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Suggest Treatment For Delirium And Acute Confusional State

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Posted on Wed, 18 Mar 2015
Question: I took pacitane 2mg with sulpitac 300mg for 8 months from May 2014 to December 2014. But 3 months after I started it, pacitane made me develop delirium and very acute confusional state. I didn't know what was going on, I was totally confused, it made me feel sick and then I felt like committing suicide. It also made me feel that I'm going to die or collapse. I stopped it in December but then my psychiatrist gave me game me arip mt 5mg and kemadrin 2.5mg. I also stopped them after 25 days and then went to a new psychiatrist because I was not happy with the medication. My new psychiatrist gave me despol 25mg and clonotril 2.5mg which I am on currently. But I had stopped pacitane 1 and a half months back, after I stopped it I stopped feeling drowsy and I felt little better but the delirium which it developed has not gone and I'm still confused and I still feel that I'm going to die or collapse. Now what do I do about this? Why is this happening? Is it because of pacitane? Is this delirium which it develops permanent or temporary? I feel that pacitane was the wrong drug and should have not been given to me. My new psychiatrist said that it was only anxiety which was the problem which was causing depression and I should have not been given sulpitac, pacitane or ariprazole. And I'm also on the edge of my board exams in 10 days and I'm totally confused while studying. Is it because of pacitane? I feel that pacitane has ruined my intelligence and it made me feel empty minded and gave me all these thoughts.
doctor
Answered by Dr. Seikhoo Bishnoi (3 hours later)
Brief Answer:
Most likely the symptoms are not due to delirium or side effect of pacitane

Detailed Answer:
Hello thanks for asking from HCM

I have read your query and I can understand your concern. Coming straight to your doubts.

Your new psychiatrist found that you have anxiety and depression and you should not have been prescribed Sulpitac and Pacitane. Yes, these drugs are usually not the commonly used drugs for anxiety and depression.

Pacitane is an anticholinergic drug and the drug can cause delirium as side effects but that side effect is seen in very high doses or in critically ill patients. It may cause drowsiness, confusion, dizziness, nervousness etc side effects but these side effects are usually short lived and usually reverse after stopping the medicine. You have already stopped taking medicine so I don't think the symptoms of confusion and delirium (?) are occurring due to pacitane.

Then why these are occurring. Anxiety and depression could be possible explanation for these symptoms. In severe anxiety individuals may find it very difficult to focus, inability to concentrate, feels like disoriented and confused. So most probably poorly controlled anxiety is the reason for your symptoms.

These symptoms are probably not delirium because delirium is an emergency and it doesn't runs a long course. These symptoms of confusion are not permanent and will improve with improvement of your anxiety.

You have been prescribed Dapsol (Imipramine) and Clonazepam and these drugs will help in reduction of anxiety. With these drugs you will see improvement in your symptoms and will feel better. No need to worry wait for these drugs to control your symptoms.


Thanks, hope this helps you. Don't hesitate to ask again if you have more doubts.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (1 hour later)
Pacitane ruined my concentration and intelligence and I'm finding it hard to get it back. It gave me thoughts such as "why is the world like this" and made me feel as if I am an alien and not a human being. It made me totally confused, I didn't know what was going on in my life, I felt totally sick, I didn't feel like living and all this made me feel that I have the worst life and I felt like committing suicide. It also gave me a mask like expressionless face and I stopped getting laughter, I stopped crying, and I stopped expressing myself. After I stopped it I improved a little but I had taken it for 4 months and I got used to living like that and started tolerating it. I stopped it one and a half months ago, but I still remember how pacitane made me feel. I got used to being confused and that's why I feel that I have this delirium. Is there any solution to this? And has the effect which pacitane had on me gone away permanently or it will take a year to go away? And one more thing I wanted to ask you... I have my board exams in 9 days and my brain is giving me trouble. I feel empty minded and I feel my brain has no information in it and it is totally empty. At times, I also feel that my brain is full and can't take any more information. All this affects me while studying. Even when someone is taking or I'm reading something, or I'm listening to music, this affects me and nothing goes into my head. I thought it was a problem with my eyes while studying, because of which nothing goes into my head, and I thought it was a problem with my ears because of which I can't listen properly, so I got my eyes and ears checked, I was prescribed eye drops and ear drops, but that didn't help. This empty mindedness and full mindedness still afftecs me. Why do you think this is happening? Is there any cure to it? Is it a disease? All this used to happen even before starting any drugs, that is in May 2014 and pacitane worsened it. 2 days after starting despol and clonotril, all this went away, my brain stopped giving me trouble, but it again came back. Now what do I do about this?

And also I forgot to mention in the previous thing that pacitane has changed my attitude towards everything, the way I used to treat things, the way I used to think, the way I used to respond to others also changed. Now I have improved a little, but I got used to living like that, as I just said in the previous thing, so that's why I feel confused and delirious. Pacitane even gave me hallucinations and dilutions.
doctor
Answered by Dr. Seikhoo Bishnoi (15 minutes later)
Brief Answer:
The symptoms of anxiety can be cured

Detailed Answer:
Hello again and thanks for asking a follow up

The abnormal thoughts, poor concentration, poor focus, feeling like sick, thoughts of committing suicide and other symptoms you have mentioned are not due to Pacitane, instead your mind has paired these symptoms of anxiety with pacitane. These are non-remitting symptoms of anxiety only and these symptoms will improve only on improvement of symptoms of anxiety only. As per my opinion Dapsol is a good drug for these symptoms but at high doses it has side effects and there are more efficacious and safe medicines like SSRIs are available. Once your exams are over you can discuss with your doctor to change your drugs to some SSRI medicine which would result in better treatment relief. These symptoms are not permanent.

The feeling that your brain is empty, difficulty in studying, thinking again and again about this etc are due to anxiety. Yes these symptoms can be cured. With proper treatment you will see improvement in these symptoms. Please try to concentrate on your exams right now and consult your doctor for change in prescription after exams.

Thanks


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (7 hours later)
1 last question...2 days after I started despol and clonotril I felt much better, I was feeling fresh and happy, but after that my brain again started giving me trouble, and I again started feeling empty minded etc. I thought that I would feel fresh and happy throughout till I take those drugs but it didn't happen. Why is this happening? I am also feeling drowsy and sick. Is it because of these drugs? And why do you think my old psychiatrist gave me sulpitac and ariprazole? They are for schizophrenia and bipolar disorder and I didn't have either of them. On the contrary sulpitac made me feel schizophrenic. And I'm also very upset that I'm only 15 and I took pacitane. It has ruined my life totally. And I feel that others have a much better life than mine because they didn't take pacitane.

I also keep thinking about my past that I took pacitane and I'm not happy
doctor
Answered by Dr. Seikhoo Bishnoi (55 minutes later)
Brief Answer:
All this is occurring due to anxiety only

Detailed Answer:
Hello again

Please don't think that Pacitane has made your life worse. You are very young and this would result in development of anxiety only. To some extent you have developed that anxiety. This could be a possibility that at time of prescribing the Sulpitac the doctors have assumed some symptoms of anxiety as psychosis. A lot of symptoms of psychosis and severe anxiety overlap.

You felt better after taking Dapsol and Clonotril because Clonotril helps in reducing anxiety and its symptoms which is the drug that resulted in improvement. Wait for some more time to see effect of Dapsol and you will feel better.

Try to build confidence in you and try relaxation exercises which will keep you healthy and away from anxiety. Everything is in your head, try to improve your focus.

Thanks, hope this helps you. Please ask again for more doubts.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (4 days later)
I am feeling much better after taking despol and clonotril. I have been taking them for 23 days. I can study better and my depression, anxiety and the thoughts of committing suicide have gone. But before I started these drugs, while reading, when I used to read one line, and I used to go to the next line, my eyes used to get some jerk like feeling or something. Actually they were not jerking, but I just felt that they were jerking while going to the next line. I had got my eyes checked for that in October before I started these drugs, the eye doctor said that my eyes are perfectly normal, but he still prescribed eye drops, but with that the jerking only reduced and once in a while it still used to happen. But after starting despol and clonotril it has even reduced more. So does that mean that it was because of depression and anxiety only that my eyes used to jerk while going to the next line? If yes, will this problem go away totally after a while? And if no, what could be the other reasons why this was happening? Because before when I had this problem I used to only think about that all the time, that I have this problem of my eyes jerking while going to the next line.
And even when I used to listen to music before starting despol and clonotril, I felt nothing was going into my head because I can't listen properly. I thought it was a problem with my ears, so I got my ears checked, the ear doctor prescribed ear drops but that also didn't help. I still felt my brain was empty while listening to music and that's why I used to hate listening to music. But after starting despol and clonotril, my brain stopped feeling empty, and now I can listen to music properly and I've started enjoying it. It still feels empty once in a while but it's much better than before. So does this mean that I couldn't listen to music properly due to anxiety and depression only? If yes, will it get even better? If no, then what could be the other reasons?
And 1 more doubt... Before I started despol and clonotril I couldn't be myself. I used to try and live other peoples lives. I felt I don't have a life of my own and I used to keep thinking of myself as someone else. Even while studying, I used to think of myself as someone else and I used to feel that I have his brain. Why did that used to happen? After starting despol and clonotril it has improved so does that mean that it was due to anxiety and depression only? If yes, will it get even better? If no, what could be the other reasons?
doctor
Answered by Dr. Seikhoo Bishnoi (2 hours later)
Brief Answer:
All these symptoms were due to anxiety and would reduce with time

Detailed Answer:
Hello thanks for asking a follow up question

Coming straight to your answer-

- The problems of jerk like feeling in eyes was most likely due to anxiety because nothing was found on EYE EXAMINATION by a doctor. I have come across a lot of patients who present with eye problems like twitch in eyes or jerks in eyes etc symptoms and they respond to anti-anxiety drugs.

- Yes the problem would reduce completely with your drug therapy. They are good drugs and you will see improvement with time. Try to distract yourself from that jerk like sensation in eyes. Try to reassure yourself again and again that nothing is wrong and all this is due to anxiety only.

- The sensation of emptiness in brain, not able to listen the music, feeling that you cant live life of own, feelings that you are not yourself etc were probably due to anxiety only. These symptoms would reduce with medicines and you will feel better. Just continue to take your drugs properly and visit your psychiatrist as advised.

Thanks, hope this helps. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (59 minutes later)
And when I was taking sulpitac, was pacitane given to me to prevent the Parkinsonism which sulpitac causes? Because pacitane is an anticholinergic drug. And sulpitac causes Parkinsonism by preventing dopamine from being formed in the brain right? And to counteract the imbalance between dopamine and acetylcholine, pacitane prevents acetylcholine from also being formed, right? And do the neurons in the brain die or get toxicated due to less acetylcholine and dopamine concentration in the brain? If yes, then was that the reason why I was feeling less intelligent when I was taking pacitane and sulpitac? Because more the number of neurons in the brain, more is the intelligence. And when neurons die they are not replaced with new neurons. And so if the neurons have died, then there is a permanent loss in intelligence right? Has that happened to me? Or have the neurons been toxicated or anything? I don't think anything like that has happened to me because after I stopped sulpitac and pacitane, and started dispol and clonotril, I feel I again got my intelligence back, but I just want to confirm that nothing like that has happened to me and that is temporary and not permanent, right? Because I tested my IQ yesterday, it was 143.
And 1 more doubt... My psychiatrist said that after my board exams get over, that is on 23rd March, I can stop despol and clonotril. But stopping these drugs will cause a relapse in the symptoms right? So won't I again start feeling that my brain is empty and depressed? Why don't I have to take them for 6 to 8 months, why do I have to only take it for a month till my exam is over?
doctor
Answered by Dr. Seikhoo Bishnoi (39 minutes later)
Brief Answer:
These drugs are not neurotoxic so no need to worry.

Detailed Answer:
Hello again

Sulpitac is an antipsychotic drug and the drug is known to cause dopamine depletion in BASAL GANGLIA (one area of brain) which results in extra pyramidal side effects. Pacitane prevents these side effects.

The neurone don't die permanently, and no need to fear from that. Once side effects reduce this results in regaining of normal functioning. Intelligence areas are cortical areas and some limbic areas and there is no effects on that area due to that drugs. These drugs modulate the neurotransmitters and are not neurotoxic, so please no need to fear.

Your IQ came normal (instead more than normal) so this also reassures you that you are absolutely healthy.

Stopping the drugs would not result in relapse, reduce the doses of drugs gradually and under proper consultation of your doctor. Proper tapering would prevent any relapse of symptoms. Don't over think and over analyse your symptoms. Try to distract yourself from anxiety. Relax yourself by relaxation exercises. You are absolutely healthy.

It is possible that your symptoms are getting aggravated due to exams and this is the reason your psychiatrist want to reduce doses after exams. Anti anxiety drugs are usually not prescribed for prolonged periods in most cases especially benzodiazepines.

Thanks, hope this assures you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (4 hours later)
So you mean to say that dispol and clonotril are those kind of drugs whose effect is permanent and not temporary, right? And they don't cause relapse of the symptoms? Because I was told that sulpitac, pacitane mad ariprazole do cause relapse of the symptoms when they are stopped. I was told that their effects are temporary and not permanent. Are they temporary or permanent? And if they are temporary, that means that despol and clonotril act in a different way than how sulpitac, pacitane and ariprazole act, right?
And will the neuron death in the brain which sulpitac and pacitane caused shorten my lifespan? If no, will anything else happen which will give me trouble later in my life? Will the arrangement of neurons in the brain change, or will the neurons again start living or will they be dead permanently? And sulpitac was causing Parkinsonism. I had trouble walking on my heels, while sitting on a chair I could only sit by keeping my legs crossed, and if I tried to sit without my legs crossed, they would automatically get crossed again, and it was causing a mask like face with no emotions or expressions. All this has gone away now after stopping them so I won't get Parkinson's disease, right?
doctor
Answered by Dr. Seikhoo Bishnoi (7 hours later)
Brief Answer:
The effects of drugs are nor permanent.

Detailed Answer:
Hello again

I am not saying that effects of Depsol and Clonotril are permanent but once they are stopped then relapse of symptoms is not usually seen. Anxiety can occur in future also.

Sulpitac, Pacitane and Aripiprazole don't cause neuronal death. As mentioned earlier they cause changes at neurotransmitters levels and effect get reversed once drug is stooped. So no even a rare risk of neurotoxicity or neuronal death.

No these drugs has not caused even a single permanent effects on your brain.

No you won't get Parkinson's disease. The drugs cause Parkinsonian like side effects which improves on taking Pacitane or on stopping the drugs. The effects are not permanent.

Thanks, hope this reassure you. Still have more doubts please ask again.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (2 days later)
I have been taking despol 25mg and clonotril 2.5mg regularly every night. But it is not helping me. I am feeling dizziness, and twitching and jerking of eyeballs while reading happens sometimes. My brain is also giving me trouble. It is not exactly feeling empty but I'm feeling some foggy feeling in my brain/head and that is why I'm feeling confused and not able to think. Why is this happening? Is it because of these drugs? What should I do about it? What should I do to cure it? How does a normal brain feel? If it can be cured then how much time will it take? Because my exams start in 3 days and I'm not able to study because if this foggy brain, which is adding more tension. I also slept for 9 hours and I'm still not feeling fresh and I don't feel like doing things, I just feel like sleeping. I don't even feel like exercising or going for a walk, because it will make me more tired and I feel it won't help me. And I also keep thinking about the past, time when I used to take sulpitac and pacitane, and how I used to feel while taking it which is another reason why I can't study. My psychiatrist told me to forget about it, I'm trying my best to forget about it, but I can't and I keep thinking about it. Now how do I forget about it and stop thinking about it? Can you give me a way? Because I feel it wasted 8 months of my life.
doctor
Answered by Dr. Seikhoo Bishnoi (35 minutes later)
Brief Answer:
This is occurring most likely due to aggravation of anxiety due to exams

Detailed Answer:
Hello again

I can understand your problem. The symptoms like dizziness, twitching in eyes and jerking in eyeballs occurring while reading are most likely due to anxiety. Trouble in brain, feeling emptiness, confused thinking etc are also because of anxiety. These are not because of the drugs.

Dapsol is Imipramine and as per my opinion 25 mg dose is not sufficient dose and it should be increased because it is probably not working. Alternatively I would advise you to wait for some more days till the drug start showing its full effects. The doses of the drug Clonotril is very high and increasing the dose of Dapsol or changing the drug would result in control of anxiety and this would also help to reduce the doses of Clonotril.

One more thing, try to distract yourself and don't over thing and overanalyse. Try to concentrate on your exams and don't think about results. Most likely these symptoms occurred because of aggravation of anxiety because of exams and this is a common thing seen in most of students during exams. Try to relax yourself and don't let panic to control your mind. If possible exercise for some time and this will result in reduction of anxiety.

Try to relax yourself, there is nothing serious, you will improve in some time.

Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Seikhoo Bishnoi (1 hour later)
Sorry, I made a mistake, clonotril 0.25mg, not 2.5mg, and despol 25mg. My psychiatrist had said that he is not increasing the dosage because it will make me feel drowsy. But I am feeling better than before. I am not feeling like my brain is empty or full, I am feeling it is normal. But while I am studying, for example, when I am reading a chapter, at the beginning of the chapter, I force my brain to become empty, and when I finish the chapter, I force my brain to become full, because that used to happen in the previous years. In the previous years while studying, after I had finished a chapter, I felt saturated, and after sometime, I again felt normal. But now I don't feel anything like that so I have to force my brain to become saturated because I feel my brain has become abnormal. So can you give me some tips on what to do? Because I keep thinking about my brain while studying, even after finishing reading one sentence, I think that it has taken more information, so it is becoming fuller and fuller, and when I take a break I force it to become empty. How should I study? Should I just read the chapter continuously with a flow and not think about my brain? And after I finish reading a chapter, what should I think about? Should I think that my brain has become full and I can't take in more? And at the beginning of a chapter, since I don't know anything about the chapter, should I think that my brain is empty? Because now my brain is just feeling normal, not full or empty and I'm very confused about this, I don't know if my brain is normal or abnormal, and I don't know how a normal brain is supposed to feel, full, empty or just normal?
doctor
Answered by Dr. Seikhoo Bishnoi (59 minutes later)
Brief Answer:
Take small breaks in between studies

Detailed Answer:
Hello thanks for asking a follow up question

Yes 0.25 mg of dose of Clonazepam is not a high dose and this will help you to reduce anxiety and would not make you drowsy.

For studying I would advise you to to read according to topics and chapters. After finishing a chapter try to take a small break like 10-15 minutes, which can be utilised in listening a light music or playing some game in XXXXXXX This would distract the mind and will increase concentration once you resume your reading. This would also make learning rewarding because you will have a target to listen music or playing game or something like that at the end of chapter. This learning will give best results. Try not to think whether you are retaining or not, continue to read by free mind and after finishing a chapter try to recapitulate the reading. Don't force your brain to retain the things, continue to study without distracting your mind. Don't read continuously for more than a hour and try to take small breaks at regular intervals.

Have good meals, diets rich in proteins and complex carbs and low in fats. This would improve concentration in brain. Try to relax yourself, have a cup of coffee if you feel drowsy. Brain cant become full, this is your mind which is thinking that your brain is full. Try to change your thinking and don't think about this thing again and again.

There is nothing abnormal in your brain, just continue to do your work and you will get good results.

Thanks, hope this helps.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Seikhoo Bishnoi (3 hours later)
I am also feeling that everyone else in this world has a much better life than mine. I feel like that because I feel my life is not continuous. I feel that my end is in any moment from now. I started feeling like that since October 2014 when I was taking pacitane and sulpitac, and I was studying for my exam, and I was very stressed because I had all those reading problems of twitching of eyeballs etc because of which I was not able to study and plus the side effects of those drugs such as delirium etc. When I was studying on that day, I was very stressed and then I felt I was going to die and I felt my end is going to be any moment. Since that day I stopped feeling continuity in my life and I felt I was going to die any moment but I've not. And since that day, even after I've stopped those drugs that feeling has not gone. I am feeling much better after stopping those drugs and starting dispol and clonotril, but I still feel that others feel continuous of their life and I do not. Before when I was on sulpitac and pacitane, whenever I was in a crowd or anything I started wishing that I had someone else's life in that crowd and not this one because I'm not feeling continuous of my life and everyone else is. But this thing of wishing that I had someone else's life has stopped after I stopped those drugs and I'm on dispol and clonotril, but it still feel that others have a much better life than mine because they feel continuous of their life and I do not. Why is this happening? Why do I feel that my end is any moment? What do I do about it? Is it because of depression and anxiety only and will go away or it is because of some other reason? Because this feeling of me not being continuous of life has not gone since that day in October 2014. And it is making me feel low, lack of confidence and helpless and because of that feeling it troubles me while studying and I keep thinking that my life is not continuous and everyone else's is. And 1 more doubt... From January last year I started listening to someone when he is talking or saying something in an abnormal way. I don't know why that was happening. I felt I was listening to him in a passive manner (like from the back of my ears and lazily) and not in an active manner. The same thing happened with reading. I felt that there were 2 ways of reading also- in an active and a passive manner(lazy manner). The same thing happened with listening to music. I felt I started listening to music also in a passive manner, and that is why I got my ears checked. But there was no problem with my ears. Before I had none of these problems. Why was all that happening of listening and reading in a passive manner? Was that also because of depression and anxiety only? Because it has reduced after taking dispol and clonotril. But I am thinking that happened because my brain changed or the chemicals in it got fluctuated or something. And this feeling of not being continuous of life is also troubling me a lot.

Earlier before that day in October I was feeling continuous of my life but now I feel I'm not.
doctor
Answered by Dr. Seikhoo Bishnoi (56 minutes later)
Brief Answer:
Please don't overthink, try to concentrate on exams, this is anxiety only

Detailed Answer:
Hello again

I have read the history again and it appears that the symptoms you have mentioned like while reading you think that there are two ways of reading i.e. active and passive, similar thing in listening music points towards two main things as per my opinion one is our main diagnosis anxiety with some symptoms mimicking OC (Obsessive compulsive) symptoms and other is some Psychotic episode.


I want to know few things about the voices you were listening. If the passive and active listening were for any voice like when some one is talking to you or some one in real is talking to some one? or Were you hearing the voice when no one was there and other people could not listen those voices? Were these voices were abusing you or talking to you?

In heightened anxiety individuals may hear abnormal voices or may become sensitive to sounds also. As per my opinion the active passive things related to reading or listening, feelings that your life is not continuous as others are due to anxiety only. Try to relax your self and don't feel bad, with time your anxiety would reduce and you will feel better.

Thanks, hope this helps you. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (11 hours later)
Listening was different from hearing voices which no one could hear. It all started from here- In January 2014, when I was very anxious, and I felt that my mind is very delicate, and it can become full and empty anytime, I suddenly started feeling that I've started listening to people in an abnormal manner (I felt I started listening from the back of my ears, in a lazy, passive manner). The same thing happened with reading. I felt I also started reading in a passive manner(in a lazy manner, like my brain is lazy and not focused). People also irritating me and bullying me in school. Then in March 2014 when I had my exams, my eyeballs started jerking and twitching while going to the next line. With all these problems, I wasn't able to study, I tried my best to study but I couldn't, and I was getting nervous breakdowns while studying, which added more tension, because I was already tensed about my exams. I also started becoming violent and aggressive with my parents. So after my exams in May I went to the psychiatrist. The psychiatrist prescribed sulpitac 200mg, which he increased to 300 after 1 month, and pacitane 2mg. I thought it would make me better but it made me worse. All the side effects such as delirium, mask like face, Parkinsonism etc made me worse. It also made me feel schizophrenic. I started getting more and more negative thoughts. Then when I had my exams in October, with all these problems I couldn't study, I was getting worse nervous breakdowns, and I felt that it would be better to die. I also lost interest in all my activities. While writing my exam in October, I was behaving abnormally, I didn't know what was going on, I felt I have the worst life, I felt that people are conspiring against me, and I felt like committing suicide. Then I also started hearing voices, which were like a tune, and I felt that those voices were from the people who were abusing me and bullying me in February and March. I couldn't tolerate all this. I got my eyes checked for this twitching and jerking of eyeballs, the eye doctor said that my eyes are perfectly normal, the eye drops didn't help, and I got my ears checked for this listening problem of active and passive listening, my ears were fine, and the ear drops didn't help. So I went to the psychiatrist in December and told him to stop the drugs. He stopped pacitane, he reduced sulpitac dosage from 300 to 200mg, and along with that he prescribed arip mt 5mg and kemadrin 2mg. I took that for 25 days In January but it didn't make me any better. My psychiatrist refused to stop it, so I stopped it myself, and told him that I will go to another psychiatrist. I didn't take any drugs for 7 days then. All the side effects like Parkinsonism, mask like face, dry mouth etc went away and I could hear the voices less, and I stopped being violent. Then I went to a new psychiatrist after those 7 days and he said that it was anxiety which was the problem which was causing depression. He said that anxiety is directly proportional to performance to a certain extent, and when the anxiety increases further, the performance level drops which is exactly what is happening to me. He prescribed despol and clonotril, with which I am feeling much better than before. I stopped hearing those tuned voices, I am less anxious than before, twitching of eyeballs has reduced, I started expressing myself, I again got interest in my activities, I stopped feeling that people are conspiring against me and I started enjoying life and listening to music. But I still feel that my life is not continuous, and that I can't listen properly, and there are 2 ways of listening, active and passive, and 2 ways of reading in my mind, and this trouble in the brain still irritates me. Now what is your opinion about all this? Is it anxiety and depression only which is the problem? Because I have my board exams in 2 days, and I didn't pay attention in school or in tuitions or anything because if all these problems, and I have no idea about the portion, I'm totally helpless, no one cares about me and I'm feeling lack of confidence. All these wrong drugs and problems made me do very badly in my 10th standard and in my preliminary examination, and I'm hoping that that should not happen in the board exams also.

And I still feel that everyone else in the world has a much better life than mine, because my life is not continuous, and theirs is, and I feel that my end is any moment from now, and they don't feel like that. I still remember all those thoughts of committing suicide and all.

And everyone else was/is not on all these medications and I am.

And I keep thinking of myself as someone else, and when I do that, I feel that that person has a much better life than mine because his life is continuous, which makes me more anxious and depressed. And I keep thinking that before January 2014 I was fine and now I've become abnormal and I want to go back to that time and I don't feel like living only now.
doctor
Answered by Dr. Seikhoo Bishnoi (10 hours later)
Brief Answer:
These symptoms are occurring due to anxiety and depression

Detailed Answer:
Hello again, I apologise for late reply because of busy schedule

I have read the details you provided and I can say with more confidence that these symptoms are occurring due to anxiety and have resulted in development of depression. You had complaints of listening voices in abnormal manner which you used to think that you can hear in active and passive manner. The problems like some one is conspiring against you could be occurring due to psychosis but they can also occur in severe anxiety. Feelings that brain is empty which are not up to the levels of unshakable belief as in delusions are most likely the part of anxiety.

It could be occurring due to obsessions as these are repetitive thoughts in your mind which you know that they are purposeless still you cant get rid of these thoughts. Do you think that the thoughts of emptiness in brain are not right and still you cant control them? or You have strong belief that your mind is empty?

To some extent the thoughts that you are reading or listening in passive manner and active manner are also due to anxiety. Though detailed evaluation is needed to ascertain final diagnosis.

Feelings that others have good life as compared to you could be due to depressive symptoms, and this can occur due to anxiety. Aggravation of symptoms with exams or stress, presence of insight for illness also strengthens the diagnosis of anxiety. As we discussed earlier also that twitching of eyes, difficulty in reading etc symptoms were certain symptoms of anxiety only.

Try to relax yourself and reassure yourself that this is anxiety only and nothing serious. Take your exams with confidence and then visit your psychiatrist again and get yourself evaluated again. As per my opinion as symptoms are persisting so there is need to increase the dose of Dapsol or to replace the drug with some SSRI drug like Fluoxetine which would control the symptoms of anxiety more effectively and you will feel better.

Thanks, hope this relaxes you to some extent. TAKE CARE
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (15 hours later)
I just got to know why I have all these problems. It is because of that bullying in February and March 2014. The bullies were threatening me that they are going to send people to my house to kill my family, and I didn't say anything back to them or didn't complain to anyone and I just took everything seriously what they said to me and felt bad. Everyday they were doing that, and everyday I got more and more depressed. And then when I began to study for my exams in March, when I started reading, I was only thinking about those bullies bullying me and threatening me, and so I suddenly found my eyes jerking while going to the next line. Even before and after the exams they were bullying me, and they were forcing me to be their slave. I did whatever they told me to do, which even got me more and more depressed and anxious because whenever then I was entering school, I was worried and scared that those bullies would bully me again that day. And in October, with sulpitac and pacitane which caused more problems, I felt like committing suicide. Even now when I think about those bullies, I feel some irritating feeling in my head, and I feel that those bullies are greater than me. And those thoughts of committing suicide have still not gone. And I'm very upset about this because my parents didn't even care about that bullying, and it's all my mothers fault because she didn't teach me how to not be bullied and what to do in case of bullying. And those bullies were threatening me that if I complain, they are going to kill me, so I didn't complain. And now I still feel like committing suicide. And I feel that even after my board exams get over, I will still not be happy because that depression won't go and that irritating feeling in my head about those bullies, and those thoughts of committing suicide won't go. And I just read on the internet that bullying exerts psychiatric effects into adulthood, and those thoughts of committing suicide won't go even during adulthood. I'm very upset about this, and even if I get the most expensive car in the world free, I still won't be happy, or if I get anything new, I still won't be happy, because I have all these problems. And this jerking and twitching of eyeballs while going to the next line is still happening and is not going, and now I feel that I have an understanding problem because of that. And my board exams start the day after, I don't know anything and I'm not able to study because of all these problems, and now I'm very upset. Now what do I do? I am totally helpless. Will these thoughts go or not go? And these irritating feelings in my head when I think about these bullies? And before people were bullying me, I was perfectly fine, I used to get very good marks, and they were jealous of me that people have started liking me, and I am very intelligent, so that's why they started bullying me and threatening me. And they made everyone in school hate me and make fun of me, and even the teachers were shocked about my abnormal behavior because of pacitane and the marks which I started getting after people started bullying me. And I feel that I started listening also in an active ands passive manner also because of that bullying, there was a little bullying in 2013 also, but not very much, but the main bullying started in February and March 2014. Dispol and clonotril are making me feel little better,my brain has stopped feeling empty, but I am not studying, and I don't even feel like studying, because I keep thinking about the past and this jerking and twitching of eyeballs happens while going to the next line, which makes me feel I have an understanding problem.

and those bullies were also telling me that I look very ugly, because I was very good looking, and was very healthy, and they were jealous of me, so I actually started thinking that I look ugly. And in February and March 2014 I started watching and doing inappropriate things on the internet, because that was the only way in which I could relieve my depression.

And those voices which I used to hear, were apparently from them and I felt that they were abusing me, although now I've stopped hearing them because of dispol and clonotril.

And I also used to feel that the world is going to come to an end, but now I get that feeling a little less.

And I thought that watching my favorite sport, going to the gym, listening to music, playing music would help me to study but it is not, and that twitching of eyeballs keeps happening because of that bullying, and I keep thinking about it.

And I've started thinking now that there are 2 ways of reading (not active and passive) - one without jerking of eyes while going to the next line, and the other way is with jerking of eyes while going to the next line, and I read in the second way, that is, with jerking of eyes while going to the next line. What do I do about this also? Are there 2 ways of reading? And I'm also trying to read aloud.

And I also feel that there are 2 ways of living, one way is by your life being continuous and not feeling that you're going to die any moment, and the other way is that by your life being not continuous, and feeling that your end is going to be any moment, and I feel I live the second way. I feel that my end is any moment from now, because I'm anxious, but I still feel that my life is not continuous.
doctor
Answered by Dr. Seikhoo Bishnoi (7 hours later)
Brief Answer:
All these thoughts are distracting you from studies

Detailed Answer:
Thanks for writing back and asking a follow up question

One thing I would like to know- Who were bullying you? Are those people belong to your school or some outside people or those were people you don't know? Whether you were hearing their voices when these people were not around? Whether you were aware of the thing that you are hearing voices were not real?

Currently the feeling you are having that you would not be happy after exams is probably due to heightened anxiety due to all these exams and stress. Once exams are over you will feel better and also complete.

Bullying during school times may affect some individuals but this doesnt mean that everyone develop personality issues. This doesnt mean that you have to live with depression through the life. If you want to read then check the details about depression, most of individuals with depressive symptoms and anxiety improve with time and they also lead normal life. Their life remain same as the life of others.

Don't think about future, your present aim should be to pass the exams and to get good marks. You are an intelligent person and don't loose your confidence. Try to remain calm and you will pass that bad phase of life.


Don't feel like helpless. Try to remain calm. The bad thoughts you are having will go and will not remain persistent. Don't think about those bullies, you are getting distracted because of significant stress of exam only. You will feel better after exams.

The feelings like two ways of living or two ways of hearing voices or two ways of reading etc appears due to heightened anxiety and obsessive thickenings. Visit your psychiatrist again for reevaluation after exams and ask for proper SSRI drugs for your treatment. Talk to your parents about any stressing thought that comes into your mind.

Thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Seikhoo Bishnoi (31 minutes later)
Boys in my school were only bullying me. Those voices which I could hear, I felt that they were coming from them only, and I could hear them when they were not around. I didn't know if I could hear them when those people were around me, because I used to stay away from them. When I used to come near them, I used to feel scared because they would bully me, and not think about anything else, so I didn't hear the voices when they were around me. Now I don't hear any of those voices because I am on dispol and clonotril, and after I stopped sulpitac and pacitane also, I started hearing the voices less. But I still feel that there are 2 ways of living, one in which your life is continuous and the other in which your life is not continuous, and I feel that everyone else except for me lives in the first way, and I live in the second way. I keep thinking about my death. And I feel that if everyone else is continuous of their life and I'm not, then that means that even studies is meant for them and not for me. And that is why I don't feel like studying, and I'm not able to study. And even when someone is talking to me, I think that his life is continuous and mine is not, so I keep wishing that I had his life. All this used to not happen till October 2014. It started happening that time. Till January last year I was perfectly fine, but I used to fight with my hands a lot, and I've made them dry. In February all this bullying and all started, and this active and passive listening and reading, and in March the twitching of eyeballs started. And when I started sulpitac and pacitane, more problems and side effects started happening. Now all those problems have gone but this feeling that everyone else is continuous of their life and I am not, keeps irritating me because of which I am not able to study, and I keep thinking that I'm going to die or collapse any moment. And I keep thinking about the past and I keep wishing that I want to go back to January 2014 or before that, because that time I had none of these problems. And what kind of an attitude am I supposed or have towards my studies and my daily/social life? Should I think that they are 2 completely different things? Or should I think that they are related to each other? Because whenever I'm studying I also feel that I have the wrong attitude towards studies, and everyone else has the right attitude. For example, when I read your answers and I read something about studies, should I think that your answers are part of my daily/social life and studies is a completely different thing or I should think that they both are related?

And when I am studying, should I think that while I am reading I am gaining more knowledge and my mind is becoming fuller? Or I should think that I have to study to pass the exam? If nine of these, what should I think? And when I am talking to someone, or I am with someone else and not alone, or I think of someone, should I think that I have their life or try to put myself in their place and then think how they are feeling? If no, then what should I do?
doctor
Answered by Dr. Seikhoo Bishnoi (22 minutes later)
Brief Answer:
Don't let these thoughts to control your mind

Detailed Answer:
Hello again

Try to avoid all these thinkings while talking to someone. Don't feel that you are inferior to someone. You have to come out of these bad feelings. There is nothing like that you are incomplete and others are complete. Distract your mind, exercise daily. After your exams take help of a Psychologist for Behaviour Therapy, which would teach you to stop these unwanted intrusive thoughts.

Some features you have mentioned denote psychotic symptoms like hearing voices when some one was not there, but presence of these voices while in fear and response to anti anxiety drugs make anxiety as more likely possibility. Still there is need for evaluation by a psychiatrist again to make the diagnosis confirmed.

You should not think that there are two different things. Try to think away from this, don't think about these things that there are complete and incomplete things.
Studies are different things and these answers are different.

No these answers will not make your mind full, free your mind and don't let these things control your mind. Don't think about control or not control, or complete or incomplete. Do nothing, just study hard and pass your exams.

Thanks
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. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5193 Questions

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Suggest Treatment For Delirium And Acute Confusional State

Brief Answer: Most likely the symptoms are not due to delirium or side effect of pacitane Detailed Answer: Hello thanks for asking from HCM I have read your query and I can understand your concern. Coming straight to your doubts. Your new psychiatrist found that you have anxiety and depression and you should not have been prescribed Sulpitac and Pacitane. Yes, these drugs are usually not the commonly used drugs for anxiety and depression. Pacitane is an anticholinergic drug and the drug can cause delirium as side effects but that side effect is seen in very high doses or in critically ill patients. It may cause drowsiness, confusion, dizziness, nervousness etc side effects but these side effects are usually short lived and usually reverse after stopping the medicine. You have already stopped taking medicine so I don't think the symptoms of confusion and delirium (?) are occurring due to pacitane. Then why these are occurring. Anxiety and depression could be possible explanation for these symptoms. In severe anxiety individuals may find it very difficult to focus, inability to concentrate, feels like disoriented and confused. So most probably poorly controlled anxiety is the reason for your symptoms. These symptoms are probably not delirium because delirium is an emergency and it doesn't runs a long course. These symptoms of confusion are not permanent and will improve with improvement of your anxiety. You have been prescribed Dapsol (Imipramine) and Clonazepam and these drugs will help in reduction of anxiety. With these drugs you will see improvement in your symptoms and will feel better. No need to worry wait for these drugs to control your symptoms. Thanks, hope this helps you. Don't hesitate to ask again if you have more doubts.