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Had panic attack and felt shaky. Diagnosed with Obsessive-compulsive disorder and took Effexor and lorazapam. Having hypothyroid. Advise?

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My problems started with what I would call a panic attack, 15 yrs ago. I couldn't sleep, was shakey, couldn't eat. Had an 8 mo old baby. This came on really rapidly. Went to bed fine, woke up in a nightmare. went to a psychiatrist who diagnosed me with OCD, except that I don't have any compulsions. Put me on Effexor and lorazapam, which has kept the anxiety controlled, but the depression still comes and goes. 9 years ago I started having symptoms of fibromyalgia, with extreme fatigue and lots of pain in my feet, hands, shoulders, neck and back. Had extreme fatigue where I could sleep `10 hrs., and need to go back to bed a couple of hours later. Have very dry skin, dry eyes, mouth, brittle nails. Had every symptom of hypothyroid, except my tsh, t-3 and t-4 looked fine on the blood work. The psychiatrist I am seeing now thought it might be a good idea to try cytomel, to see if adjusting my thyroid would help with these symptoms. I felt pretty good, then he upped the med, and I sort of went back to feeling the same symptoms. When he tested my blood work, my t-3 was 98, and my t-4 was .7. He switched me to armour thyroid about a week ago. Today, the pain was down a lot, I could exercise without as much fatigue, but my heart is pounding and I feel jittery. I don't know what I should do at this point. I'd like to see an endocrinologist, but there aren't any that specialize in thyroid issues in N. Nevada. What should I do? Can I cut the armour thyroid in half? I'm on 60 mg. now. I have been to so many drs. about my pain and fatigue, and this is the first time it has actually been somewhat normal.
Posted Wed, 4 Sep 2013 in Mental Health
Answered by Dr. Ashish Mittal 21 hours later
Brief Answer:

Detailed Answer:
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     48 year old female
•     Known case of anxiety disorder
•     Complaints of: residual anxiety symptoms and adjustment of thyroid medicnes.

From history you appear to have following disorder which broadly classified in anxiety disorder:
-Generalized anxiety disorder
-Panic disorder

Good thing is that treatment did not differ significantly in these disorders.

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 (lead to pain in different parts of body), heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth.

Anxiety occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter. You need regular treatment with psychiatrist to treat your anxiety.

Thyroid problem also increases chances of developing anxiety. It is better to get evaluated for serum T3/T4/TSH. But as you mentioned that your thyroid function test were normal initially, then in my view there is no need to start thyroid supplement.

In drug treatment of anxiety two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines (like lorazepam) are used for short duration (due to risk of dependence). For long term relief most commonly SSRI and SNRI (Serotonin and Noeepinephrine reuptake inhibitors like like effexor) are used. SNRI takes around 3-4 weeks to show its effect, till that time benzodiazepines control the anxiety symptoms. All these medicines are prescription medicine and given after in person examination by physician.

All these process is complex. I have just simplified it to make you understand it. So, your treatment is appear to right but in some cases improvement may take time. Although I understand that you are suffering, but you have to keep patience.

Apart from above advice following simple measures will help you:
-Decrease worrying by keeping yourself busy and distracted from worrisome thoughts by talking to family members or watching T.V. or counting back (100 to 0).
-Healthy diet: Milk and fruits in diet.
-Daily morning walk
-Breathing exercise, yoga and meditation (which you can learn from some expert in person)

Some time patient (40% cases) did not improve with initial treatment, in that case one of the following steps are used under treating psychiatrist:
-To rule out any medical condition leading to existing symptoms
-Stop: alcohol or other substance or excessive tea/coffee/cold drink use (if present)
-Detection and correction of vitamin deficiency (especially vitamin B12): so take vitamin supplement and fruits/milk in diet.
-Monitor Blood pressure
-Checking compliance to treatment: Take medicine regularly: as medicine used to show effect after 4-6 weeks of continuous use.
-Increase the dose of current medicines
-Change of existing medicine
-Addition of other medicine

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.
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