Suggest treatment for panic attacks with generalized anxiety

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Posted on Thu, 24 Apr 2014 in Mental Health
Question: Dear Sir, I am in need of your advice. Below is the medical history that has transpired on my end I am 35 years old now. My dad had been suffering since 2010 from late stage prostate cancer. After a 3 year struggle he succumbed to the disease and passed away on 2nd December 2013 For 3 years I had been under obvious mental stress. Also during dad’s late stages I developed a weird feeling that I might have cancer myself in any part of my body and slowly developed anxiety and phobia out of it Around 2 weeks after dad’s death, I suddenly felt moderate to acute shortness of breath while I was in the loo (It was 18th December 2013). It stayed there for around a couple of hours and then settled on it’s own. But I felt slight tightness in chest and throat. Baffled by the episode and anxious with the thought that my mom will be alone without me, I rushed to the ER and did a whole body check-up, the most exhaustive one that was available as a package. It included comprehensive and complete blood-work, chest X-Ray, ECG, Echocardiogram, TMT, PFT,USG of whole abdomen, Fibre Optic Laryngoscopy. All results came normal except for my cholesterol, Triglycerides, Uric acid and SGPT which were elevated. I had fatty liver since the last 9 years. So that sort of explains the elevated SGPT and the consultant also attributed it to thatPost the result declaration the XXXXXXX consultant at the hospital (Apollo Gleneagles) advised me that there is no major organic cause and that it was from Post Traumatic Stress Disorder and Anxiety Disorder. However he prescribed the following for me and advised me to review after 3 months Rozavel 5 (once Daily) Evion 400 (once daily) Udiliv 150mg (once daily) Lodoz 2.5 mg / Zabesta 2.5 mg (once daily) Trika 0.25 mg (on As and When Required basis) (I took this only since February 2014) I took the above medication for 3 months. During those 3 months I noticed moderate improvement in symptoms. During initial days although I didn’t have intense SOB episode ,(which I had only a couple of times after the 1st one I think) I did have chest tightness, tingling pain in chest, hands, legs, shoulder, jaws etc. I also had fatigue. The SOB was not real SOB that way during normal nostril breathing and my SPO2 always measured 99% to 100% all along. But what I felt was that during deep breathing or when I wanted to breath a XXXXXXX OF RELIEF (very deep breath) through my mouth then it felt as it 20% air is not going inside and my chest and throat are tight. But strangely the SPO2 level never went below 99% ever (I have a portable oximeter with me :-) ). Sometimes it settled down on it’s own and if it lingered then I took Trika which definitely relieved me quite a bit. I have also observed that the SOB, Chest and throat tightness is relieved by sneezing, mustarbating, brisk walking, distraction and definitely when I am in a good mood (this is my observation though). Now, after 3 months, I repeated the blood-work, chest X-ray, PFT with reversibility, ECG and echocardiogram and everything again came normal !! Also now the fatigue and chest pain and tingling in hands shoulders and legs have almost disappeared. But I have mild tightness in chest and throat still although the SOB thing is much more infrequent now (I mean SOB on deep breathing). Now the medicines that I take are as follows: Rozavel 5 (once Daily) Zabesta 2.5 mg (once daily) Trika 0.25 mg (on As and When Required basis) Request you advice and guidance in the backdrop of the medical history that I have mentioned above Dear Sir, This is in continuation with the medical history that I enumerated in my previous writeup above. Please consider my latest reports that I have attached now In addition to the above history I should mention that my cholesterol, Triglycerides, SGPT and Uric Acid are also within normal limits now as per the latest blood-work. Kindly consider this information as well during your assessment Dear Sir, In addition to the above-mentioned medical history, please note that now when I feel trouble taking a very deep breath, it's mostly when I try breathing huge volume through my mouth. Not so much so when I do nostril breathing. And then that happens I do feel mild chest and throat tightness as if 15% to 20% air is not entering through mouth. But then when I change position and try nostril breathing or even mouth breathing sometimes then it's works fine .. Also if it leave it on it's own for sometime and try to distract my attention the after 5 or 10 mins I am able to take a satisfying very deep breath. Please consider this detail in addition to the detailed medical history I enumerated before please Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 10 hours later
Brief Answer: Anxiety disorder it is Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. The condition that you are having is basically panic attacks with generalized anxiety. This is a very common disorder and I see plenty of such patients in a day. Unfortunately it is not being treated by your doctor as of now except for a cosmetic trika being given. This is a disorder of anxiety and occurs cause of imbalance of certain neurotransmitters in the brain. especially serotonin, nor adrenaline, and dopamine to some extent. The symptoms that you are describing is basically catching your breath. Its very common and believe me, your physical status is perfectly fine and please do not proceed with any further investigations. It will not help you and further it will drain your pockets. This illness is diagnosed and treated by a psychiatrist. Medicines are the best options to take care of these symptoms. Paroxetine is the the most popular medicine and my drug of choice. I generally prescribe my patients 12.5 mg per day at night which takes care of anxiety symptoms. Also certain medicines like propranolol and clonazepam can be give as required when there is a panic episode or expected situation where panic attack can appear.The improvement will occur in 1-2 weeks time. Also there is an option of cognitive behavioural therapy (CBT). This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness. I have gone through your reports as well and they are mostly within normal limits and are not alarming anywhere. You need to continue the medicines given by your treating doctor and then you mayrequest a psychiatry consultation who can add up paroxetine in your regime. Also as mentioned CBT is a good option for you. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 31 minutes later
Hello Sir, Thanks so much for your consultation. Gradually I am also feeling the same over time. I just got too much paranoid about my health after that 1st SOB episode and then whatever happened with me over the last 3 months which I mentioned. I forgot to mention the following 3 points before .. 1) I get a very sound sleep each night. I sleep like dead especially when I am on Trika 2) After waking up I feel for sometime as if I am blessed and there is no SOB or tightness. After sometime it catches up again 3) Yawning relieves the mild SOB and tightness like anything. When I yawn (and sometimes frequently) I feel as if there is no SOB and no tightness .. Then after sometime it catches up ... Absolutely bizarre and confusing condition I am in Can you kindly have a look at the 3 points I mentioned above and share your thoughts please ? Your words have greatly pacified me Sir and I can sense a peace of mind now. Can I go ahead and try the medication you prescribed ? Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 1 hour later
Brief Answer: My thoughts about your statements Detailed Answer: Hello Trika is a good drug to treat the anxiety disorder symptomatically. Its as if applying cosmetics over a burn area to look good. But the wound underneath needs to be healed. Hence you feel good after taking trika but the illness has to be cured as the grass root level. Its a hypnotic drug (sleeping pill) and no doubt you will get a good sleep with it. The fact is that you need to be on paroxetine as wlel along with the trika. Trika also poses risk of dependance if used for long. Yawning is a type of relaxation exercise. You will feel good as the anxiety reduces. Other relaxations exercises like exercising. stretches and aerobic exercise will also make you feel good. Its not bizarre and it definitely makes sense. Regarding prescription. As health care magic is an online forum, legally we are not supposed to prescribe medications without physically examining you. Such regulation are primarily meant for the safety of the patients as well as the Doctor. Further any prescription given in E-mail will not be honored by the pharmacy in your country. Sincere apologies for the same. Hence I would not be able to prescribe you the medicine. You may ask your doctors to refer to a psychiatrist who can prescribe you or you may yourself go a psychiatrist who can prescribe you this medication. Regards Dr. XXXXXXX Reddy
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 2 days later
Dear Dr Shrikanth, In addition to our recent discussion (as present in the trail) I need your opinion and advise on a couple of things as mentioned below. I have attached a recent CBC blood report that I got today and the CBC report that I got on 1st February. 2 things concern me a bit and so I thought of taking your advice. I spoke to my general physician and he says that these are of no concern. But I want your advice as well 1) The haemoglobin count is 13.7 now but it was 15 in the last report. Although the 2 reports were done from different diagnostic centres. And also in December the value was 14.3. So I can see that it varies but just need your opinion on whether there is something of concern with this recent value of 13.7 2) I can see a parameter called ESR which was 5 and 6 in the last 2 tests but in the current test it's 18. Is that of concern ? I am sorry to be so fussy and I know I am getting paranoid about my XXXXXXX But I hope you understand the situation I am going through. As advised by you in our last discussion I'll meet up with my psychiatrist soon. Shall eagerly wait to hear from you on my queries at the earliest :-) Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 11 minutes later
Brief Answer: Nothing to worry Detailed Answer: Hello Thanks for the follow-up query. The variation that your report is showing of 13.7, 14.3 and 15 are acceptable. Many times it can be explained by technical problem with the machine. As long as the values stay above 11, there is nothing to worry. Further the change in the ESR is significant. However ESR is a very non-specific parameter. It can increase to such an extent even with excessive exertion or even a mild viral fever. As long as you are not having any symptom, there is nothing to worry. In case in future if you have any health problem, I will be very much available for help. If possible do update what your psychiatrist has advised to you if possible. Wishing you good health, Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 11 minutes later
Thanks Dr Shrikanth, What kind of symptoms should be of concern in the backdrop of an elevated ESR ? As of now the symptom is that mild chest and throat tightness and mild SOB which we discussed before. But that had been since December as I have mentioned and during that period the ESR was 5 and 6. Recently I had bit of a stomach upset which settled down in 2 to 3 days. So could that have impacted the ESR ? Also I had caught cold as well a week back and is in the process of recovery from that .. Can that be a cause as well ? Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 13 minutes later
Brief Answer: Your cold could be responsible Detailed Answer: Hello Your cold could be very much responsible for the raised esr. It may settle down in 2 weeks time. You may repeat it after 2 weeks. Regards Dr. Srikanth Reddy
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 1 hour later
Thanks Dr Shrikanth, Yes I can now relate. I had caught cold and had sore throat some 4 to 6 days back. It's still settling down. Also the last 2 days were bizarre in office as I had to handle 5 projects designs simultaneously. I had to divide my time to cater for projects in Tehran, KL, Colombo, Dhaka and Manila. It was crazy and I was dam stressed to the extent of being anxious to meet deadlines (in addition to my state of being paranoid about by health ha ha ... may God save me :-) ) Also I can remember my haemoglobin had fluctuated from 12.5 to 15 when done from different diagnostic centres in the near and distant past. So probably the recent value of 13.7 is just incidental and transient. 1 thing Sir.. In a bit to lower my cholesterol I had totally cut down on milk and eggs and high protein stuff .. The cholesterol is now as low as it can be and the HDL, LDL, VLDL distribution are also perfect. Should I start consuming milk and egg-whites ? Yes Sir I'll surely let you know what my psychiatrist has to say.the appointment is scheduled for this Friday (11 am) Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 12 hours later
Brief Answer: Yes it is acceptable Detailed Answer: Hello Eating egg white and milk is acceptable. There should be no problem. Take in a moderate quantity. Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 15 days later
Hello Dr Shrikant, How are you Sir ? I hope you remember me :-) Please refer the previous discussion with you for context. I want to attract your attention to the following in continuation with our previous discussion 1) As discussed with you I consulted an eminent psychiatrist in Kolkata and his prescription is attached herewith 2) However I didn't want to take those anti-depressants and as an alternate measure I resorted to Ayurveda to just try it out. I was prescribed Ashwagandha capsules, XXXXXXX juice and Brahmi tablets and had been having that for the last 2 weeks. Surprisingly I can feel that the SOB and chest tightness have greatly reduced. I definitely feel better. Sometimes I still have a sensation of tightness in upper chest, throat, forehead, face and side of eyes and at junction between the jaws and ears. But that tightness seems to go away after sometime once I do some brisk walking or I meditate. Seems like it's totally out of anxiety and stress and there is no other organic cause .. Is it so Sir ? I too have started feeling the same now although the symptoms are still there occasionally although fainter than before 3) If you remember I was worried about my increased ESR a couple of weeks back. So I did another Complete Haemogram again (attached.. Please refer file "Retest of CBC"). The ESR has come down from 18 to 11 :-) But there is slight reduction in RBC and platelets although both are well deep into normal limits. WBC count and haemoglobin has increased. Any interpretation of the results from your end Sir ? :-) In the light of the above latest development I request your consultation and advice. Specially if I should follow the psychiatrist's prescription or continue with my Ayurveda. I was worried that the anti-depressants will have side effects on other organs and so wanted to try something else first. Although it can all be in my head again .. ha ha .. Kindly advise please
doctor
Answered by Dr. Srikanth Reddy 14 hours later
Brief Answer: reports are fine Detailed Answer: Hello Thanks for the follow-up query Mr. XXXXXXX I very much remember you and your concerns. Its good to hear that you symptoms have subsided. I dont have any reservation to use uyruvedic drugs or homeoptahic drugs. I generally dont comment on their use as I have not been trained in those alternative medicine branches. I have my training in allopathy and I am a firm believer of allopathy. If you have benefitted with the use of ayurvedic medications and that you did not develop any side-effect either, then you may continue taking them as of now. However if symptoms revert then do get back to the allopathy which is well researched treatment. The medications which have been given to you are good and the psychiatrist seems to be learned as well. You may follow his advice if the ayurvedic medicines do not work. Regarding your blood reports, they are all within normal limits and nothing to worry. As I had suggested the ESR has come back to normal. Dont worry about the normal fluctuations, untill all the reports are within normal range. Hope that was helpful. Do continue your exercises and meditation as much as possible. Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 17 minutes later
Thanks Dr XXXXXXX :-) Just wanted to check one thing. Do those 2 medicines which my psychiatrist have prescribed, have any adverse side effect on stomach/liver or anything ? Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 14 hours later
Brief Answer: No major side-effects Detailed Answer: Hello You have been prescribed flupenthixole (spenzo) and paroxetine. Both of these drugs can cause some gastric irritation and acidity in some, but all said these medicines are quite safe in the dosage prescribed by you. Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy 12 hours later
Hello Sir, If I take these medications and do develop some gastric irritation or acidity then can I take any over the counter antacids like Diegene or PAN 40 etc ? As I mentioned before in our previous discussion , I have fatty liver since the last 10 years or so and my SGPT stays a little above normal always. I was a bit apprehensive about the medication because of this Thanks, XXXX
doctor
Answered by Dr. Srikanth Reddy 10 hours later
Brief Answer: Yes you may Detailed Answer: Hello You may start using the drugs and if at all you develop a acidity you may take pantoprazole 40mg. Mild increase in the liver enzymes and fatty liver need not be worried about. Regards Dr. Srikanth Reddy MD
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Srikanth Reddy

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