Brief Answer:
I prefer CBT only, No to linden or Riyan method

Detailed Answer:
Hi XXXXXXX

Welcome again. It is nice to hear that you were stable in 2016. I remember your case and probably I have still that discussion somewhere.

Your current problem is likely related to changing home. Many persons feel some kind of stress after changing the home. You have anxiety disorder and that is why you are prone to it and you are suffering. As I told before you can be treated and likely cured from your problem with help of CBT and some medicines (if you wish to take). As since 3 days anxiety is more, medicines will surely help. As you were better in 2016, it means you can be cured also with proper treatment.

If I have not sent before I am sending links,

Feeling Good by yyyyyyyyyyyyyyy burns a self help book for depression. It may be helpful in anxiety also.

You can try online CBT with following links

https://yyyyyyyyyyy yyyyyyyyyyyy edu.au/xxxx

http://yyyyy.me.uk/

So please consult some local psychiatrist and start the treatment.

And you are welcome to disturb me. Do not hesitate.

Take care.

---

Brief Answer:
CBT can cure

Detailed Answer:
Hi,

Actually from my 9 years experience I can say that in may patients only CBT cannot do everything. Medicines are needed for short time. Yes in many patients for many years medicines are required and they really do well. You are right on your part about medicines. But believe me concerns of yours are somewhat high about medicines. You can go definitely without medicines and can be cured with CBT alone. However with medicines and CBT you be cured for sure. Whatever you read if you can send me link of that article I can comment on that. I guess author is not psychiatrist but psychologist likely.

In 50 % patients with anxiety disorder relapse can occur after stopping medicines but not in all and yes if CBT added there are negligible chances of relapse.
Choice is totally of patient, doctor can give the options.

I am sorry I heard only about linden method. And I am not knowing details. I searched about it and did not find any scientific evidence about it.

Your attitude matters for cure. If you move ahead with positive attitude and start psychotherapy you can be cured for sure.

Hope your doubts are cleared.

Feel free to ask further.

---

Brief Answer:
yes you can try moodgym on your own

Detailed Answer:
Hi XXXXXXX

Yes your dp is due to anxiety. You can control on your own if you can understand that it is due to your excessive thinking. There is very much possibility that you can live normal life not only for 5 years but more than that if you can digest and apply CBT.

You can try on your own moodgym or other recommendations without consulting doctor. No side effects are there.

All the best.

---

Brief Answer:
I am not at all fed up

Detailed Answer:
Hi,

Thanks for asking your doubts. I am sorry if you are not satisfied with previous answers.
I feel I have answered but there may be some confusion which I could not sort it out.

CBT is not at all difficult. It needs dedication and attention with positive attitude. Yes you can do it.
Actually your problem is not so big but your concerns regarding your problem are more and that is troubling you. In simple language anxiety about your anxiety disorder is more.

Almost 60 to 70% of the patients with anxiety disorder like you have been cured as per my clinical experience. And they are doing well without any medicines. few of them are good with only medicines few with both medicines and psychotherapy and very few alone with psychotherapy have been treated.

Frankly speaking I am not totally aware about details of linden method so I cannot comment but considering its technique there should not be side effects.

For your information I have searched out past confirmation and sending you for your information. You can read it and may find something helpful.

You are always welcome to disturb again if you wish.

Take care and all the best.

Hi Sir
I am 34 yr old male sufeering from anxiety and associated depression with obsessions also. Started in 2001. That cme once or twice in a year. So i avoid it. After 2008 it was completely dissappeared till 2012. In 2012 I got maried. Just two days before my marriage the problem stared again.It also last for one week then gone. Then again come after 10 days abd then gone. This cycle continued for almost two to three months. After that my life almost normal. Then again it came in 2015. Till that time I never went to see a doctor. i am living away from my native state for my job with my family and kid. I am govt. employee. In feb 2015 when it started. i was totally disturbed. I read many pages in internet regarding these problems. I undergone several online symptom checks. Finallly I went to my native place visited first a psychologist and apsychitrist. both of them said that I have some mood problems associated with obsessions. No need o worry. No need to take medicine. Try to change my life style and try some relaxation technique. Afetr 1 month I consulted one more psychiatrist abd he prescribed me nexito plus medicine for one month and diagnosed the problem as OCD. I came back to my workplace did not consume the medicine. almost three months gone without any problem. But in aug problems stared again. Actually I am in a dilema, I dont know what to do. my wife is also worried about my problems. I have anxiety some times obseesions and depression, Pls give me aguidance sir. I want to live a normal happy life with my family.
Asked by XXXXXXX , Sun, 4 Oct 2015
Doctor's reply to question above...
Brief Answer:
cognitive behavior therapy and stress management will help

Detailed Answer:
Hello XXXXXXX

Thanks for writing to us.

From your history it is clear that whatever the psychological problem OCD, depression or anxiety it is not severe enough which requires medicines. Problem is frequency of the problem. Episode subsides with your efforts or on your own with some efforts. It means you can come out of the problem permanently with professional help.

In any of the mentioned problems Cognitive behavior therapy (CBT) is specifically used to correct automatic thoughts and distorted cognition.

In CBT psychiatrist/psychologist helps person to identify his/her automatic thoughts and faulty behavior which would ultimately be modified by person with active efforts and help of therapist. It also includes time management, daily sleep, meals and exercise timing.

Relapse of your problem should be associated with some stress likely. You need stress management also. It is also part of CBT.

I have successfully used CBT without medicines in few patients of depression, anxiety and OCD with mild severity. You can also be cured with the same in my opinion.

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.
Replied by Dr. Chintan Solanki , Sun, 4 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir Thank you so much for your reply. I think that you really identified my problem. I also know that my problems are not lasting for weeks or months. Since 2001 only in this year problems are increased. But in this year also durations are not big but frequency increased significantly. In between 2008 December to February 2012 I was completely OK. Even one single episode was not happened. In between 2012 and 2015 only one episode happened. But Feb 2015 onwards I was disturbed. Problems are coming and going. That's why I went to a doctor and consulted you also. Anxiety depression and obsession are there. But none them last for weeks moreover these are coming together. That's why I also hesitant to take medicine. For which problems I have to take medicine. I don't know. So I think your opinion is right. May I know something more about CBT. How much duration or spell it required. Is any significant side effect for CBT. Is it available in XXXXXXX because I am residing near to XXXXXXX Sir I really want to come out of this problem permanently. Hope you will help further.
Asked by XXXXXXX , Sun, 4 Oct 2015
Doctor's reply to question above...
Brief Answer:
find details about CBT in following links

Detailed Answer:
Hi XXXXXXX

Thanks for follow up.

CBT has no side effects. You need to give time for sessions. Role of therapist and patient matters for effective CBT. For detail information you can read following links.

http://www.nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx

https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
XXXXXXX has lots of psychiatrists. You can find the names with following link.

http://doctor.healthcaremagic.com/doctors/Psychiatrists-in-Pune/L18934S35/20

I recommend Dr. Dhavle and Dr. Deshmukh.

However you can choose any psychiatrist near to you. But the point is that very few psychiatrists will be ready for exclusive CBT. Never the less you can ask to any of the psychiatrists about the clinical psychologist who is good at CBT.

Feel free to discuss further.
Replied by Dr. Chintan Solanki , Sun, 4 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir Sorry for disturbing you again. Can you identify my problem. From my experience can you tell that it is depression anxiety or OCD or any other problem. Secondly if CBT is unsuccesfull then I have to undergo for medication. If yes then what are the side effects of medication.I am deeply concerned about my problems.
Asked by XXXXXXX , Mon, 5 Oct 2015
Sir One more query is that one doctor prescribed me nexito plus. in your opinion how is this medicine. Is it useful for these problems. What are the side effects of this medicine.
Asked by XXXXXXX , Mon, 5 Oct 2015
Doctor's reply to question above...
Brief Answer:
I need detail history and mental status examination for diagnosis

Detailed Answer:
Hi,

Thanks for new queries.

From your available history possibility of anxiety disorder is likely. For specific diagnosis I need detail history and mental status examination.

Yes if CBT is unsuccessful (that is unlikely I guess) you may need medicines.

No significant side effects of medicines are there and exact side effects depend on type and dose of drug.

Whatever the diagnosis from above three medicines will remain same with minor variation in dose and duration of treatment.

Nexito plus contain escitalopram and clonazepam. Escitalopram is an SSRI group of medicines and good drug with the least side effects profile and used in anxiety and depressive disorders. Clonazepam is a benzodiazepine and helps in anxiety and sleep. No significant side effects of nexito plus are there. If you feel sleepy or drowsy you should use plane nexito (escitalopram).

Hope this answer will help.

All the best.
Replied by Dr. Chintan Solanki , Mon, 5 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
May I know that the things I posted is exclusively visible to you only or is it available to public those visiting the site. I wish to post my medical history. that is why I am asking
Asked by XXXXXXX , Tue, 6 Oct 2015
Doctor's reply to question above...
Brief Answer:
it is between you and doctor only

Detailed Answer:
Hi,

Things you posted will be visible to you and me only and also to the person handling the site and moderating communication. It is not visible to public at all.

Whatever the samples of question and answers you can see on site do not disclose identity of the persons. And on request of your after completing the consultation you can ask to customer care to remove all communication also.

Take care.
Replied by Dr. Chintan Solanki , Tue, 6 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
Thank you so much for valuable support. I will try to explain the mental history in detail.
Let me introduce myself. I am 34 yr old male working in central govt. as a class II gazetted officer. I got married in April 2012 and have a boy kid of 2yrs. I am staying away from my state (south india) in XXXXXXX
My problems started in XXXXXXX 2001. Immediately after my study at that time I was preparing for an interview for a private job. During that day I feel tensed (not because of interview, I think so), lost concentration to study, loss appetite, early morning sleep disturbance, shivering of legs and hands, these are the symptoms. Two three days gone like that and one day some obsession thoughts came into my mind. I had a feeling that I will physically attack my brother. That time I spoken to my mother and brother. They told that it will go don’t worry. Next day I went for interview with my mother. The problems lasted two more days and then completely gone. I cleared the interview and worked there for three years. I was away from home (weely visited home). In that three years these problems are came like episodes but not severe as my 1st experience. These episodes lasted for weeks or some days. During episodes sometimes I was comfortable sometimes I was disturbed a little. After three years I got a govt job near to my home and joined there in 2004. In 2005 feb one episode came like my 1st experience and lasted for two weeks. But in between I had an affair with my cousine sister. Actually I was in love with her. But she just liked me as friend rather than brother. This affair started in 2001 also. Why I am telling is that after 2002 to 2008 60% of my problems are started because of her relationships with her lovers. She loved me as a friend and at the same time had affairs. So most of the time trigger of my episode was her affairs. My family was aware of my problems with her, So whenever I got tensed they thought it is because of her. They were not aware about my mental problems. After my 1st episode I didn’t disclosed a single episode to my family. So from 2002 to 2008 episodes are started some time because of her and some time without any reason. But episodes lasted for weeks or some days only. When that happens I thought better to consult a doctor but I scared to consult a doctor. After the episodes I was completely Ok. Yearly two, three times these episodes happened. Not exactly every year. Approximate guess. In 2009 she went to gulf and I got central govt job in XXXXXXX Sir I can really say that after 2008 dec to april 2012 one single episode was not happened. Two happened but that is of genuine reasons one is that I met when she came from gulf for the first time in 2009 aug and the second at the time of her marriage. I can specifically say that that was only because of that incidents. Apart from that almost 3 and half years I was completely Ok. So I thought my problems are over. From 2009 onwards I was staying away from my state also. I thought about my marriage in 2011. As I was completely Ok I never had a feeling that I am doing injustice by engaging in a marriage. Such kind of thought never came in my mind. And I got married in 2012. From 2008 dec to 2012 april I was 95% Ok. Only two episodes with genuine reasons happened.
But unfortunately three days before my marriage the problems started again without any trigger. I was totally broken because I never thought that it will come back. I thought to cancel the marriage but that didn’t happen. I got married and the episode started three days before marriage lasted for almost 10 days and gone. Then I was completely Ok. After two weeks I came back to my workplace for two week stay. But after two days of my arrival to work place the problems started again I went back to my home after one week. At that time my wife and my family came to know that I have some problems. After reaching home two to three days staying there again I was completely Ok. Two weeks I stayed there then went back to workplace with my wife. After came here the problems started again but this time it was due to some obsession thoughts. I had a feeling that my wife is not so glamour. My choice was wrong. I was trying to convince me. But I got severely tensed and episode started again, after two weeks I disclosed about my feeling to my wife. Means she was not beautiful. She was really crying. But once I expressed my thought to her my problems started decreasing slowly and I was ok till 2015 feb. In between these three years only once the problem came and lasted for only one week. By hearing about my obsession thought of my wife glamour the psychiatrist diagnosed me as OCD. But after 2012 XXXXXXX that thought completely disappeared from my mind. I was 90% ok from XXXXXXX 2012 to 2015 february.
I can say that all the times I suffered almost similar symptoms that I mentioned earlier. And I was completely ok in between the episodes.
But in this year February the problems started again without any specific reason. Anxiety was there with obsession thought and depression was also there. But the symptoms like early sleep disturbance shivering of hands and legs were almost absent. Loss of appetite was present at some time only. But this time I really shattered search in the internet about these problems and tried several online symptom checks finally I went to my home. My wife parents were also came to know about these problems. Accordingly I consulted two doctors in my home town one psychologist and one psychiatrist. Both of them diagnosed not serious problem, at present no need of medication. So I came back with my family but problems are came in between. Then in april 2015 I went to home again consulted a psychiatrist and by hearing about my obsession thought of my wife glamour the psychiatrist diagnosed my problem as OCD and given nexito plus. But I didn’t consume the medicine. Then I came back to workplace alone left my family in their house. I was almost Ok on may XXXXXXX and July. In july I brought my family back. In august the problems started again lasting for one week gone then came after one week and are going on. My wife is totally disturbed with my problems. I also don’t know what to do exactly. Because I can clearly say that I was completely Ok in the last week but in this week I am disturbed a lot.
In this year symptoms like early morning sleep disturbance, loss of appetite were almost absent. But some physical symptoms like headache, numbness in face were present. In feb 2015 during episodes some obsession thoughts like I will thrown my kid from top floor present. Not all the time. Some time only. But now that is completely absent.
One more thing I really need to mention is that from teenage I had some obsessions and anxiety problems. Obsession means repeatedly doing something, some kind of numbering systems etc. But that was not severe at all. Not disturbing at all also. Not associated with my problem episodes also. And anxiety means associated with diseases. For example during dengue fever season if I got fever then I rush to the doctor and confirmed that I had not dengue fever. But as I got matured and read books search internet I came to know that these kind of obsessions and anxiety problems are small kind of mental disorders. As I came to know that fact I tried to control that and I can clearly said that I completely controlled that both problems. Both are completely absent from many years.

I really want to come out of these problems permanently. My wife is ready for treatment but after hearing about medication she also worried. Sir please help me to come out of this problem permanently.

Hope you help me further.

Thanks
Asked by XXXXXXX , Wed, 7 Oct 2015
Doctor's reply to question above...
Brief Answer:
It is likely panic disorder, not severe, without medicine it may be treated

Detailed Answer:
Hi Mr. XXXXXXX

Thanks for excellent details. I am sorry for delayed response. Actually your narration was long and I had busy day. I read your problem twice.

Your illness is not continuous means very less possibility of OCD.

Depression symptoms can appear secondary to any type of anxiety problem but to diagnose depression problem should be sufficiently disabling and needs attention for treatment. Primary diagnosis of depression is also less likely.

You had anxiety symptoms like panic attacks most of the times. Symptoms started with some stressful situations/incidences most of the times. Sometime you had apprehension about such symptoms/problem when you are normal in between panic attacks. These all suggest possibility of panic disorder though severity is not so much. You feel depressed and worried after such episodes only for few days and recovered on your own. As time progressed your episodes duration is increasing likely and you are worried more about the same.

If you have progressed well in your career according to your caliber with these disturbances, there is no severe disorder that is confirmed.

Even after 4 years of marriage your wife is cooperative to you and no major relationship problem also suggest that your disorder is not severe.

As you have controlled your apprehensions regarding dengue on your own I think you are good candidate for CBT.

To alleviate panic attack I would like to suggest some approach.
General approach to manage panic attack is relaxation therapy and deep breathing. Take deep slow breathing. Inhale for 3 seconds, keep breath in for 3 seconds and exhale for 3 seconds. Do it for 10-15 minutes. You will feel relax.

Apart from medicines you need to maintain healthy lifestyle. This includes regular daily exercise (walking or running), hygienic food habits ( no junk food, no fatty food, preferably only home-made food with law salt and fat with more fruits and vegetables) and timely scheduled sleep. Yoga- meditation can also help.

In medications anti anxiety medicines like clonazepam or etizolam can help as on when required basis.
Simultaneously CBT- cognitive behaviour therapy can stop panic attacks and can cure the same if applied genuinely.

At any stage if you need medicines no need to worry about the same. Latest medicines are enough good without significant side effects and they can be stopped under doctor's guidance. Inform this to your wife and ask her to relax and not to worry.

I suggest reading criteria for OCD and Panic disorder according to DSM-IV TR or DSM- 5 to get some idea about your problem.

Hope this answer will provide some help.
Replied by Dr. Chintan Solanki , Wed, 7 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir Thank you so much for your support. Inspite of your busy schedule you read my long story and give me a positive response. Once again thank you so much sir. I am completely agreed with your opinion about depression and ocd because my depressive episodes are coming with anxiety or obsession and lasting for only two to four days. My obsessions are also not continuous but the obsession thoughts are really disturbing me when they come. Some more queries are, the breathing technique you mentioned is to be done regularly or at the time of anxiety problems only. Based on your suggestions I made a plan, please advise me my plan is that firstly I will change my life style in terms of food, sleep, exercise etc try to practt yoga or meditation. If it not give good result then I will go for CBT with the help of a good psychologist or physiatrist. And both of them fails only then I will go for medication. Is it fair sir. Or I have to do the first two steps simultaneously with medication. Pls guide me. Regarding your opinion about my career I can clearly say that I got a job that is the topmost in terms of salary and status with my qualifications. My wife also cooperative. Yes she is definitely worried about my problem. But she is adjusting and assured me that she will with me till the end. Right now I have some physical problems like headache, feeling that my ear is blocked etc. But after my discussion with you I have improved a lot. Sir can you said that if I need medication then what will be the minimum duration six month, one year etc.The stigma associated with medication is still disturbing me sir. Expecting good reply from you sir I assure that will not disturb you further. Thanks and regards. XXXXXXX
Asked by XXXXXXX , Fri, 9 Oct 2015
Doctor's reply to question above...
Brief Answer:
no medication in first step

Detailed Answer:
Hello Mr . XXXXXXX

Again sorry for delayed response. You are not disturbing me at all. This is just coincidence that I am busy with some work for few days.


Deep breathing you can do regularly as a part of meditation or yoga but you need to do so specifically when you feel more anxiety or panic attack.

You have decided almost right plan. I recommend going for lifestyle changes with psychotherapy simultaneously as lifestyle is part of behavior therapy.

If after 3-4 months of psychotherapy no sufficient improvement we can go for medicines.

If at all medicines are required medicines should be continued at least for 6 months after complete improvement so duration varies according to drug response and your symptoms. Probably in your case not more than a year that is for sure. No need to worry about medicines as they are like same as you take for other physical problems.


You have support of your wife. Go ahead.

Do not hesitate to ask further if still any doubt.

Take care.
Replied by Dr. Chintan Solanki , Sat, 10 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir thank you so much for your support. Now I have a right way in mind to go ahead. I will follow the plan as advised by you. I will let you know the progress and results. Only one doubt left in my mind is that the side effects of medicines means what means the effects are purely physical or it is mental. Once again thank you so much sir XXXXXXX
Asked by XXXXXXX , Sun, 11 Oct 2015
Doctor's reply to question above...
Brief Answer:
more physical side effects but not in all persons

Detailed Answer:
Hi,

Let me clarify you about side effects of medicines. When you take paracetamol for fever it also can cause side effects in some persons but it is in less than 2% of the people. Likewise all medications used for psychiatric problems can cause some side effects but not in all persons. Common side effects like nausea, vomiting and headache occur in 3-6% of the people. Most of the side effects are reversible. And no serious side effects of most of the medicines use for depression, OCD or anxiety.
Some psychological side effects like irritability, anxiety and nervousness can occur with these medicines but not in all patients.

By chance if you need any medicine ask the doctor about side effects of that medicine and doctor will clarify you. Internet can give you list of side effects but clinical experience provide right info from doctor.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page

All the best and wish you early recovery.
Replied by Dr. Chintan Solanki , Sun, 11 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir

I will close the discussion after this question and answer.

Regarding side effects I heard (via internet) that some people are saying that after consuming medicine their identity really changed. Means their problems are almost solved but they felt that they are not like what they are before medication. Means it changed the entire mental status of the person. I dont exactly what it means.

Secondly can I live my normal life with this medicine. Can I do my all routines. Right now I am having medicine for cholestrol. Can I take this medicine with psyichiatric medicine. Can I have a normal sexual life with this medicine.

Hope you will clarify.

Thanks and regards
XXXXXXX
Asked by XXXXXXX , Mon, 12 Oct 2015
Doctor's reply to question above...
Brief Answer:
No it is not true for medicines for depression and anxiety

Detailed Answer:
Hello,

There are almost more than 350 diagnoses of psychiatry disorders. Some rare occurring disorder like schizophrenia or uncommon disorders like bipolar disorder may need anti-psychotic medicines. These may have some side effects on person's behavior. However disorder process itself changes the person's identity and behavior drugs alone are not responsible. And believe me it is very rare possibility.
For disorders like depression, anxiety or OCD such medicines are not used and no such side effects I have observed in my patients with such problems.

Yes you can take the medicines with cholesterol medicines. Of course you can live normal life with medicines. Some sexual side effects are there with SSRI medicines but not always and not with low dose and ultimately they are reversible or treated if by chance it happens.

I wish you good health and probably you do not require medicines.

Take care.
Replied by Dr. Chintan Solanki , Mon, 12 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Hi Sir
Once again I am here to disturb you.
As adviced by you I read dsm 5 for OCD and Panic attack, not fully. But I have a feeling that my problem is not panic attack.Most of the times my problems are started with slight anxiety. And it increased slightly then some obsessions and depression started and then gradually decreasing all the problems. Most of the times are like this. Some times it started with obsession then anxiety and depression comes. One or two times panic attacks were happened during the episodes.
Actually I am realiy confused. My first psychiatrist identified as mood problem, second identified as OCD and you identified as panic attacks. Exactly what is the problem I dont know. After discussing with you I was almost Ok for one week. Then again problems started. It also last for one week. And after that I was completely Ok. Means from oct 21 to 27 I was completely Ok. Almost like a normal person. But from 28 onwards again my problems started. I can say that for this month actually my problem is that when I was Ok, at that time also I was thinking about my problems and got a feeling that ''now I am ok, but how many days will go like this surely my problems will come again'', these thoughts come in to my mind during my normal times and as the day progresses these thoughts really starts disturbing and I am sliping from normal to problems. Really this is happeninng for the last one month. Means by thinking about my mental problems again I am sliping into that episode from normal life. This monday I was completely Ok, but by thinking about my mental problems anxiety started slowly on tuesday afternoon and from yesterday onwards I am feeling anxiety and little depression. I really dont know what to do.
Sir please help me.
Asked by XXXXXXX , Thu, 29 Oct 2015
Doctor's reply to question above...
Brief Answer:
sometime treatment matters more than diagnosis

Detailed Answer:
Hi XXXXXXX

Thanks for contacting again.

In psychiatry diagnosis is done on basis of history and mental status examination. Still there is no objective way of diagnosis. You are suffering from anxiety spectrum disorder (OCD or panic) that is confirmed and secondary to that some mood symptoms (depression) are happening. Sometime treatment matters more than diagnosis in psychiatry. Please do not go into detail about diagnosis. It is confirmed that you do not have any major problem.

However with above narration and past history I feel that there is possibility of illness anxiety disorder (previously called hypochondriasis). In this person has concern about having some illness which cannot be diagnosed by doctor and anxiety symptoms appear.

You need counselling and cognitive behavior therapy only. You need to learn not thinking about your problem.

Feel free to discuss further.
Replied by Dr. Chintan Solanki , Thu, 29 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
Thank you so much for your support. I know that I have to learn to not thinking about my problem. For the last one month that is happening to me. When I was Ok, some days goes like that then I started thinking about my problems. Then again problems started slowly and increasing. For eg. today I am tensed a lot but on previous thursday(22 Oct) I was completely ok means like any other normal person that I can surely say. But on 15 Oct I was really tensed like today, but on 08 Oct I was almost Ok. Till monday I was completely ok in this week. On tuesday I was thinking that how many days will go like this defenitely it will come again, thaese thought slowly increased and I slipped in to another episode.But this story is hapeening now only. earlier (before 2012) it was not there. At that time frequency was very less. Noe frequency is very high but amplitude is somewhat less.

So in your opinion I have to go for CBT as early as possible for the recovery. Actually I am staying in XXXXXXX and I am from Kerla. I really wish to take tratment from my hometown, Means from Kochi or XXXXXXX But for that I have to take lot of leave as CBT need time. That is a concern for me. But I will try to go for CBT as early as possible.

One more thing I heard that the earlier treatment started then recovery will also be earlier. Otherwise recovery will take time. In your opinion am I late for treatment.

As I said before illness anxiety disorder was there for me years ago. But when I came to know that is a mental problem I was able to control that thought. Means I am not concerned like before regarding physical problem. But regarding my mental problems lot of thinking happening, it is too late for treatment, may be it is a serious problem, how can I live a normal life with treatment like that. So I have to control that kind of unnecessary thought, that I know I will defenitely try to stop.

Please give your advice sir.
Asked by XXXXXXX , Thu, 29 Oct 2015
Doctor's reply to question above...
Brief Answer:
You can take CBT at local place also

Detailed Answer:
Hi,

No need to take leave for CBT. Try to search for therapist near to you unless you prefer your mother tongue.

No you are not late in treatment. When total duration of episode is more, severity will be more and treatment will take more time to be effective. You are facing problem since one month more. To prevent worsening better to start treatment soon however it is not late yet.

Illness anxiety disorder does not mean anxiety for physical illness only even anxiety for psychiatric disorder can cause illness anxiety disorder also and you are passing through the same. I do not think that your problem is serious as you improve in between. If you can just avoid thoughts of your mental problems you will have good relief. CBT will also teach the same that how to remove automatic negative thoughts.

At present I am busy until Diwali otherwise I also would like to treat you through online video discussion. I will think over it if it is feasible. Let me know which languages do you know?

In conclusion please make your mind sure that you do not have any serious problem. And keep using deep breathing technique mentioned previously.

Take care.
Replied by Dr. Chintan Solanki , Thu, 29 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
You said that You I am facing problem since one month more. I couldnt understand the meaning of this sentence. My problems started way back from 2001. That is why I asked like that.

I am ready to do CBT here. But all are comfortable in their mothertongue.
I am going to my hometown for diwali. i will try to consult psychiatrist/psychologist there for a first opinion. Then I will definitely coninue here.

I am also ready to take treatment from you. It is a pleasure for me. I know english and hindi. But I am comfortable in Hindi as compared to english.Let me know the procedure/fee of your online video treatment.

Illness anxiety disorder by thinking about my psychiatric problems is started now only. But the problems taht I am facing for the past 15 yrs is still there. In your opinion evrything will be ok with CBT. Anyway I will try to control my negative thoughts.

Really I want to come out of these problems permanently.
Please guide me sir
Asked by XXXXXXX , Thu, 29 Oct 2015
Doctor's reply to question above...
Brief Answer:
Yes I think CBT can cure your problem if done effectively

Detailed Answer:
Hi,

Now first step of CBT is here. You mentioned,'' You said that You I am facing problem since one month more. I couldnt understand the meaning of this sentence. My problems started way back from 2001. That is why I asked like that.''. You took my opinion in different manner and interpreted it negatively. You need to learn positive interpretation.
I wanted to say that since one month frequency of problem in relation to previous episodes are more. Your problem is not continuous it is episodic. Positive aspect is that since only one month frequency is more otherwise it was not. And you are aware that you need treatment from psychiatrist that is again positive part otherwise many of the persons consult physicians and spend lots of on investigations frequently.

I hope you will find some therapist in your native.

I am comfortable in English, Hindi and Gujarati. At present I have not established any charges for video consulting. But yes probably it would be done through skype or google hangout. When it will be needed we will discuss.

From available history I can definitely say that CBT can cure your problem if skill of therapist and efforts of yours are sufficient.

Be hopeful.

If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback and rating so I can improve my service. In future you can contact me directly on this site if you wish with this link:
http://bit.ly/drchintansolanki
by clicking on 'Ask me a question' on same page.

take care.
Replied by Dr. Chintan Solanki , Fri, 30 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sorry to disturb you again.
From your answers and my experience I clearly understood that I had two problems.
One is some kind of Anxiety problems associated with obsession and depression. Some times anxiety comes with specific reasons sometimes without any reasons. Most of the time it disappears automatically within days or weeks. Sometimes it disturbing a lot sometimes very less.
And the second problem is that when anxiety associated problems are coming I think a lot. It may be that disease, I have to do this, It will affect my family, Need medicines and if medicines needed have lot of side effects, like that. And these kinds of thoughts really increasing my anxiety and some times when I was normal these kinds of thoughts triggering my problems.
I have to control both. But in my opinion treatment for the anxiety is more important, because once that is disappears then second has no role at all. Am I right sir? But at the same time I have to learn to control my negative thoughts also.
In your opinion probably CBT will control both the things. Am I right sir? And you wrote that role of the therapist and effort from my side is important. What is exactly means by role of therapist and effort from my side?
If you can give at least one session of online treatment then I will be very happy sir. If it is feasible to you only then sir.
I will definitely try to control my negative thoughts and do the breathing technique. I hope that I can come out of these problems permanently. Desperately I need that. I want to live a peaceful life with my family. Your suggestions and advices help me a lot and I will definitely revert back to you with my results as soon as possible.
I will close this discussion after your answer.
Once again thank you so much sir. Thanks a lot.
Asked by XXXXXXX , Fri, 30 Oct 2015
Doctor's reply to question above...
Brief Answer:
to treat second problem is more important in my opinion

Detailed Answer:
Dear Mr. XXXXXXX

Yes you understood your problem right. However more or less first and second problem are concerned with anxiety only. I feel at present second problem should be target of treatment. When you can control your thoughts about your problems it will be easy to control your anxiety problem. And it is possible that with treatment of second problem first will be also automatically treated.

CBT as described theoretically is exactly not applicable always. Therapist has to modify its aspects according to patient, culture and problem targeted. Skills of therapist matter according to me. And you as a patient need to follow instructions of therapist (like to identify-write your thoughts, watch-analyse your behavior, apply relaxation techniques) matters in treatment.

I will try to give online sessions not only once but full until you treated if you will not be satisfied with treatment at your native place. Just let me know what happens at your native place when you go for treatment.

All the best.
Replied by Dr. Chintan Solanki , Fri, 30 Oct 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
Sorry for disturbing you again. Next week I am going to my native place. I will consult a doctor there and will let you knpow the developmwnts. Before that i would like to ask you one more doubt.

I had a feeling of 'who am I' from last 5 to 6 years. Means that kind of thought happened in the previous years at times when I was completely normal. Some times when I am inj front of a mirror suddenly that thought came in to my mind, i got tensed and this thought last for only seconds. As I leave from mirror I was completely Ok. At that times I was not all in a tension episode. Means these kind of thought came when I was completely normal not a part of anxiety episode. Only once in an year like that. Means in my entire life it happened 5 to 7 times approx. All the time I was completely normal and as it goes away I never think about after that.

But in this year in september after a tension episode these kind of thought came into my mind. I know that what I am where I am etc. I am completely aware of what is happening in y surroundings. But I slipped into some previous situations like that not exactly the feeling of who am I. Moreover I slipping in to some previous situations in y life like that. I got tensed and it last for almost one weeek and completely dissapppeared.

But in this monday I was in some tension these thought of who am I came into my mind and disturbed me a lot. This is the first time these kind of thought disturbing me in my life. After that I thought that why it is happening to me what is this like that. I am almost releived from that thought but I am in hangover of that feeling. Is it part of anxiety.

I searched in the internet and know that this is not serious isssue. It is quiet a normal thing in life and happening to almost 50% of population like that. Is it right sir. I know completely what I am where I am but still diaturbing me. All these things together disturbing me sir.

Please clarify me sir. Hope that I am not disturbing me


Thanks
XXXXXXX
Asked by XXXXXXX , Fri, 6 Nov 2015
Doctor's reply to question above...
Brief Answer:
it isnot serious issue

Detailed Answer:
Hello XXXXXXX

Thanks for writing me back. You are not disturbing me at all. I am sorry for delayed response.

Your concern can be viewed from two aspects.

First is a normal concern or we can see it from spiritual point of view. Person thinks this is my body but where is my soul. Who am I and why am I here in this world and so on. Person thinks when he/she is in some dilemma about any life situation. It is normal phenomenon and occurs with most of the people. Even I myself have thought like this before. So for few years you have faced this situation likely.

In last year frequency is increased as well as you felt slight discomfort. In this case it is due to anxiety. We can call it depersonalization - who am I and derealization - where am I. It happens during some stressful situation , anxiety or depression. However it is not serious and does not suggest any neurological problem. It is absolutely reversible. You are facing more discomfort due to your underlying anxious nature/anxiety problem only not due to thought itself.

No need to worry about the same. When you will be able to control your anxiety this will not happen.

Take care.
Replied by Dr. Chintan Solanki , Sat, 7 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your answer. Right now I am relieved from almost all the problems. No anxiety no tension no depression no obsession no depersonalization or derealisation etc . but I don't know how many days will go like this. Tomorrow I am going to XXXXXXX for Diwali vacation. My wife is there since last month. She was not aware about my discussion with you. I will discuss with her all the developments and take a decision. I know that CBT is not at all possible there because it needs lot if time. Still I will have a word with one more psychiatrist or psychologist there and will let you know the developments. I am once again expressing my deep gratitude to you. And wishing you a happy Diwali. XXXXXXX
Asked by XXXXXXX , Tue, 10 Nov 2015
Doctor's reply to question above...
Brief Answer:
Hope for the best, Wish you great time at home

Detailed Answer:
Hello XXXXXXX

Thanks for wishes. I reciprocate the same.

Hope for the best. Discussing the issue with some professional in local language will help. I wish problem will never come. Just keep relax yourself and enjoy festival time with family and friends. Happy Diwali to you.

Take care.
Replied by Dr. Chintan Solanki , Tue, 10 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your wishes. I will try to relax myself and keep away from tension raising situations. Lets hope for the best and if needed I will go for CBT and so on. As on today I am relieved from all problems. If needed I will definitely come back to you for online treatment and suggestions from your side.

I am expressing my sincere gratitude to you for affection and care provided by you because for me the support from your side was not explainable. Once again thanks from the bottom of my heart.

Thanks
XXXXXXX
Asked by XXXXXXX , Fri, 13 Nov 2015
Doctor's reply to question above...
Brief Answer:
You are always welcome

Detailed Answer:
Hello XXXXXXX

Thanks for kind words. I am just here to guide you. Ultimately you are the one yourself who can change your destiny. I feel your problem is minor and no need to worry much. With positive attitude and optimistic feelings you can deal with such issues effectively.

Enjoy holidays and hope for the best.

Take care.
Replied by Dr. Chintan Solanki , Fri, 13 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir I have one more doubt. General doubt. What is mean by mindfulness. Is it a treatment. For what diseases it is used. Can you explain in detail. This is only for my information. Thanks for your wishes and support. I know that I am the only person in this world who can change my life in a positive way. I will definitely try to change the things by which I can achieve good results. Be positive and optimistic is the right attitude. I will be like that in my future.Hope that you will guide me in future also. Thanks XXXXXXX
Asked by XXXXXXX , Sat, 14 Nov 2015
Doctor's reply to question above...
Brief Answer:
mindfulness means thinking about thiinking

Detailed Answer:
Hi XXXXXXX

Mindfulness is a status of mind. It has many therapeutic applications in psychiatric problems like that is in CBT. Even it is helpful for positive mental health.

In simple meaning it is quality or state of being conscious or aware of something.

In broad sense it is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.

It is not feasible for me to write lots of details here. I am giving a link from where you can read about mindfulness in details.

https://en.wikipedia.org/wiki/Mindfulness

I will always be ready to help you.

Take care.


Replied by Dr. Chintan Solanki , Sun, 15 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.

Sir
Your wish and my prayer didn’t last long. Again I am in an episode. From 7th of Nov to 16th of Nov I was completely normal. During that period I sent two XXXXXXX to you stating that I was completely Ok. But now again the problems are starting to disturb me. This time the main thing is that kind of depersonalization and derealization feelings thoughts. It started slowly on last Tuesday and increased on Thursday and Friday. Saturday I came back from XXXXXXX and reached here yesterday in XXXXXXX On Saturday and Sunday I was not seriously disturbed. But yesterday night that who am I thought came into my mind and lasted for few seconds. After that suddenly I fall in to another episode. That who am I feeling is really disturbing me. I know very well that who am I, where I am, what is I am doing, all those things I know very well. Today I went to office and did my office work also. Bit still that feelings really disturbing me and because of that feeling I am really in deteriorating mood with depression and anxiety also. Why it is coming, how it will go. By thinking like this I am really depressed.
During normal anxiety, obsession and depression episodes I can completely and clearly communicate to another individual about my feelings. But with this kind of depersonalization and derealization thoughts I cannot explain clearly about my feelings.
Unfortunately I could not consult a doctor in my hometown. When I reached home I was completely Ok. So I thought lets wait for 2 ,3 days and then after discussing with my wife then go to a doctor. That was my thinking. But After 3 days physical health of my wife was not good. She was suffering from throat pain. Stomach pain. Some bleeding problems etc. At that stage I was not able to discuss with her about my problems and my conversation with you also. And when I was slipped to another episode no time was left for me to consult a doctor there. I am extremely sorry for that. But still my problems were not severe when I was there in my home. But today I am alone here and my mental condition is poor.
After one month I will again going to XXXXXXX to bring back my family. At that time definitely I consult a doctor that is for sure. But I have to survive minimum one month here. I don’t know how I can survive.
I don’t know what kind of help will I ask from you because you gave me all the suggestions. Still I am disturbing you. What should I do sir? Why these depersonalization and derealization feelings are happening to me? Can it be treated with CBT? I will explain deeply about that kind of feeling. When I am hearing an old song I had a feeling that I am in that old time means my mind is slipping to that old time like that and it starts disturbing me.
Hope you will clarify something.
XXXXXXX
Asked by XXXXXXX , Mon, 23 Nov 2015
Sir
Recently obsession thoughts are completelya bsent for me. But today that is also coming. Really I dont know what to do. Yesterday only I came back from my home. So return journey is not at all possible for me. If my wife heard about my current situation she will defeniteley cry. I am in that kind of situation. Really that depersonalization and derealization feelings disturbing me. Please help me sir

XXXXXXX
Asked by XXXXXXX , Mon, 23 Nov 2015
Doctor's reply to question above...
Brief Answer:
do not think about problem, short course of medicine will help

Detailed Answer:
Hello Dear XXXXXXX

Welcome back.

Thanks for contacting again and sorry for delayed response.

It is ok that you couldn't consult anyone in your town.

Considering current episode your wife's health and again returning back to work away from family are likely stressful situations in your life which have made you anxious likely.

At present I suggest do not give more attention and do not think much about depersonalisation, anxiety, depression and overall your problem. Your problem is there but it is not serious and you can do your work that is positive part.

Considering your whole history I recommend starting 0.25 mg clonazepam mouth dissolving tablet as and when required only when you feel more disturbed. Put one tablet in mouth when you feel anxious. It will make you relax. Simultaneously exercise, meditations, deep breathing, sports and other leisure activities should be part of your life.

It may be possible that when next month your family will come with you will not have problem as loneliness can create such problem also.

Again remember that your problem is not severe/major.

I do not remember that you have undergone serum B12 and thyroid hormone level testing or not. If you don't have undergone please go for these investigations.

I will be happy to help further.
Replied by Dr. Chintan Solanki , Tue, 24 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you much for your support. Actually my cyrrent problem is that depersonalization feelings. That is disturbing me a lot. Whenever I try to forget about my problems thses thought strongly come to my mind and I got depresed. It is not like previous anxiety episodes. Where anxiety was predominant. But now that thought is predominant because of that depersonalization thought anxiety and depresseion coming. This is horrible sir.

I have to start medicines right now sir. CBT is not at all useful for me. My problems not started because of lolnliness. It started when I was in my home with my family. But increased after reaching here. Before starting medicine I have to inform my wife otherwise it will be injustice to her. Thats waht I am feeling. But how I can convice her via phone regarding medicine I dont know. She is already tired with her physical problems. Sir exactly two weeks back on tueseday I was 100% Ok. How this drastic change is happening. If I am in a mood for one month continuosly then defenitely I have to take medicine. But 10 days before I was completely Ok.
I undergone thyroid test and it was completely fine.Serum B12 i didn't. What is it mean sir.

The medicine you prescribed is for anxiety sir. How long I have to continue with this medicine sir. Is any side effects for that medicine sir. Nothing is going right in my life now sir. Hope you can help me furhter.
Thanks XXXXXXX
Asked by XXXXXXX , Tue, 24 Nov 2015
Sir
Thank you so much for your support. Some more doubts I want to share with you. The medicine you prescribed is for continuous use or occasionaly. In net I found that it is dangerous to liver. I have fatty liver means SGPT and SGOT levels are much higher as compared to a normal person. All tests including LFT already done years ago and doctor said that by birth I have fatty lever no need to worry. Biopsy also done.

Is my depersonalization and derealization thoughts are part of anxiety sir. CBT wont help to treat depersonalization and derealization. Once I convince my wife about all these developments I am ready to go for CBT in XXXXXXX Shall I wait for the results of CBT before medication. Can you give me online CBT Sir

Today as compared to yesterday I feel somewhat reliefed means very little improvement. By thinking about my wife and kid I feel nervous. I had done an injustice by getting married thats what I felt. Actually I am in dielama what should I do where I have to start How I convince my wife everything together disturbing me a lot.

Expecting positive reply from you
XXXXXXX
Asked by XXXXXXX , Tue, 24 Nov 2015
Doctor's reply to question above...
Brief Answer:
better to use medicine now

Detailed Answer:
Hi XXXXXXX

Considering overall situation I recommend starting clonazepam as and when required basis. It is good drug for anxiety as well as denationalization.
You may find side effects on internet but in reality we use it more without any problem. Let me know your latest SGPT and SGOT reports. As such no liver problem is there at dose up to 2 mg.

Frequent mood changes suggest possibility of dysthymia or cyclothymia.

Vitamin B12 is an important vitamin deficiency of which may cause anxiety and depressive features. And it is commonly associated with many psychiatric problems.

You can inform your wife that I have been advised to take only one medicine and that is not daily. you can continue it for 3-4 months and then situation can be evaluated.

We can think about online CBT. However I would suggest starting clonazepam first and see the response. What situation is there in next 15 days. After that we can plan CBT.
Replied by Dr. Chintan Solanki , Wed, 25 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
I don’t know, what I will tell you.
How many problems you are identifying on me, anxiety disorder, hypochondrias, depersonalization, de realization and now cylyothymia
Regarding medicine it is a herculean task to convince my wife via phone. She is already tired with her physical problems. She is very much caring about me. When I was travelling on a train alone she always told me to sit inside the train don’t get out of the train. How can I convince her that is also without physically consulting a doctor? I know that how valuable is your service for me. But how she will take it I don’t know.
Earlier you told me that my problem is not severe/major. But now you advised me to take medicine. What should I do sir………..
My recent LFT results are not with me. It was taken around 4 years back.
I know that you will be unhappy with my approach. But my situation is like that.
After reaching home within one month definitely I will convince her and take medicine. Before that can you give me at least one session of CBT? If CBT is not possible at least one video chat so that you can identify me more. This is a request sir……
From your analysis and my experience I had a feeling that my problem is anxiety disorder that is left untreated for last 14 years and as a result now some depersonalization is also happening to me. If my anxiety is treated properly then the rest of the problems will also disappear. That’s what I am feeling.
Sir please excuses me if I write any mistake. I am in that kind of situation right now. That is why…
I don’t know what more I will write to you and got a feeling that you are also closing the shutter for me.
Right now I indirectly discussed with my wife regarding the problems and during discussion she told me that psychiatric drugs are dangerous. If possible not take it like that. Nothing I revealed her like my discussion with you and your opinion about medicine etc. Still she responded like that. Then how can I convince her
Thanks
XXXXXXX
Asked by XXXXXXX , Wed, 25 Nov 2015
Doctor's reply to question above...
Brief Answer:
medicine will make you calm

Detailed Answer:
Hello Mr. XXXXXXX

I can understanding your feelings. I am not at all unhappy. You are right on your side.

Again I want to clarify that your problem is not severe as your work and social life is not significantly disturbed.

We have been discussing since more than 1 month and I feel that your main problem is anxiety irrespective of diagnosis. You are not able to cope up with minor anxiety and start thinking more about your problem which in turn is creating more anxiety. In reality there is no specific occupational or social stress I guess.

In many patients we need to give anti anxiety drug like clonazepam for symptomatic relief. Considering your situation I think you need the same. I can understand your wife's view but believe me most of the drugs for psychiatric illness are very safe and can be used without any problem when used with doctor's guidance. Your wife should be convinced by doctor. At last one option is no need to inform your wife as you need not to take medicine regularly.

CBT includes may sessions one session is not useful. And whatever we are discussing is partial CBT. I will let you know about video chat. We can plan probably next week in noon time.

I want to suggest one recently launch new nutritional supplement which used in such anxiety. It is L thianine (α- thianine by Sun pharma 100 mg). You can take daily morning and it is available without prescription. Try this and revert back to me.

Replied by Dr. Chintan Solanki , Wed, 25 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your support in spite of my approach.
Your suggestion of without informing my wife consuming medicine is possible. But already I had a feeling that I done injustice by marrying her without informing about my problem before marriage. That was not purposely done because before marriage almost four years I had no problem at all. Still I had a regret feeling of that. Then again doing injustice to her my mind doesn’t allowing me. I know that if one professional doctor convinces her she will definitely agree. That is for sure.
Anyway after a gap of 2 months today I discussed with her my problems. So I will definitely share my experience with you to her in the coming hours. Let’s wait and see what will happen. You know before 2 months when i was discussing with her she advised me to take medicine for tension and told that many people are taking medicine for tension. You also try like that. At that time I replied that lets wait for few months. But now she strongly opposing for medicine.
I will try to control myself for the coming days. If not possible then I will return to my hometown and after discussing with her and family members we will consult a good professional doctor and take advice. And I will let you know all the developments.
I am waiting for video chat with you but how can I know that you are ready and the timing also because I think that this session may close after your answer.
Yes I know that my problem is anxiety and associated problems. If something happen then I follow that then anxiety increases a lot. Exactly two weeks before I was in XXXXXXX on the way to my home and was completely Ok. My wife is also asking that when you are here you were absolutely right. Then why it is happening like this. And she asks me to come to home and stay here. That is not practical she and I know very well.
Any way let’s hope for the best. Please confirm me the video chat program. I am eagerly waiting for that.
Once again thank you so much for your support
XXXXXXX
Asked by XXXXXXX , Wed, 25 Nov 2015
Sir
I have deep discussion with my wife. she was really crying on the phone by heraing me. I was in that kind of anxiety stage in the evening. After went to temple and spent 2, 3 hours with my 2 friends now i got some relief. She also told me that I have some anxiety problems but I am increasing my anxiety by thinking so much about my problem. And she asks me to be positive be bold as I am a male and again promise me that she will be with me. And assure that if needed she will also come with me for consultaion with a psychiatrist next time I reach home.Now that depersonalisation thought is somewhat reduced and this time the real trigger was that thought.
I know that may after two three days I will be ok or somewhat reduced anxiety stage. But again it will happen. I want to come out from this problem permanently. Any of my family member who saw me on diwali vacation defenitely say that I am Ok I have no problem at all and they dont believe that I have some mental problems becaus eI was so much Ok on that time. But me and my wife can understand my problem. I really want to come out permanently from this problem. I need a treatment on that dimension. by taking a medicine only at the time of anxiety may not heel the problem permanently, but if needed I have to take that Iknow that very well. But permanent solution is more important from my point of view and for that CBT may help. Am i right sir or CBT with medicine will help. I really need a solution. Next when I go to home defenitely I consult a good profesiional doctor there. lets hope fro the best. I will consult you in future also and waiting for a video chat with you. I am extremely sorry for anyhing I done wrong with you.

Thanks and regards XXXXXXX
Asked by XXXXXXX , Wed, 25 Nov 2015
Doctor's reply to question above...
Brief Answer:
you need to learn to deal with anxiety

Detailed Answer:
Hi XXXXXXX

It is good that you have talked with your wife. You can observer that your anxiety is relieved every time without any medications, on its own or by talking to someone. This means problem is nor serious. Problem also starts with minor life stress or misunderstanding of physical/psychological perception as problem. Otherwise there are no symptoms suggestive of any serious illness.

You just need to learn this precipitating signals and try to deal with anxiety before it increases.

You can note down my email address YYYY@YYYY and phone : 0000.

You can email me your email and phone on this email. Above phone number may not be available all time so please send sms on the same.

I will plan video chatting and let you know.

All the best.
Replied by Dr. Chintan Solanki , Thu, 26 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
I know that you are fed up with me. I promise you that this will be the last session. We are discussing since one month and I thought that you have a real idea about my problem.
I am repeating my question that by taking anti anxiety medicine at the time of anxiety can solve my problem. How it can be permanently cured. For eg. If fever come with some specific reason means due to liver problem by taking paracetamol for fever it will reduce the fever. But for permanent solution you have to treat the liver. Like in my case how it can be permanently cured.
I am not questioning you. You are a well known doctor. This is a doubt from my mind. I am not all trying to argue with you. I am extremely sorry for anything I said that hurt you.
My wife and her parents are really concerned about my problem and said that you have no problem. Everything you are created by thinking so much like that. Sir I really want to live with my family my wife and my small kid. If anything happen to me then they will also suffer. I am ready to take medicine. I will convince my wife also. As a last attempt she will say yes. I am sure. But which medicine, how long what benefit it will give or shall I go for CBT, these are the things are now in my mind. I will go to my home as early as possible and definitely consult a doctor there. But I am discussing with you for last one month. Then also proper solution not come out, then how can a doctor after only one consultation how can identify my problem in a perfect way I don’t know.
I know very well that depersonalization is part of my anxiety. That is sure. And I promise you that I will not think so much about that in future. I know that if I able to control my anxiety everything will come right in my way. Still I am having that derealisation and depersonalization is somewhat. And I am desperately trying for a transfer so that I can go to closer to my hometown. That will also help me I guess.
Today I had a deep discussion with my wife, and she told exactly as what you said. If I am having an anxiety of 10 kg because of any reason or may be without reason, by thinking about that 10 kg tension I am converting into 100 kg or 1000 kg. By thinking that why it is coming, how long it will go how it affect my future, is my wife asks for divorce, whether I have to take medicine, if medicine required is there any side effects like wise thinking I am converting this. And she told that most of the time anxiety is coming with some reasons and asked me to try to control my anxiety and if needed in future definitely we will have medicine like she replied. After that discussion I got a big relief. but whenever that depersoanlisation like thought comes again it started.
I know that many things which I mentioned here was already known to you. I know that since we are discussing for the last one month you are best person in this world to guide me properly. That is why I am disturbing you again.
I am having early morning sleep disturbance Night sleeping is not a problem. For the last three days I woke up around 5 o clock then not able to sleep further. But from 11 to 5 no problem for the sleep.
XXXXXXX
Asked by XXXXXXX , Fri, 27 Nov 2015
Sir
Some more things I wnat to clarify.
My two recent episodes including the current one starts with that depersonalisation thought. But both the time before the depersonalisation some thing was happened. In the first time I was Ok in the office and planned for the leave of diwali vacation. I had two three options was avialable.Means slots of date. Some family function was there.So i was thimking that which slot i will prefer. each slot has some advantages. By thinking so much on that I went to some anxiety and depersonalisation feelings After discussed with my wife she told me that whatever you choose that is convenient to you. After that I took a decision. Afetr my leave got confirmed that anxiety got reduced and disappeared in 3-4 days.

Then I went to home and was completely Ok for almost 7-8 days. Every time when we go to home we stayes more days in wifehouse rather than on mu home. After our child birth that is convenient for us. My mother had complaints for that. so every time to stay in my home as much as possible. This time also after staying two days in wifehouse I went to my home but after two days My wife got physically unfit si i had to came back from my home. Everytime this is happening and By thinking that again I went to anxiety and depersonalisation feelings and problem stsrted and continuing now also.
Asked by XXXXXXX , Fri, 27 Nov 2015
Doctor's reply to question above...
Brief Answer:
you are always welcome

Detailed Answer:
Hello Dear,

Thanks for follow up. First of all make one thing clear in your mind that I am not at fed up with your questions. I used to come across such patients many times and it is not all disturbing. You can continue as many sessions as you want. I just request you that whenever you want to start new session do not refill and follow up with this query but please use this link: http://bit.ly/drchintansolanki
and clicking on 'Ask me a question' on same page. This will be direct query to me and I will reply faster.

I am not all saying that medicine is permanent solution. But yes in fever we need to reduce fever by giving paracetamol and same way your anxiety needs to be controlled by anti anxiety medicines. And in some fevers only paracetamol is required no antibiotic is needed. And that is possible in your case also.
With medicines you can reduce duration and severity of anxiety which in turn reduces suffering and you may have confidence that your problem is treatable.

You are always welcome to clear your doubts. Do not hesitate.

For CBT mind should be relaxed and person should be able to grasp the abstract of the sessions. At present by suggesting medicines I would like to just make you relax. Then CBT will be more effective.

Your wife is really cooperative and understanding. If you can do some effort positively you can reduce that 10 kg anxiety to 5 kg anxiety gradually on your own without any or less medicines.

Yes I am aware about your case with detail I did not have any specific experience of video consultation and I am planning out for you which will be likely feasible between 7th to 10th December.

For good sleep there are some measures called, ‘Sleep Hygiene’ which may help you in getting sleep. You can find the same in this link: http://sleepfoundation.org/ask-the-expert/sleep-hygiene.
Drinking a cup of warm milk before going to bed helps in sleep in many patients.

Depersonalization can happen in normal person also. Thinking more about the phenomenon is creating more anxiety.

Oh I just received new follow up from you. Good you have thought about precipitating factors. Confusion about leave slot and staying at home are the factors. We can discuss more about it while video chat. Please keep note of these points. And hope you will not have new anxiety now but anytime if you become anxious just try to search for event which is preceded and causes anxiety.

Take care.
Replied by Dr. Chintan Solanki , Fri, 27 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your reoly.

Right now I am so much reileved not fully byt as compared to previous days I am quiet comfortable now. Clearly I can say that is after todays discussion with my wife.

Regarding medicne, what is you suggesting. Taking medicine only at the time of anxiety, or continue a course of medicne for minimum 6 months or any other type.

In your opinion the meeicne you suggested is like my cholestrol medicine, dont have much side effects and I can stop it without major withdrawal symptoms.
What is you expecting that by taking medicine for a particular period reduces my anxiety frequency and duration and then with proper lifestyle changes and CBT will help to permanently cure the problem. Am I right sir.

Yes most of the time some precipitating factors were there, but not excatly all the time.In this month that depersonalization kind of feeling really disturbed me.That element is still there.

Converting from 10 kg to 5 kg what are the exact steps I have to take. Now I have a clear idea about my problem. I have underlying anxiety and most of the time with reasons and some times without any reason that anxiety trigers, and by thinking too much after that then that anxiety doubles.Now my wife also admit that I have some kind of anxiety problems. That is also a good sign for me so that I can convince her next time when it comes.

So I think coming days or months will defenitely show me a way and I will follow the good way and I promise you that if needed I will defenitely take medicne, the fear of medicne in my mind is somewhat reduced.

I am waiting for the videochat with you. I am ready at anytime, your convenient time can choose.

Once again thank you so much for your support.
XXXXXXX
Asked by XXXXXXX , Fri, 27 Nov 2015
Doctor's reply to question above...
Brief Answer:
take medicine only when needed

Detailed Answer:
Hi,

You can observe that you have been relaxed after discussion with wife and in recent past after discussing with me. This means problem is not at all serious.

At present I do not feel that you need regular medicines. Take only when anxiety is more and you cannot control on your own.

Taking medicine only when needed will not cause any dependence and withdrawal and at dose of 0.25 to 05 no side effects will be there.

By chance if next episode of anxiety comes try to relax your self with deep breathing or actively thinking that this is just merely anxiety episode and it is not big problem it would go away. And even after this if you do not feel relief or anxiety is severe you can take mouth dissolving medicine.

Keep note of precipitating factors. In CBT you need to learn about these situations and what actually you could have done to prevent anxiety you have to think. Repeating this exercise every time will make you efficient to take decision without being confused and anxious. DO not give attention to depersonalization and derealization.

Now you are aware about your problem. Try your best to deal with it otherwise medicines are always there to help you out.

Yes I will plan video chat and let you know.

All the best.
Replied by Dr. Chintan Solanki , Sat, 28 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Hi Sir
Again here to ask you some questions.

One thing observed that during my current episodes, episodes when my family was with me, I didn’t reveal when my tension starts. This is because that whenever it starts I thought if I disclose to my wife she will cry, so don’t put her under pressure. So the 10 kg starts to increase and when it reaches 500 or 1000 my wife identify herself or I disclosed her. So if I reveal her at the start that will also help to reduce. Am I right sir?

From my all experiences can you tell that possibility of other disorders (schizophrenia, bipolar, depression, OCD etc.) is there? I know it is a foolish question.

If this problem left untreated is there any chances of converting it into other mental disorders.

One thing I can clearly state that till this February I was disturbed only when the problem comes and rest of the life I was 100% Ok. And the frequency as well as duration was also very less. With some specific reasons sometimes episodes last more than 10 days. Rest of the time it was a feeling of relief from some physical illness like fever means a frequency of less than one week. But since 2015 feb frequency as well as duration increased. That is why I am concerned a lot.

What you think about my future. With the help of my effort, therapy and medicines if needed and with my wife support I can have a good quality of life ahead.

I know that you are facing lot of patients day to day and your experience with the patient’s is the best symptom checker rather than internet based symptom checks.

If I start anti anxiety medicine how long I have to continue sir. If I can control my emotions now without medicine I can continue like this na sir. And if I am not able to control then I will start medicine as and when required. If I start then also can I safely stop that and can I continue my normal life. Actually what this medicine is doing in my brain sir. Is it increases serotonin?

To be XXXXXXX I never did the breathing exercise regularly only when more tension is there and only for 2-3 minutes. I have to continue it for daily basis sir.

Defelitely I will try my level best to deal with the situation before that I am clearing my queries by disturbing you.
XXXXXXX
Asked by XXXXXXX , Sat, 28 Nov 2015
Sir

Sorry to disturb you in the holiday.

Now anxiety problems are somewhat reduced. At present only two problems are really disturbing me. One is thinking about the future. How all the problems will go? Till now I skipped all the time without any treatment, but now that is not possible. I have to do something.

Secondly that depersonalization and derealisation thoughts. You already said that it is not a big problem, it is not a neurological problem, it is absolutely reversible like that. But still that is disturbing me. Now it is confirmed that my wife will be able to come here on february only. Because she is having an important exam on 31st of January. So I have to live here alone for two more months. What come into my mind that how I will live here alone for two months secondly after two months shall I forget them because of this DP and DR like thoughts? These two problems are now disturbing me.

Hope you clarify...
XXXXXXX
Asked by XXXXXXX , Sun, 29 Nov 2015
Doctor's reply to question above...
Brief Answer:
modify lifestyle

Detailed Answer:
Hi,

Welcome again.
Yes you are right that if you have described your feelings earlier to your wife or someone else you might have relived form anxiety early.

No possibility of schizophrenia or bipolar disorder at all and very less chances of OCD. Depression may be there but it is also secondary to anxiety problem.

If your problem remains untreated possibility of depression is likely but no other disorder.

It is possible that you are living alone since February or think about any previous stressful event which has triggered the symptoms.

Yes of course with your efforts, support of your wife and therapy (psycho-behavior therapy or pharmacotherapy) you can live good quality of life.

Yes you are right if any person reads on internet about psychiatric illness symptoms he/she may start thinking that there is some illness however it is not always there. Professional opinion always matters and that also differs according to professionals also.

No this medicine is just going to make your anxiety symptoms reduce or stop by acting on benzodiazepine receptors. Clonazepam does not interact with serotonin. You can try on your own and if you want to start you can take medicine to control severe anxiety and in that case you can stop without problem as you are not taking regularly.

Yes if you can continue breathing exercise and meditation/yoga daily, it may have very significant effects.

You are always welcome to disturb me but next time please do not recharge this query as it is too long. Please use previous link I mentioned earlier and with same amount and 3 follow up you can ask.

Do not even think about your problem. It is not restricting you from your work or your routine so it is not serious that is confirmed. Wait, do deep breathing/meditation/yoga, follow my suggestions and try to keep your mind busy with some activity.

You have been living alone and you can spare 2 more months. DP and DR will not be there or less in severity if you will follow lifestyle just described. Rather take living alone for 2 months take as challenge and tell yourself that you will fight with your problem and will come out of it.

All the best.
Replied by Dr. Chintan Solanki , Sun, 29 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Than you so much for your valuable reply. It will help me a lot. I am sure. Some mistake is there. I am not living alone since February. My family was with me on Feb,March,April, July, August, September and October all these months They were with me. May XXXXXXX and now in November only I am alone. Not because of loneliness this is happening. I know that. This time it started when I was with my whole family in my home town. But right now the loneliness increased my problems especial DP and DR thoughts. Sir regarding DP and DR it is not due to any chemical imbalance. In my case it is due to my anxiety. From internet I know that for DP and DR therapy is important rather than medication. So if I control my anxiety with therapy and medicine if needed parallelly DP and DR will vanish automatically. Am I right sir.If little DP and DR thought is there then also it is manageable na sir. One characteristics of my DP is that if I heard an old song or something like that I had fear that my mind is also slipping in to that old time. I know that years ago during my anxiety episodes this DP may happened at that time also. But at that time I was not aware of DP like thought so I didn't think about that. Now internet is giving information but at the same time it is frightening also. From next question inwards I will start new session. And I promise you that today onwards I will try my level best to control myself. Remove negative thoughts from my mind think positively. Actually I am not able to do the breathing as you said. But I will try everything I can to come out if this problem. I know that the wife I am having is a God gift for me because she really adjust ing with me. Otherwise in this times girls are seeking a reason for divorce. But she said that she will try her level best to continue with me. And if not possible we will together commit suicide but never let me alone. The suicide thoughts are not serious only she sharing her willingness to live with me. So I promise you that I will do the level best to come out and will definitely come out permanently with the help if god, you, my wife and with my efforts. Once again I am expressing my sincere gratitude to you sir. You are like a brother for me Thanks. XXXXXXX
Asked by XXXXXXX , Sun, 29 Nov 2015
Sir regarding video chat please let me know sir I am always ready and waiting for that
Asked by XXXXXXX , Sun, 29 Nov 2015
Doctor's reply to question above...
Brief Answer:
go for deep breathing/meditation/yoga regularly

Detailed Answer:
Hi,

If you were not alone then try to think that any type of stress were there which has triggered events.

Yes DP and DR are mostly associated with anxiety disorders. Treatment of anxiety problem is needed in that case which would stop DR and DP automatically.
Yes in your case it is manageable without medicines.

Do not much read on internet about symptomatology as your mind will be confused more and you may increase your anxiety by thinking more on information which may not be interpreted correctly by you.

You need to unlearn correlation of listening old song and DP and try to enjoy song itself.

Removing negative thoughts completely from mind on your own may not be possible but yes thinking actively positively is in your control which in turn can cause reduction in negative thoughts and anxiety.

There is no need of suicide and by any time if you have such thought please consult psychiatrist and inform your wife also that committing suicide together is not a proper way to deal with illness rather fighting and treating it together will have good overall outcome for family.
You can be treated well and there is no need to be pessimistic, be optimistic and you will have good results.

Please go for deep breathing/meditation/yoga regularly and see the results.

You are welcome and I will inform through email about video consultation.

Take care.
Replied by Dr. Chintan Solanki , Sun, 29 Nov 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Please wait while user ask another question

Sir
I am again here to disturb you. I know that I discussed lot of things with you. This time also I want to discuss something that is I forget to discuss.
As compared to previous week I am improved a lot. This may be lengthy please bear me sir.
I want to give you an idea exactly what was happened with me means the actual symptoms in the earlier episodes. As I already said it started on 2001. It all started with a feeling that suddenly something disturbed my mind. Suddenly some darkness like feelings came to mind and from that moment the episodes started. Then other symptoms like shivering of legs & hands, numbness of face, loss of appetite, early morning sleep disturbance are started. And I got a feeling that I will hurt my brother and disclosed to mother and brother like that.. After one week everything goes away perfectly without anything done.
Means I want to say that is was the real characteristics of my episodes most of the time. That physical hurt to someone not at all there in the next episodes. But rest of the feelings was there almost with all episodes. In the first episode I could not remember the point at that stated but after that lot of episode were there I can clearly said that it was happened on that time. While I was traveling on a bus suddenly that darkness to mind feeling comes then problems started and lasted for few days most of the time less than 10 days and sometimes one or two days. Some episodes I relay remember that vanished in one day. In 2004 when I was driving on bike in the evening around 5.30 that thought came in to my mind and then episodes started. Sometimes episodes started with genuine reasons but after start the symptoms were almost same. In 2012 before four days of my marriage when I was travelling on a bus the same thing happened and the episode started there. That is why said that from 2008 dec to 2012 april that kind of start was completely absent means 100% absent. Only few two or three episodes with genuine reasons happened.
What I want to ask you that these kind of start that suddenly some darkness come into mind like feeling is also anxiety or any other disorder. Till 2012 I was not using internet so I didn’t study on that. But in 2012 and in 2015 I really searched on the internet and I never got my symptom (means that darkness comes to mind like symptom) matching with any mental disorder. In 2015 first it started like that then I think lot about on that and problem increased. From august onwards that kind of start was not there really starting with some events or thoughts.
One more thing is that till 2008 when it happened it was horrible for me during the episodes but the frequency as well as duration was very less. Means I completely came out from each episodes means my life between episodes were completely normal. Only at the time of episode I was concerned once it vanished I didn’t think about that. But in 2012 and 2015 I think lot about problems and really that may increased my problem. Means I am almost Ok now but I cannot say that I am completely normal.
Means till 2008 if three episodes happened in a year covering total of 30 days then I was completely (100 %) ok for the remaining 335 days. But in 2012 it started in april before my marriage and continued till XXXXXXX end with problem-Ok –problem-Ok like that. After XXXXXXX It was almost normal. Similarly in 2015 also it started in February continued till may first with problem-Ok –problem-ok like that and completely gone. And from august till today it is again like problem-Ok –problem-ok.
I think you will clarify my doubt.
I think that I can communicate this to you in far better way while video chatting. XXXXXXX
Asked by XXXXXXX , Tue, 1 Dec 2015
Doctor's reply to question above...
Brief Answer:
it is anxiety spectrum disroder

Detailed Answer:
Hi XXXXXXX

Welcome again.

You have narrated brief history of your problem in very good manner.

It seems that your problem is anxiety related only.

Initially panic attacks were there. Apprehension of these panic attacks were lasting for a week and subsiding in a week or so. Later on after 2012 after panic attack your apprehension about your problem was increased and lasting more than previous duration and frequency increased. Precipitating factors/events were there sometimes and sometime not. From one point of view we can call your problem is panic disorder. And overall your problem fits in anxiety spectrum disorder.

It is completely treatable condition.

I request you going for some basic investigations before we video chat. CBC,RBS, RFT, LFT, Serum Vitamin B12, Serum Vitamin D and TSH. Also go for general physical examination by a doctor. We will have video chat next week. I will let you know time and date after 6th through email.

All the best.

Replied by Dr. Chintan Solanki , Wed, 2 Dec 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your reply.
Today also I am little disturbed by thinking about DP and DR thoughts. It is not severe but still it increased my anxiety a lot.

One thing I forget to tell yesterday about my obsessions. Sometimes after start obsessions were happened and sometimes problems started with obsession.

Any way I wish to believe that my problem is anxiety spectrum disorder only and it is completely treatable also.

I will try my level best to do the blood tests before our video chat.

I think I explain all my symptoms and related problems to you and after analyzing all you are again and again saying that my problem is Anxiety spectrum disorder only.

I also know that it is not like pure panic disorder but sometimes like that but it fully lies in anxiety spectrum. I have to believe that and from now on wards I will try to tell my mind that my problem is anxiety only and it is completely treatable also. By thinking like I can reduce my current tension as much as possible.

Sir can you tell something more about DP and DR how exactly its coming and what are the main symptoms like that

If that DP and DR thought relieved from my mind then I will be in a manageable condition

Once again thank you so much sir

But after directly asking questions by using the link the answer was somewhat late. Is it because you were busy or some technical problem sir.
XXXXXXX
Asked by XXXXXXX , Wed, 2 Dec 2015
Sir one more thing is that during initial trigger you said that it is like panic attack, but the physical symptoms of panic attack were not there like increased heart rate or something physically going to happen me or heart attack like symptoms were not there.

Just for clarification
XXXXXXX
Asked by XXXXXXX , Wed, 2 Dec 2015
Some more things sir during episodes sometimes physical symptoms were there. In this year also on feb mar april time severe headache, feeling of ear is blocked like that. But from august onwards no physical symptoms were there.
Asked by XXXXXXX , Wed, 2 Dec 2015
Doctor's reply to question above...
Brief Answer:
good you are moving forward

Detailed Answer:
Hi,

Sorry for delayed response. I am busy in marriage of my cousin from 2nd to 6th December so my response is late.

Though physical symptoms are not always there your problem is like panic attack. It is good that there are more psychological symptoms now.

You mentioned, ” I have to believe that and from now on wards I will try to tell my mind that my problem is anxiety only and it is completely treatable also. By thinking like I can reduce my current tension as much as possible.” This is very good. You have understood your problem and you are moving ahead to fight your problem.

Depersonalization is defined as the persistent or recurrent feeling of detachment or estrangement from one’s self. The individual may report feeling like an automaton or watching himself or herself in a movie. Derealization is somewhat related and refers to feelings of unreality or of being detached from one’s environment. The patient may describe his or her perception of the outside world as lacking lucidity and emotional coloring, as though dreaming or dead. During this reality testing remains intact.

Transient experiences of depersonalization and derealization are extremely common in normal and clinical populations. They are the third most commonly reported psychiatric symptoms, after depression and anxiety.

It can be treated with psychotherapy like CBT or drugs like fluoxetine.

All the best.
Replied by Dr. Chintan Solanki , Thu, 3 Dec 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
Sorry to disturb you in the busy schedule.

Now I am crystal clear that my problem is associated with anxiety only and obsessions as well as depression is also sometimes happening with anxiety. And right now some DP and DR like thoughts are also there. But the main problem is anxiety only. I understood that and yesterday I convey this to my wife also. She said that I am also having anxiety then why should you treat it as a disease. And I replied her that your anxiety is natural, depends upon the situation only and completely vanish after the situation and you are not at all disturbed with anxiety.But in my case I am suffering from anxiety for many years and it disturbed me a lot. So to heal it permanently I have to take treatment means yoga, meditation, CBT and if needed medication also.I think she understood the problem.

You said that it is completely treatable. Sir can you explain brifely. Where I have to start. what will be the first step and what are the remaining steps. Really I need to come out from this if permant solution not possible at least to a managable condition so that I can look after my wife and son. By thinnking about them and thinking about the future I am really concerned. I am really trying to forget the past incidents but the future is like a question mark for me. I promise you that I will do whatever I can. Please guide me sir.

One family counseelor was there for me to support. But after I denied to take nexito plus for OCD she really try to avoid me because she guided me to meet that doctor. So the people those I expected to support me are really absconding me. No problem I will fight with the help of god, you, my wife and my efforts.

Hope you will guide me in a proper way
XXXXXXX
Asked by XXXXXXX , Thu, 3 Dec 2015
Doctor's reply to question above...
Brief Answer:
we cannot forget, we should digest and accept

Detailed Answer:
Hi,

You are going on right track.

First step is to understand about the problem, why it is happening and how I can control it. You are now much aware about your problem that is a good sign.

Understand that we cannot forget past but yes we can digest and accept the bad past and put it aside in one part of brain from where it does not come again and again to disturb us.

For that whenever such episode of anxiety/DP/DR comes, you should explain your mind that this is just anxiety and I can control it and here will not be any major issue. By doing the same thing again and again you can reduce the frequency and severity of episodes.

To be treated without medicine is difficult but not impossible.

Anxiety can be normal but it is required in optimum level when level increases beyond threshold and causes distress it is pathological and treatment is needed.

Do not worry about future, accept past and try to live in present with positive attitude. This will make your future automatically well.

All the best.
Replied by Dr. Chintan Solanki , Thu, 3 Dec 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Thank you so much for your reply

I am very much aware about the problem. But one thing I wish to know that sudden attack or that kind of feeling is coming from where, if genuine reason is there it is ok. Otherwise it is because of chemical imbalance sir.

For chemical imbalnce we are saying that it is because of chemical imbalance of seretonin, dopamin etc etc. But no body know the correct level and nothing is invented fro testing this level. Am I right sir?

I am not saying that I am not ready to take medicne. If needed I will defenitely take medicne. But where I have to start? Diectly start from medicne or take medication as last part of treatment. I have to convince my wife only. If she agrees then no problem for me to take medicine. But as all wishes I also want to take medcine as less as possible. Can you explain the correct method where I have to start? What are the remaining steps like that.

I am disturbed for the last two weeks but now the severity is reduced, but not completely Ok. Lonlines may be one factor for preventing me from complete recovery. Complete recovery means that I told two times that I am now completely ok no anxiety, no depression no DP/DR like. That kind of situation is not coming. At that time I was with my family in my hometown also.

Sir I really want to come out of this problem permanently. I am ready to do anything. As I am suffering from this as a part of that my family is also suffering, my friends relatives all are living a very good life, why me and my family only suffering from this. Whenever the problems comes I think like that.

One more thing I want to tell you that in the initial stages in the year of 2002 or 2003 one day morning when this sudden attack came and at that time I told to my twin brother about the problem and he replied that he is also having smae kind of problem as he was living away from home as part of his study and said me that dont give atention it will go like that.He also have some kind of small obsession like numbering, repetetion of some acts etc. But after his study he was very busy with her job friends etc. An dhe is doing very well now.But from childhood onwards I am living alone not much of friends only that my cousin sister that I already said was my friend for some years. Now also my wife complaining me that you are not maintaining relation with friends like that. That may also increased my problems na sir.

Expecting a positive reply from you and video chat also
XXXXXXX
Asked by XXXXXXX , Fri, 4 Dec 2015
Sir
One article I read on the internet regarding anti anxiety medicines. In that they said that by anti anxiety medicines your anxiety will be reduced. But after you stop it will come back. And by continuously using it you will not learn how to deal with the anxiety. So rather than continuously using medicines you should learn how to deal with anxiety and live with anxiety. Your comments on this sir. XXXXXXX
Asked by XXXXXXX , Fri, 4 Dec 2015
Doctor's reply to question above...
Brief Answer:
yes medicines should be used with psychotherapy for better outcome

Detailed Answer:
Hi,
I am sorry for delayed response. I just reached home and checked that your follow up query is half day old.

Yes you are right that exact mechanism of neurochemical imbalance is not known. However drugs are invented on basis of hypothesis and they are working. Sudden attack or feeling happens in anxiety disorder and specifically in panic disorder. When event occurs without any reason it is due to brain activation on its own from past experiences.

I give option to patient to choose between medicine and psychotherapy when either of them can be alone effective. In your case I think you can go ahead without medicine but final decision will be yours. I have already told that you should start with clonazepam when required only with psychotherapy. If that not work after sufficient efforts then only regular medicines are needed.

You are concerned more than required about your problem now that is why you are not able to be normal completely. Your current problem is excessive thoughts “ I have some problem and what should I do come out of the same”.

Do not compare yourself with others. We do not know how much suffering is there in others same like they are not aware about your problem. Explain your mind that you do not have major problem and you need to keep patience until it go away completely.

Your history of not having friends and not able to keep relationship with others make me think to evaluate about some anxious personality problem. It needs information from your wife and parents. However in that case also treatment remains more or less the same.

Yes you read it right that in 40-60% of the patients anxiety can come again if drugs are stopped without use of psychotherapy. That is why I have mentioned psycho-therapeutic approach. Medicine may be needed to calm initial anxiety and make person ready for psychotherapy.

Hope this answer will help.
Wish you good health.
Replied by Dr. Chintan Solanki , Fri, 4 Dec 2015
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.

Sir
Again here to disturb you. You were promised me a video chat between dec 07 to 10. Unfortunately that didn’t happen. I know that may because of your busy schedule. I am accepting with both hands.
The blood test you mentioned was conducted except serum B 12 and vitamin D. As I am residing in a remote location here is no facility to conduct both the test. The samples to be send to XXXXXXX and it will take 07 to 10 days for he results. That is why those two tests (serum B12 and vitamin D) not conducted yet. But will conduct as soon as possible. Results of the remaining tests (CBC, RFT, LFT and RBS) were normal. TSH is already conducted din the month of April as per the request of psychiatrist whom I met first and that was also normal. Blood pressure and cholesterol is also normal, for cholesterol; I am taking medicine daily for the last two years.
For the last one week I was doing well. As I conveyed mu problems related to anxiety to my wife and she accepted it, my anxiety stats reducing,. Early morning sleep disturbance. Numbness of face, loss of appetite were also gone. So for the last one week was better for me as compared to the previous week. That’s why I didn’t disturb you too. But apart from my anxiety relief DP and DR always there to disturb me. But that was somewhat manageable. As I am staying alone, when I was alone in my home DP and DR increased. Similarly in my office also I have not much of work to do. So in my office also I have that DP and DR thoughts. But when I am talking to my wife on phone I was almost normal. Similarly when I am with my friends in the evening and night ( I am having dinner with two friends as they were also alone now) at that time also I was almost normal. We are discussing lot of things and I am actively participated in that discussion also. So I can say that loneliness really increased my DP and DR thoughts.
But from today morning onwards that DP and Dr really disturbing me a lot than in the previous week. By looking myself in the mirror I really got that feeling of Who Am I or Who Are You like feelings. That is really disturbing me. In one sentence I can say that it is really killing me. I don’t know how I can convey this to my wife. She really accepted my anxiety but this Dp and DR how she will accept I don’t know. She may tell that I am mad and may ask divorce also. That’s what I am feeling. I think it is very difficult for normal people to understand DP and DR except professionals like you. I searched in the internet several times and watch many videos in you tube regarding DP and DR. All telling that it is not neurological problem so you can cure it with your own efforts like that. In you tube many people those who cured from DP and DR shared their experience also. They are telling that is s because of anxiety, by your own efforts you can come out from this like that. It is not because of chemical imbalance of serotonin, dopamine etc like that. Therefore medication is not a solution like that.
Actually I thought let’s wait for one more week and after meet my family then will see what changes it make on me like that as I am going to home next week. But from today morning it really frustrating me.
I am severely affected by this DP and DR, I know very well that who I am, what I am where Iam. But still it is hurting me. What I have to do exactly to come out from this sir. I don’t know how I can go ahead. Please guide me sir. This DP and DR slowly increasing my anxiety also. I really need your help sir. XXXXXXX

Asked by XXXXXXX , 2 days ago
One more thing sir. Till this september for the last 14 years I sufeered from anxiety, depression and obsession but never DP and DR disturbed me. Yes I had that feeling once in a year like but that lasted for seconds or minutes only. Through all my anxious episodes I never got detached from reality. I know very vell that what was happening around me and what was I am.

But from this september anxiety with DP and DR really frustrating me. I cannot convey the feeling clearly. It is horrible sir. This time also I know exactly what was happening around me, who I am, what I am everything I know but still this feeling is horrible for me.
XXXXXXX
Asked by XXXXXXX , 2 days ago
Doctor's reply to question above...
Brief Answer:
DP/DR can be controlled by person himself

Detailed Answer:
Hello,

I am extremely sorry for forgetting email you about postponing video chat. I suddenly came across with some unavoidable and personal work so busy in some matter.

Reports are normal that is good but I was not aware which medicine you are taking for cholesterol, please let me know.

Your DP and DR feelings are only when you are alone this means it is not serious.
Yes these feelings should be controlled by parson himself/herself and you can do this. Medicine can help to reduce anxiety as it occurs due to anxiety otherwise medicine cannot treat DP/DR feelings directly.

For DP and DR whenever such feeling comes you need to tell yourself that you are XXXXXXX – son of so and so, husband of someone –father of someone. I am working at this place in so and so field in this city. I do not need to think or ask who am I and where am I again and again. It is not so difficult. After responding to yourself you must not think more about DP/DR and start something else work or thought means divert your mind. You should repeat every time what I have mentioned and this will surely reduce the frequency of DP/DR and can stop it gradually without medicine.

Feel free to discuss further.
Replied by Dr. Chintan Solanki , 1 day ago
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir
Thank you so much for your reply.

What you are advised by telling I am son of so.. and so husband of so and so is already practiced by me at the time of severe DP and DR. It give some relief also.

My anxiety is reduced significantly. But DP and DR whenever comes it increases the anxiety. One unique characteristics of my DP and DR is that slipping into old situations like I already said when hearing old songs my mind slipping into that old times like that. One more example is that when come across some situations like rain comes after a long gap as water touches the soil there is a smell from the soil. By feeling that smell my mind is slipping into a situation when I had that smell like that. But I cannot remember the time of the old situation that it is a memory that was happened in 2010 like that. I cannot tell that but some old feelings that was happens before but time and place is not in my mind.I cannot remember that.

Sir it may be due to my prolonged anxiety. By doing treatment for anxiety it may also vanish. CBT is good fro both anxiety and DP/DR na sir.

I will try to control this DP/DR with my own efforts and definitely go for CBT as early as possible.

I am taking Rozavel 5 for cholestrol.

Thanks XXXXXXX
Asked by XXXXXXX , 1 day ago
Sir Really I am going through a tough situation. As compared to yesterday the severity of DP and DR is reduced. But for the whole day I was in a mood that I was floating through some old situations. Yes I did everything today. Went to office had breakfast in canteen had lunch with my friend had chat four times with my wife played games in my smartphone... Everything I did.But still I was disturbed throughout the day.One moment I did a reality test also that who am I where I am like that. Everything was correct. Actually I don't know how to express my feelings to others.
Asked by XXXXXXX , 1 day ago
Sir
Sometimes I think about to commit suicide. Not take it as serious. I will never do that. As long as I remember my wife and son I cannot do that and I promise you that I will not do that. Sometimes I feels that I am going through a very stiff situation and no permanent solution is there so it is better to escape is suicide like that. I just want to tell that how difficult the situation is.
If possible can you share any experience of treatment of a DP/DR affected patient. If it is not against of you ethics then only.
I remember exactly one month before I was on the way to home and how I happy I was at that time. I really want that time back. I have afeelig that anxiety is still somewhat manageable but this current situation is horrible sir.
XXXXXXX
Asked by XXXXXXX , 1 day ago
Doctor's reply to question above...
Brief Answer:
please do not try to attempt end your life at all

Detailed Answer:
Hi,

Sorry for delayed response.

Your DP/DR feelings are not serious problem. You mentioned that by diverting it you get some relief. Carry on the same and you will notice gradual improvement.

Please do not do reality testing. It seems that you are over concerned about your problem and that is creating more anxiety rather than anxiety problem itself.

Oh dear XXXXXXX please do not try to end your life at all. I can understand your situation. Believe me your problem is not too serious what you think. Please try to live with thought that you do not have any major problem and it is like common cold problem.

In most of the patients I have seen with DP/DR is not a major issue they are generally part of some underlying psychiatric problem.
I do not have specific patient with such concern for DP/DR but yes many patient come with concern for some illness (it may be physical or psychological) but in reality there is no illness. In such patient depending upon severity I use medicines for short period and do frequent sessions of counselling to correct their false perceptions. Many of them become normal without medicine later on. In few patients medicines needed for long to control anxiety as their cognitive ability is not sufficient to correct their automatic negative thoughts.

I also want to clarify one thing that I am not all avoiding video chat. I have stuck in a situation in which I cannot spare continuous an hour. I also need to check for internet that we can communicate without disturbance. I will try my best for the same as soon as I will be able to spare time.

take care.
Replied by Dr. Chintan Solanki , 20 hours ago
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.
Sir Thank you so much for your reply and your promise for video chat. I am going to hometown next Friday. Coming Monday and Tuesday also I am not here going to XXXXXXX for official meeting. So I don't know when our video chat will happen. Sir you are the only person in this world who knows all my problems. So please tell me sir what I have to do exactly for good quality of life.I am really confused sir. What I have to do for what I take treatment for anxiety for DP or DR I don't know sir. Today is holiday for me. Floating through some old emotion's Like feeling was there throughout the day. In addition to that some kind of physical discomfort was also there. I had a feeling that I will fell down. Actually I can't differentiate that feeling is physical or mental. I can't communicate this to my wife also. I don't know how she will take it. So I am in a dilemma now. At the time of that severe anxiety I have made a plan. Means after communicating with my wife my anxiety reduced. Then I thought that after going hometown consult a physiatrist there with my wife and then do all the relaxation techniques and CBT and wait for good results and if not fully successful than go for medicine also. This was my plan. After convince myself and with this plan I really came to the right track. But this horrible DP and DR changed my plan. Now I don't actually what to do. How go ahead. Really I am in s dilemma. My wife is also not aware about DP and DR thoughts then ..I don't know sir what is next. Please guide me sir. Thanks. XXXXXXX
Asked by XXXXXXX , 11 hours ago
One more thing is that if request customer care to delete all the chat history and transaction history then how you can remember me. All the data should be deleted na sir.As I am going to home my wife may read all the chat so I thought it is better to delete it otherwise it may create more problems. Shall I do sir
Asked by XXXXXXX , 11 hours ago
Sir Actually in the evening I did everything. Had chat on fb watsap played one video game had chat with wife watched TV news football match on TV had dinner with friends everything I did. But I still had that DP and DR feeling. But during anxiety episodes I couldn't do that kind of things I mentioned earlier. From my face from my voice my wife can easily identify that I am facing some problems. But now from my face or voice nobody can identify anything wrong with me. Only I can feel that. Just now I played one video game in the computer and went to bed for sleep. But still that existential thought is disturbing me. My wife is not aware of this situation. I don't know how to come out from this sir. XXXXXXX
Asked by XXXXXXX , 4 hours ago
Doctor's reply to question above...
Brief Answer:
continue your plan, I have taken back up, you can delete history

Detailed Answer:
Hi,

Thanks for follow up.

I already mentioned that DP and DR are not serious problem. Whatever you have planned before you should carry on. Consulting doctor personally with your wife certainly help.
If you have not eaten well feeling of falling may be due to low blood sugar or low blood pressure due to anxiety.

Yes you can ask for deleting history. I have taken back up of whole conversation until now, this thread as well as previous closed thread. You can also do the same.

When other person cannot be aware about your situation it is likely less troubling and relatively less anxiety provoking. In my opinion yes your thoughts should be answered with positive active thoughts clearing reality and then diverting it will always help. It will help in long run and you need not to take medicines. You cannot control that existential thought on your own however you can of course fight with it, gradually decrease its frequency as I told and even can stop.

I will communicate through email for video chat. Just keep reminding me after 16th through emails.

Please also take note that I am giving answer this much early morning as I am going for some family work. Now I can give answer of next query after 10 pm today only.

Take care.
Replied by Dr. Chintan Solanki , 0 minutes ago
Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.

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