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Have anxiety. On klonopin .5 mg. Experiencing strange sensation in mouth. Should I be worried?

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38 year old female with health anxiety. On klonopin .5 mg as needed, have recently tried to cut back a bit to just .5 mg or less daily. A few weeks ago I noticed some strange sensations in my mouth. Not every day, but some days it may feel, tingly, burning, swollen (without actual swelling) and tense, mostly in my tongue. Last night I had rush come over my tongue, and felt more intense than usual, and at times my lips felt tingly. I am worried about bulbar als. I do not have any slurred/nasal speech, or trouble swollowing, weakness or any issues like that. I am worried these feelings are the beginning. Could it just be another way for anxiety to present itself or should I be worried? I did start birth control pills 2.5 months ago?
Posted Mon, 24 Dec 2012 in Anxiety and Stress
Answered by Dr. Jonas Sundarakumar 3 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I understand that you are concerned about your recent onset of symptoms in the tongue, and are worried whether they could be indicative of a bulbar ALS.

Now, firstly let me tell you that the the incidence rate for ALS in the U.S. is 2 per 0000 people. Out of this less than 1/3rd present with bulbar ALS. This simply means that your chance of getting bulbar ALS is less than one in 180,000!

Secondly, and more importantly, your symptoms are in no way indicative of a bulbar ALS, where the predominant symptoms are muscle weakness, paralysis, resulting in difficulty in speaking or swallowing. Loss of speech occurs in 93 per cent of people with bulbar ALS. Difficulty swallowing occurs in 86 per cent of people with bulbar ALS. So, on and off strange tingling or burning sensations over the mouth, is no way indicative of a bulbar ALS.

Thirdly, it is important to understand that anxiety can present with not only psychological ymptoms but also with physical or somatic symptoms. My opinion is that your symptoms are most likely physical manifestations of anxiety. Now, this does NOT mean that 'everything is in your head' and that you are simply imagining the symptoms. Not at all. It has been found that anxiety disorders are associated with certain neuro-chemical imbalance in the brain and this can cause the person's pain threshold to get lowered and he / she can become 'hypersensitive' to sensory stimuli, and therefore have tingling, burning, etc. The underlying anxiety also causes a person to become more worried whether his / her problems could be a symptom of a major meedical or neurological disease, and then this worry itself then starts worsening the symptoms more. Soon this becomes a viscious cycle, leaving the person with more symptoms and suffering.

There are effective treatment options - in the form of medication or counselling / psychotherapy which will help you overcome your anxiety-related problems. There are also several psychological techniques and relaxation therapies, for example, progressive muscle relaxation, applied relaxation, biofeedback, etc. which can yield effective and long-lasting results. Additionally, you can also try simple relaxation techniques like XXXXXXX breathing, yoga, etc. which can be quite helpful. Regular physical exercise helps in relieving both the physical as well as psychological symptoms of anxiety and also helps you stay more functional.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
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