Brief Answer: Can be due to depression or anxiety Detailed Answer: Hello and welcome to HCM! I have read the question and from my clinical experince I can say that the current presentation can be due to - anxiety or depression or bipolar disorder. Now we need to see the symptoms in detail in order to come to extact diagnosis. The most important point which can lead to the presentation is substance abuse ( if you take alcohol , or any other substance?). Please tell me following answers- 1. what is your predominant mood- irritable, or sad, or anxious ? 2. how do you feel in crowded pleases, closed places? 3. is your sleep disturbed : increased or reduced? 4. what do your close ones say about the change in your behaviour? Have you been diagnosed of some psychiatric illness in past and treated ? I would like to tell you that psychiatric illness can be treated successfully but one needs to make a correct dignosis. please reply the above questions so that I can help you Dr. Manisha Gopal MD psychiatry

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Brief Answer: mixed anxiety and depression. Can be treated Detailed Answer: Hello, The symptoms you mentioned point towards a combination of anxiety and depression ( I think you might be felling low on and off along with being anxious). You mentioned that sleep is increased but I think that it is more of lethargy and even after lying down for hours together- there is no freshness. It is quite a common clinical presentation and easy to manage, so donot loose Hope. In such cases, I have seen excellent results with paroxetine 12.5-25 mg ( or venalafaxine 37.5-150 mg) in night time after meals , along with etizolam 0.25mg in day time. Many times appetite is also reduced and so some good multivitamin takes care of nutritional depreciation and helps in early recovery. I would advice that you should get some basic tests- routine blood counts, thyroid, lipid profile, liver and kidney function test, and serum Vit. B 12 level. These will help to rule out any other existing problem. In food: Please drink enough water, in form of sips every 10-15 minutes increase salad in your diet ( two - three servings daily). add more nuts ( walnuts and almonds) in your diet and try to practice deep breathing daily for five minutes two times cut down or stop drinking alcohol ( if you do it). it is seen that either some recent stressful event or some existing family history in cases with early onset of illness. Is there someone having similar problem I your closed ones? Hope the reply is useful for you please feel free to ask more questions for any clarifictaion, I will be pleased to answer them Dr. Manisha Gopal MD Psychiatry

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Brief Answer: Need to rule out paranoid symptoms Detailed Answer: Hello, You said that sometimes you feel scared in room and feel as if there is someone else there. This can happen in anxiety and also in paranoia state. please tell me of you often feel that some one is following you, or that people talk about you and make gestures towards you ( but there us no overt evidence of the same)? If yes, then this fear can be due to paranoia and might require addition of an antipsychotic for some time. Secondly, there is a complain of black out for some time and the becoming normal. This is very commonly found in every anxiety states, in which there can be associated palpitation, perspiration and feeling of impending doom but everything comes back to normal within few seconds to minutes. However, black out can be due to low blood pressure states too, so you should get the blood pressure checked ( if possible, during the time of episode). and try to lie down when it happens. Getting an ECG along with blood pressure monitoring will rule out any assocyied cardia pathology which may be causing the black outs. The black out caused by anxiety can happen more under stressful conditions and increasing demands of life ( also in I case of increasing illness.). Please see if there is more to your illness and symptoms which concerns you, I will be pleased to answer them. Dr. Manisha Gopal MD psychiatry

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