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Suggest Treatment For Severe Depression And Anxiety

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Posted on Wed, 25 Jan 2017
Question: Hi,

I'm so frustrated by this problem,

First, during studying time I had mild anxiety and was prescribed symbalta 60mg with alprazolam for one year and half. stopped the medication for 3 to 5 months then my problems started.

My main problem is feeling that my physical body disappeared "Does not exist", so I have to look at my arms and my legs to make sure it is there! while I have no psychological or mental problems at all but this feeling make me develop fear of going out or ride a car or get a bus. Then was put on Effexor XR with no benefits, then to Clomiprimine; which the best one for helped me put a had to increase the dosage every week by 10mg because it loses its benefits. Then tried Prozac which helped for 3 months with no side effects but I had to increase the dose every 3 weeks by 20mg until reach 60mg. My doctor asked me not to increase it anymore but after one month all my symptoms returned severely and I had been taken to ER.

After stopping Prozac, I developed another problems which are "inability to tolerate cold weather, inability to do any physical movements like walking for 300m, almost faint while taking shower; feeling like I have low blood sugar where I have to eat quickly to stop the feeling", these proplems happens when I'm not using any medications for about 2-3months.

Then, I started Zoloft 50mg, it loses its power after 4 weeks where I have to increase it to 100mg then stopped it due to side effects. "It helped with my physical feeling "the main problem" and panicking in cars and buses.

Now, I'm on Esitalopram; started with 10mg "Helped with the cold intolerance and fainting during shower" but not with my main problem "feeling weightless" and after 3 weeks it stopped working where I had to increase the dosage to 20mg. Now after 3 weeks on 20mg it loses its power too.

Do you think this problem is related to Anxiety and panic attacks? why all medications lose it is power after couple days? what should I do now? This problem affecting my life significantly.
What is you diagnosis and recommendations?



I feel my body very light weight and very dry mouth. Sometimes while driving specially I feel fainting and can not breath for couple seconds then start sweating. I had have some Antidepressant medicines "Alprazolame, Cymbalta up to 60mg for a year and have then I stopped that for 6 months then I started to have this problem. In reality I do not have any psychological problems or depression during the stopping time but I had to take Anafranil 10 mg now to solve this problem. It helped little bit with the the light weight feeling but not the dry moth or breathing problems especially while driving. I had to increased the dose 10 mg every month because the light weight feeling is coming back in the end of each month, so I reach to 50 mg today of Anafranil. What is my problem. How do I fix it without taking Antidepressant medicine anymore? Is there a solution? so sick of this problem and I do not want to take these medicine anymore. For how long do I have to use this medicine? Is there any diagnosis?
doctor
Answered by Dr. Dr. Ashok Kumar Choudhary (2 hours later)
Brief Answer:
It seems coward syndrome with strong psychological process

Detailed Answer:
Dear XXXX,
Thanks for using Healthcaremagic.

I read your query and understand your concerns.

First of all I am of the opinion that there is more than simple depression and anxiety.

Depression never mean you have sadness and it can exist without sadness.

From the very beginning I feel that you suffered with major depressive disorder with nihilistic symptoms which are otherwise known as cotard syndrome. This is a kind of depression where the person feels that he does not exist or some of his body parts cease to exist due to psychological process.


Regarding treatment as I can see there is strong psychological component which is affecting the action of medications over a long time. As I see you get good response even with minor dose initially which stops after a some time which indicates that you have good placebo effect but due to psychological process the effect weans after few weeks or months.

I feel that rather than simple antidepressant there must be combination of antidepressant plus low dose antipsychotics for the treatment process to yield long lasting and persistent effects.

I hope this helps you.
If you have more questions feel free to write back to me.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Dr. Ashok Kumar Choudhary

Psychiatrist

Practicing since :2000

Answered : 3355 Questions

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Suggest Treatment For Severe Depression And Anxiety

Brief Answer: It seems coward syndrome with strong psychological process Detailed Answer: Dear XXXX, Thanks for using Healthcaremagic. I read your query and understand your concerns. First of all I am of the opinion that there is more than simple depression and anxiety. Depression never mean you have sadness and it can exist without sadness. From the very beginning I feel that you suffered with major depressive disorder with nihilistic symptoms which are otherwise known as cotard syndrome. This is a kind of depression where the person feels that he does not exist or some of his body parts cease to exist due to psychological process. Regarding treatment as I can see there is strong psychological component which is affecting the action of medications over a long time. As I see you get good response even with minor dose initially which stops after a some time which indicates that you have good placebo effect but due to psychological process the effect weans after few weeks or months. I feel that rather than simple antidepressant there must be combination of antidepressant plus low dose antipsychotics for the treatment process to yield long lasting and persistent effects. I hope this helps you. If you have more questions feel free to write back to me. If not, you may close the discussion and if possible you may rate the answer for my future patients. In future if you wish to contact me directly, you can use the below mentioned link: http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386 Thanks and regards.