Brief Answer:
Need evaluation

Detailed Answer:
Hello
I can understand your concern. You are with complaints of anxiety and confusion. The symptoms are persistent since last 10 years. You also have complaint of poor concentration.

Such symptoms can occur due to many reasons and we have to rule out one by one-

One possibility is low Vitamin B12 levels and anemia. I would advise you to get tests of B12 and Hb levels checked.

Other possibility is low thyroid levels or hypothyroidism. Get your thyroid levels checked to rule out these conditions.

Then we are left with anxiety and depression as possibility. Before making diagnosis I would ask you some details-

- If you have persistent sadness of mood.
- Have you ever had panic attacks?
- What are main anxiety provoking situations?
- Any history of alcohol intake?
- If you have ever had death wishes?
- if the anxiety is hampering your work or studies?

Please provide these details in follow up question so that I can help you.

Thanks
Dr Seikhoo Bishnoi
Consultant Psychiatrist

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Brief Answer:
levels lower side.Fatigue

Detailed Answer:
Hello and thanks for asking a follow up

Though the levels of iron, vitamin B12 are in normal range still they are on lower side.

In a healthy male the levels should be higher than that. I would advise you to take iron folic acid and Vitamin B12 supplements. They will help in regaining energy.

Low levels also increase the risk of depression and anxiety. The drowsiness, fatigue and poor concentration could be due to this.

For lower energy during day time medicines like Modafinil or Armodafinil can prove useful. These medicines help to improve alertness and reduce depressive symptoms. You can consult your psychiatrist for these medicines. If no improvement occurs with these medicines then proper antidepressants will be needed.

Have diets rich in protein and carbs and low in fats. The diet will increase tryptophan levels in brain and improve your symptoms.

Thanks, if you have more doubts ask again.

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Brief Answer:
Modafinil is not associated with abuse potential

Detailed Answer:
Hello thanks for writing to us again

Modafinil doesn't cause dependence and it is not a drug of abuse. The drug improves day time alertness and help in improvement of motivation. Yes it’s easy to wean off from modafinil if taken properly under guidance of a psychiatrist.

Modafinil helps to cause biochemical changes of some neurotransmitters in brain and this result in immediate effect in a day or two. I usually prescribed the drug to my patients for about 6-12 weeks depending upon clinical condition. In the mean time your Vitamin B12 and Iron levels should come to normal range and your symptoms will improve. You can consult a psychiatrist for prescription of this drug.

Psychotherapy especially Behavior therapy in form of Breathing Exercises, Progressive Muscle Relaxation Exercise help to improve symptoms related to anxiety. Exercise will also result in release of endorphins which lifts the mood and help in decreasing day time fatigue.

History of suicide in family increase risk of psychiatric complication in family but that is not a significant risk for your symptoms. You should not be worried about the genetic effect.

Thanks, hope this helps you.

Wish you a good health. If you still have more doubts please ask again.     

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Brief Answer:
Yes most likely it is related to your anxiety

Detailed Answer:
Hello thanks for asking again, no need to feel sorry for questions, we are here to help you.

Erectile dysfunction
One of most common cause of erectile dysfunction (ED) at your age is psychological. It could occur due to underlying anxiety. Improvement of anxiety results in improvement of erection.

I would like you to self check, Are you getting spontaneous early morning erections or tightness during sleep?

In most cases of psychological ED nocturnal penis erections remain normal.

If the complaint is causing serious impairment in your personal life then you can take medicines like Tantex Forte one to two tablets per day. The drug is a herbal medicine and need no prescription.

Thanks, hope this helps you. Don't shy to ask again.

Take care

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