpful and you would soon get over all your problems. In case of any further help, please ask.
Best wishes,
Dr. Sunil Gupta
Please see details below
Detailed Answer:
Hi,
Thanks for following up and many more thanks for you kind words of appreciation.
Regarding diet, my advise would be to follow a simple balanced diet with lots of green vegetables, fruits and high fibre content. Keep the content of fats (oil, butter, ghee, etc.) on the minimum possible level. Drink adequate amount of water. I would suggest not to go for any designer products as they are mostly show off with out any proven efficacy.
Try to keep the intake of caffeine/ tea to a minimum level. In at all you want to drink tea, green tea should be preferred. Frankly, it doesn't have any specific effect on anxiety, but is considered better in general as it contains anti-oxidants.
From your history, I really don't feel that your symptoms are due to spondylitis. Spondylitis does't lead to anxiety as such. It can cause back pain with associated radiating neuropathic pain only in the area involved. So, I feel you can feel relaxed on that part.
One last piece of advise. Anxiety is a condition which gets aggravated if you remain more preoccupied by it. You will have to start ignoring few symptoms. More you think about it, higher will be the level of anxiety. So just try to relax and distract yourself and I am sure you will be able to overcome your symptoms.
I hope that the information provided was helpful and you would soon get over all your problems. In case of any further help, please ask.
Best wishes,
Dr. Sunil Gupta
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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