Question:
My name is XXXXXXX I am male aged 43 years vegetarian. My height is 5'10" and weight is 75 kg.

I am a Central Government employee having sedantary lifestyle.

I born and broght up in XXXXXXX Andhra Pradesh and settled in XXXXXXX because of job in 1998.

When come to the point, I am having some problems since childhood. This I observed when I was 10 years old. I though this is normal. At that time, my problem was reddishness in the face while talking to someone (irrespective of gender and age), of course my complexion is so fair. Gradually this problem developed till teens i.e., 16 years along with the problems of palpitation. I will tell you exactly the problem of palpitations used to occur in the childhood is that whenever I used to have any argument with anyone. symptoms are reddishness in the face, increasing of heartbeats, unable to express the problem, unable to take breathe and finally unable to talk not even a single word. This problem started since childhood but I ignored. Along with that I have the problem of performance/social anxiety i.e., I was not in a position to explain anything. This problems aggrevates when I was the centre of point. Means when someone asked anything I was not in a position to explain, feels palpitation. Also I used to face the problem of minor depression (sadness throughout day without any reason) along with these problems.

When I joined in the college afer completion of my 10th class (reddishness in the face faded away) and all the symptoms bursted out.

When I went to college, first day when I met a girl who knows me the first thing occurs unknown anxiety, tremendous palpitations (unable to talk not even a single word). From this time all these problems like anxiety, palpitationa and depression came to surface.

At that time I do not know what is this problem and did not mind also. Gradually this problem increased. In the year 1996 I observed along with these problems I developed one more problem i.e., unable to express my facial expressions freely i.e., normal circumstances, when I laugh and worst in the social moments. Although rest of the points inside mide but this problem is open to everyone. I used to face nervousness in the face, pain in the jaw, hotness in the face.

With all these problems, I landed up in XXXXXXX in 1998. I ran from pillar to post like General physician to Pschiatrist/pyschologist spent laks of rupees but in vain. Because of these I got complete picutre about my problem that I am having anxiety disorder, panic attacks and depression. Then I started going from one doctor to another doctor.

I started taking medicines. I took CBT, Psychotherapy, Hypnotherapy, PMR, Finally recently I took to the treatment for RTMS (Rapid Transacranial Magnetic Stimulation) but in vain.

Let us come to the present stage:

My present problems are:

1) Unable to express my facial feelings freely. i.e., when I laugh, talk or in the normal circumstances I face nervousness in the face. Like everybody I can't express my facial expressions freely. I get severe pain in the jaw. THIS IS THE MAJOR PROBLEM WHICH I AM FACING. IT IS REALLY A HINDRANCE IN MY LIFE TO ACHIEVE ANYTHING.

2)Unable to talk: Like everybody I can't explain any situation/ can't narrate anything freely. Particulalry when I am at the centre of attraction like when I am in group even small things like some asks about myself. At that also I feel nervousness. I don't know whethe it is SOCIAL OR PERFORMANC ANXIETY.

3) Unalbe to argue: When argument occurs irrrespective of gender and age palpitations occurs. Breathing increases, heart beat increases. At that time I can't speak a single world. I become total panicky.

4) Mild depression (unknown sadness/ moodswings).

THESE THINGS REALLY HAMPERING MY LIFE ALSO BECAUSE OF THESE I LOST INTEREST IN THE LIFE AND LSOT MANY OPPORTUNITIES.

TO OVERCOME ABOVE PROBLEMS I AM TAKING RIVOTRIL 2 MG 1 TAB I N A DAY. IF REQUIRED TWICE. I KNOW THIS ONLY FOR TEMPORARY RELIEF AND HIGHLY ADDICTIVE IN NATURE BUT THERE IS NO OTHER OPTION.

WHAT I AM DOING RIGHT NOW IS:

1) TAKEING RIVOTRIL
2) DOING REGULAR EXERCISE, YOGA, PRANAYAM AND MEDITATION
3) TAKING PROPER DIET WITH PLENTY OF WATER
4) SOUND SLEEP

WHAT I NEED RIGHT NOW IS ALL THE TREATMENTS I TOO AND I HAVE CHANGED MY LIFESTYLE SYSTEMATICALLY. THE THING IS KINDLY

SUGGEST SUITABLE MEDICINES TO OVERCOME THESE PROBLEMS. ALSO SUGGEST WAYS TO TAPER RIVOTRIL.

THIS IS MY FINAL REQUEST.

ALSO I CANT COME TO CLINIC, I WILL START TAKING TREATMENT WITH YOU THROUGH ONLINE TILL I RECOVER FROM THESE PROBLEMS

Kindly tell me as suggested in lybrate whether i take fluvoxamine cr 50mg or fluxotine. Also exactly tell me the dosage of Fluvoxamine or fluxotine either in the morning or in the evening and propranolol Sr either in the morning or in the evening.

2) If a sudden panic attack what medicine i have to take

3) You have not mentioned about the problem of facing facial nervousness. How to overcome this problem

4) Whether along with these shall I take revotril.

5) I am not getting time to do yoga/pranayams now a days. What to do. Kindly address the as I questioned in the sequence the answers please

Thank you for details. I will take the medicines as suggested by you. But how can I get in touch with you for day to day developments. Because I reside in XXXXXXX in case of emergency which number I have to dial. Second thing apart from medicines I am doing simple muscle relaxation and simple breathing exercise for half an hour. I think that is sufficient. Because winter started it is not possible to go out for jogging.

Also kindly tell me is there any link to tummy. Becoz before starting the medicines i was lean and after taking medicines till date my weight increased almost 20 kgs and tummy came out.

Kindly suggest me what to do for flatten the tummy. It is looking awkward

Thank you Doctor. I will follow the same as advised. Weekends I will contact you through HCM. Next time when shall I contact you sir.