Suggest treatment for phobia, generalized anxiety disorder and panic attacks

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Posted on Tue, 3 Feb 2015 in Mental Health
Question: I have a known history of GAD, OCD, Panic disorder since I was 7. I am now 40. Diagnosed with BC in 2010, underwent chemo, surgery and radiation. I fear being alone, elevator, travelling by plane, crowded places, driving, taking medications..etc
Some symptoms I had developed lately like fear of driving, taking medications and now I fear getting anaphylaxis from food!!! Accordingly my eating is very poor.
I am over worrying, but I cant stop.
I had stopped taking tamoxifen my essential medicine because of anaphylaxis. I don't take SSRIs afraid from interaction and allergy reaction.
Please help me to over-come this fear. If I continue this way, I will die slowly
doctor
Answered by Dr. Chintan Solanki 48 minutes later
Brief Answer:
Psychotherapy is very useful in such case

Detailed Answer:
Hello,

Thanks for writing to us.
I can understand your concern and worries.

You seem to have panic disorder,generalized anxiety disorder and phobia. All are part of anxiety spectrum disorder.It can be treated with pharmacotherapy and psychotherapy.
In your case limitation is that you have fear of medicines also.
So the best option is psychotherapy.Specifically CBT- cognitive behaviour therapy is very much useful in such case.

CBT comprises of understanding of wrong automatic thoughts, its wrong interpretation and then correcting them with real and practical thoughts and applying them in your behavior. It requires 6-10 sessions of 45 minutes each depending upon severity of problem, motivation of patient and expertise of doctor.

"I fear being alone, elevator, traveling by plane, crowded places, driving" suggest claustrophobia and agoraphobia. These can be treated with graded exposure to fear and exposure and prevention technique.

Your apprehension towards medicines to be treated first.

I can understand that you have allergy to penicillin and that might be the reason of your fear of medicines. It is not at all necessary that allergy to penicillin means allergy to all.

Just understand the fact that if you do not have any allergic reaction or significant side effect of any drug within 3-5 days of starting the medicines, you will not have anaphylaxis at all with those drugs. Anaphylaxis is almost acute reaction.

As you told tamoxifen is an essential medicine for you for BC. You can not afford to stop it. Your BC treating doctor can counsel specifically for tamoxifen and clear your doubts.Just discuss about that with your doctor treating the BC.

Anaphylaxis with SSRI is very rare incident. Some allergic problem may occur but they are also quite uncommon.
Your concern about drug interaction between SSRI and tamoxifen is right. But it is not always the case. SNRI or NRI can be used if SSRI is not tolerated or not suitable. Decision for starting antidepressant medicine in your case should be taken jointly by your cancer specialist and psychiatrist.

You have been given Deanxit, Loxetanil, lexillium ; all are anti anxiety medicines. you should take them regularly to relive anxiety symptoms and after that CBT would be more effective.In my opinion clonazepam is more effective for anti anxiety effects.

In conclusion you should ask your psychiatrist for psychotherapy or if he /she is is not accustom with that,you should be referred to some specialist for psychotherapy.Also discuss about your doubts for anti anxiety and SSRI medicines to get real information.


Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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