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Suggest Treatment For Social Anxiety Symptoms

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Posted on Sat, 10 May 2014
Question: Hi Sir. My name is XXXX and I am 23 years old. I am working with with Bank of XXXXXXX its a internation call center. I work in night shift. I have met with three psychiatrist and my problem is not resolved yet. Let me explain about my latest medicine. I met with XXXXXXX XXXXXXX who is consulatant psychiatris in AIIMS. He first suggest me to take Buprion XL 150 mg a day after breakfeast and Rexipra 10 mg after meal in night. I felt a little bit improvement with these medicine but not very good result. I face side effect with these medicine the main side effect is CONSUMPTION and lack desire of sex as well. After then he suggested me to take Prodep 20 mg daily after breakfast. It is very harmful for me. I just used it only for last 10 days. It increased my wheight and full CONSUMPTION problem I am taking the medicine to solve the CONSUMPTION problem due to prodep and sexual side effect. Now let me explain my problem. I have facing this problem more then 3 years. There are symptons which I face on reguar basis. 1. I forget recently learned informations. I am working with bank of XXXXXXX and my job is handling the customer over the phone and through chat from the U.S.A. I know I am not dump or something like that. Due to these symptons I face this problem. I have learned my process well and I performe well. But there is a sitution where I am not recall anything, I feel completely blank at my work. The thing is that the queries of the customer which I handle on the daily basis since long even I forget the same thing as well which I have aleady performed a lot of time. I can not recall any thing and it makes me very embarse. I get the feed back from my XXXXXXX " whats wrong with you XXXX sometimes you perform very well even in very diffcult situation Or in terms of difficult task and the other hand you perform very poor on very simple and basic task" It makes me very frustating Sir. I know I have learned everything regarding my process and I perform on the same task very well. I know everything but why I forget everthing suddenly. I feel blank completely. Why I am not able to perform continously on the same task? Why I am not able to gather the information from my mind which is already store in my brain? 2.I face trouble while speaking over the phone and face to face as well. I suddenly lose my thought process what to say in the middle of a conversation and have no idea how to continue and i feel struggle to choose the correct words and face the problem prononce the words correctly some times. 3. Diffcultiy completing the daily task at job and unable to consntrate while reading, writing,speaking. 4. I feel trouble to understand the things,question and anything. In this situation if you repeat the same things 10 times my mind does not understand anything. 5. Challenges in plainning or solving the prblems. 6. In this sitution I feel very poor judgment and not able to think on that matter. I feel like the mind has shut down completely. I even do not see anything in this sitution and forget everything. I feel this sympton frequently basis. I mean some time I feel very clear with my thoughts . I remember everything properly. I can recall everthing even when I performed the things in past. I will really appericiate if you can help me to resolve the above symptons. It is about my job and I do not want to lose my job due to this problem. I have taken the help from three psychiartist which was not much helful. I really hope from you. Please help me. If I would not have been facing these sympton I would have been permoted yet. These are the symptons which stops me to go ahead. Thank you. I look forward for your reply and medicine info.
doctor
Answered by Dr. Ashish Mittal (1 hour later)
Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 23 year old male • Currently on Bupron XL 150mg and Prodep 20mg. • H/O: wt gain and sexual problems with medicines (Rexipra and fludac) • Complaints of forgetfulness, poor concentration, blank spells, poor judgement, difficulty in planning/completing task, difficulty in talking on phone/talking with eye to eye contact. Considering your history the more probable cause of your suffering is social anxiety. Anxiety also lead to poor attention and concentration which leads to symptoms like: forgetfulness, blank spells, poor judgement and difficulty in planning/completing task Other symptoms of anxiety which may or may not be present in your case: nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth. As you are having poor response to treatment with sexual side effects then some of the following steps will be helpful for you: -Detection and correction of vitamin deficiency (especially vitamin D/B12): Get vitamin assay done and take vitamin supplement and fruits/milk in diet. Addition of multivitamins like Cap Vibrania-D one capsule in the morning will be helpful. -Screening of thyroid dysfunction: Get serum T3/T4 and TSH level done -SSRI medicines (like rexipra and prodep) can cause weight gain and sexual side effects (in 10-20%) cases. But these side effects are reversible. So do not worry about them, as they will cure soon. Same time stop rexipra and prodep. Following medicines do not cause sexual side effects and can be preferred in your case: Bupron xl, mirtaz, Buspin. -Use the medicine in maximum doses. Medicine used to show effect after 4-6 weeks of continuous use. Hope in your case medicine had been used for sufficient duration (6 week) in maximum doses before changing to other medicines. Optimum dose for Bupron XL is 300mg per day. Bupron even reverse the sexual side effects of rexipra and prodep in many cases. Although I can understand your concern, but we can advise medicine on online platform. As you are in Delhi ncr you can meet me personally in Gurgaon. Same time let me know about meaning of CONSUMPTION Problem. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashish Mittal (3 hours later)
Thank you for answering my question. I will meet you personally in Gurgaon as I have already visited your clinic. I have met with XXXXXXX as well. I will meet after 30 April. I am on leveas for next 8 days. So I will not be able to meet you soon. Could you please specficaly guide me which medicine should I start now,as of now I am not taking any medicine from last 10 days. Thank you.
doctor
Answered by Dr. Ashish Mittal (14 hours later)
Brief Answer: Hi XXXXXXX Detailed Answer: Hello again, Thanks for follow up. In that case best option to continue Rexipra 10mg and increase Bupron XL dose to 300mg in morning time. As you have partially benefited with that treatment and we can not change treatment much on online platform. Bupron XL beneficial in prevention of weight gain and sexual side effects. Same time start daily jogging for at-least 30 minutes in morning time and decrease sweet/fat/junk food intake. Please accept my answer and give feedback in case there is no further query and you found reply helpful. In case of doubt, I am here to help you. Wish you good health. Regards,
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashish Mittal (6 hours later)
Thank you very much sir. I will start taking the Rexipra 10mg and Bupron XL dose to 300mg again. One last question due to this social anxiety problem I feel very lack of interest in sexual activity as I am in relationship. I do not want to break up with my girlfriend due to this problem. I have been facing this problem from last 8-10 months. I am sorry for typo error, I was referring to constipation problem instead of CONSUMPTION. Its really a very bad side effect. I will really appreciate your advise. Thank you again and you are really a genius person. I am very happy from your response. :)
doctor
Answered by Dr. Ashish Mittal (18 hours later)
Brief Answer: Hi Detailed Answer: Hello again, Thanks for follow up. In that case continue Rexipra 5mg (half tab of 10mg pill) and increase Bupron XL dose to 300mg in morning time. It will bring benefit in constipation and sexual issues. We will change treatment on your return. Wish you good health. Regards,
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ashish Mittal

Psychiatrist

Practicing since :2004

Answered : 1859 Questions

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Suggest Treatment For Social Anxiety Symptoms

Brief Answer: Hi Detailed Answer: Hello, Thanks for your query. I appreciate your efforts for medical consultation in so much distress. Important aspects of your query are: • 23 year old male • Currently on Bupron XL 150mg and Prodep 20mg. • H/O: wt gain and sexual problems with medicines (Rexipra and fludac) • Complaints of forgetfulness, poor concentration, blank spells, poor judgement, difficulty in planning/completing task, difficulty in talking on phone/talking with eye to eye contact. Considering your history the more probable cause of your suffering is social anxiety. Anxiety also lead to poor attention and concentration which leads to symptoms like: forgetfulness, blank spells, poor judgement and difficulty in planning/completing task Other symptoms of anxiety which may or may not be present in your case: nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth. As you are having poor response to treatment with sexual side effects then some of the following steps will be helpful for you: -Detection and correction of vitamin deficiency (especially vitamin D/B12): Get vitamin assay done and take vitamin supplement and fruits/milk in diet. Addition of multivitamins like Cap Vibrania-D one capsule in the morning will be helpful. -Screening of thyroid dysfunction: Get serum T3/T4 and TSH level done -SSRI medicines (like rexipra and prodep) can cause weight gain and sexual side effects (in 10-20%) cases. But these side effects are reversible. So do not worry about them, as they will cure soon. Same time stop rexipra and prodep. Following medicines do not cause sexual side effects and can be preferred in your case: Bupron xl, mirtaz, Buspin. -Use the medicine in maximum doses. Medicine used to show effect after 4-6 weeks of continuous use. Hope in your case medicine had been used for sufficient duration (6 week) in maximum doses before changing to other medicines. Optimum dose for Bupron XL is 300mg per day. Bupron even reverse the sexual side effects of rexipra and prodep in many cases. Although I can understand your concern, but we can advise medicine on online platform. As you are in Delhi ncr you can meet me personally in Gurgaon. Same time let me know about meaning of CONSUMPTION Problem. I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Wish you good health. Regards,