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What causes fear of elevators, infidelity and fear of speaking in public?

Answered by
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Dr. Seikhoo Bishnoi

Psychiatrist

Practicing since :2007

Answered : 5115 Questions

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Posted on Mon, 19 Oct 2015 in General Health
Question: I am overwhelmed with how I feel and I am afraid that I am never going to get better. For a background of me I am a 23 year old, 5’ 11’’, 145lb, Caucasian, male that is in the military. I have not been in a war situation and have no connection to fears from the military. I am pretty sure that I had fit the definition of having panic disorder. In my child and teen years of my life I can recall being fearful of having another panic attack and having anxiety over having a panic attack. I was overly concerned of the whereabouts of my family members, scared of elevators, but both passed with age and maturity. I lived my adult life with a fear of throwing up due to nausea, a, what I believe as common, fear of public speaking and a fear that my now husband would cheat on me again and hurt me again due to an event of infidelity that happened around October of 2012. I lived my life with the occasional panic attack, at least one or two a month that I would have with no trigger other than maybe the fact I would have one after going to the movies, most likely from the sugar, caffeine, fat overload from the refreshments at the theater.
On XXXXXXX 21st 2015 I was underway, out at sea, getting ready for an inspection of the hazardous material program of my ship. I believe at the time I was under stress, but was living life as normal. I was an emotionally driven person, I spoke quickly, and I lived passionately told most of the time that I was “too much”. While I was underway I was working as normal and all of a sudden I had a sharp pain above and behind my left eye in my head, this pain was only for a second, it was intense and made the area of my upper left cheek twitch with the pain. I thought, “That was weird”, and I went to resume what I was doing and it happened again. At this point my immediate thoughts were, “What’s going on?”, “Am I having a stroke?”…and my heart started pounding, my breathing was shallow, I felt like I was going to die. So I thought I was having a panic attack so I went to a bathroom stall and took out my cellphone to distract myself. The panic attack was more intense than any I had before and it would not go away so I went to seek medical help. I went to medical on my ship and my blood pressure was through the roof, my heart rate was high. The more the corpsman spoke around me about me having a panic attack it made it worse so I asked to go the bathroom to distract myself. I was shaking and my heart was racing and I felt like I was going to die, I took out my phone and tried to play a video game…it took longer than normal but I got myself down to a manageable level of anxiety and my medical doctor did a “field neurological” examination that I passed. She told me to take off my scopolamine patch and relax for 24 hours. As I was going back to my work center I started feeling nervous again so I hurried and went to my rack, or bed, on the ship to relax. I barely could get myself to relax and I went back to work after eating dinner. I remember at the time that I was not very hungry for dinner. At work I continued doing my job until around 10pm and we were pulling into port the next day. I remember speaking to my coworkers about how I had a bad panic attack and no one could relate to what I had gone through, as most don’t. I started feeling a bit sea sick so after showering and about to go to sleep I applied another Scopolamine patch before going to bed. I slept and I woke up the next morning in a complete panic. My heart was racing, I was sweating, my vision was blurry up close (due to the scopolamine patch), my motor skills were way off, I had a problem getting my shower shoes on so that I could “escape” to the bathroom to distract myself, again thinking that this was another panic attack. I again thought that I was going to die. I believed that all I needed to do is get back into port and get home and everything was going to be okay. For over an hour I felt disoriented, in an anxiety attack, and it went to a manageable state where I could function. I took off the patch as soon as I could and long story short we pulled into port. Now I normally feel “a little off” when I come home from being underway. So when I arrived at my home I felt a little nervous and I came through the door and my husband greeted me and he was about to leave for work. I told him that I loved him and I remember feeling anxious when I came home. I shook it off as well I just need to readjust to being home…even though I was only gone for a week and a half. I drank a beer since I was nervous, ordered pizza, spoke to my roommate about my panic attack at sea, and tried to relax. I got the pizza and I remember that I didn’t really feel hungry. I think that I dozed off and my husband later came home from work. I met him at the car, kissed him, and went on with my night. I felt nauseous and I felt nervous so I curled up on the couch and watched tv until the I started falling asleep. On Wednesday my heart kept pounding, I felt nervous, something was wrong. I went to medical and they had me try and relax in a quiet room. I drank water, ate some food, and tried to relax. I got to a point where I felt I was “calm” but my heart was still pounding and my blood pressure was still high. I went to the emergency room, they gave me Ativan and sent me home. I was unable to sleep on Antivan. I spent the whole night sweating and shaking my mind racing wondering what was wrong with me. I went back to work the next day nervous and again tried to go home and was unable to sleep. I remember on Friday that I drove my husband and I to a friend’s house and I felt no connection to him or others. When I played billiards I would make a shot, but have no feeling of happiness. I made shots playing basketball, but felt no reward of doing so again no happiness. For the next three weeks I was apathetic, had no appetite, no thirst, a loss of needing to urinate (though I was able to urinate), and I had extreme insomnia. I was unable to go to sleep. My mind would not turn off. My heart kept pounding and pounding, I would start shaking and sweating. I moved from the bed to the couch, tried fans, made it colder in the house, no artificial light for an hour before bed. I tried reading before bed. I could not sleep! My search for what was wrong with me was on I desperately tried to figure out a way to get better. I was not happy or sad. I could not cry if I wanted to. I continued working even though I was not able to sleep with the thought that if I could just tire myself out I would be able to go to sleep. I would try and think of the saddest things that would make me cry before, but I was unable to feel sad. I felt apathetic and nothing gave me pleasure. I did not know what was going on with me. With the social stigma within the military community to go to mental health I was prescribed Trazadone 50mg at night to go to sleep. I tried the 50mg for many nights and I was unable to go to sleep. Again after some time of this going on I was at my wits end, with anxiety, about going home and not being able to sleep so I called mental health after hours to see someone and after talking to me on the phone about how little sleep I was getting I was told to go to the ER. After the on call psychiatrist saw me I was told by her that she thinks it was Depression/Anxiety and that she was going to give me 100mg of Trazadone to get to sleep. I told them I was not comfortable with going home so they let me try to sleep in the psych ward for the night. I was able to sleep that night. I woke up and still felt very apathetic, nervous about how I felt very distant from my husband, of anyone for that matter, all of a sudden, lack of caring about really anything. After telling my story to the “team” they thought it was an anxiety issue and sent me home with the 100mg of Trazadone. I was unable to sleep that night at home and days to come. I was then able to go to Mental Health to see my current psychiatrist. They first tried to give me Paxil which didn’t really take because I was afraid of the sexual side effect of the medication, which I already had a lack of interest in sex anyways and had no morning erection for this period of time (probably because I wasn’t sleeping) I went through a period where I was checking my memory because I started to have memory issues such as forgetting names of coworkers that I saw on a regular basis, forgetting the lyrics to song, childhood memories, etc. I did early onset Alzheimer’s test online because I was afraid that was happening to me. Anyways I have now been put on Remeron (Mirtazapine) for about 4 weeks now. I am able to sleep every night and some nights I believe that I probably could sleep even if I didn’t take the medication. I have some instances of minor anxiety attacks, but now recently feel nervous all the time. I was talking to people again, laughing, somewhat feeling a bit normal. At first I started eating more, but had horrible bloating, started to make lists of things I was going to do, like exercise, see friends, etc. then one weekend I told my husband that I felt like the medication wasn’t working. I felt again like doing nothing at all…I have energy, but don’t know what to do with myself because nothing interest me. I am hungry physically, but have no appetite or don’t know what to pick out to eat since nothing interest me. I feel apathetic towards my husband and my friends almost not knowing what to talk about since I am not really interested in speaking about anything. I feel like I am lost in myself. Like all my dreams and aspirations no longer exist. I don’t know what I want to do in life…don’t know now if I want to have kids….don’t really know what I want to do with my Naval Career. I do know that I don’t want to lose my job in the military since that is what provides for my family. I wake up in the morning thinking what am I going to do with today? I still don’t feel like myself, but what does normal feel like? I am nervous that I am never going to get better. Prior to all this happening to me I did visit two grandfathers, one in Florida, and one in Illinois, at about a month apart, in the hospital since they were not doing well. I have not lost anyone in my family thus far and they are still alive today and doing better. I don’t feel sad, but nor do I feel happy. I almost feel like I am nervous because this “lack of feeling” is uncomfortable and I want to get better!! I have had a couple instances where I have teared up a little and felt sadness from missing my mom and the thought of how I feel bad for my husband because I am not really my “full me” right now. My friends call and I don’t pick up the phone. I urinate and have normal bowel movements now. I am going through life not really doing anything. The whole depression thing does not make sense to me because I still have energy most days, and it came literally like a light switch! Out of nowhere. I had an anxiety attack and then BAM! All this came about. So yes my question is what do you honestly think this is and can I get better? If Remeron is not working what would you recommend? Thank you for your time!
doctor
Answered by Dr. Seikhoo Bishnoi 1 hour later
Brief Answer:
Anxiety disorders can be treated easily with medicines and relaxation

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern and thanks for providing detailed history. In my opinion the history you have mentioned suggesting more towards Anxiety related disorders rather than Depressive disorder.

The symptoms like fear of getting better, history of symptoms like fear of elevators, anticipatory fear that something bad would happen to family members, fear that husband would cheat, fear that you might throw up, fear of speaking in public all are commonly seen in anxiety. The symptoms you had while during work were classical panic symptoms and this panic triggered the anxiety. The fear that you might have stroke was nothing but due to anxiety. Pounding heart, blurred vision, autonomic disturbances etc are common symptoms of anxiety and panic. In a lot of individuals severe panic attack results in anticipatory anxiety that such thing would happen again. This anxiety cause intense fear and thus hamper sleep, day to day routine etc. The symptoms of apathy, depressive symptoms etc are complications of anxiety and are not due to classical mood disturbance.

Now what can be done. First of all you have to accept that this is anxiety and there is nothing wrong if we consider your physical health. Anxiety is a psychiatric disorder and can be treated effectively with medicines and behaviour therapy with relaxation exercises. SSRIs as Fluoxetine, Paroxetine etc are drugs of choices in anxiety but are associated with sexual side effects and you don't want to take these drugs. Remeron or Mirtazapine is a good drug that will treat the anxiety as well as depressive symptoms. The drug is not associated with sexual side effects so not need to worry for that also. Behaviour therapy associated with relaxation exercises like yoga, progressive muscle relaxation exercises, reassurance, breathing exercises help a lot in severe anxiety and panic attacks. So apart from the medicines start doing relaxation exercises also.

I'd also advise you to get your thyroid function tests, haemoglobin, vitamin B12 levels checked to rule out any medical condition associated with these symptoms. Some times deranged levels of these parameters result in increased risk of panic attacks.

Coming to your doubts-

Yes definitely you will be alright. No doubt in that. Please continue to take the medicines as per your doctors advised and attend your appointments regularly. Combination of medicines and relaxation exercises will help in early recovery. Accept that this is anxiety and this can be treated. Reassure yourself again and again. Don't get afraid of anything.

Remeron will work, if not working the adjuvant drugs along with Remeron can be used. Bupropion, Buspirone, even Trazodon helps a lot in supplementing the actions of Remeron. You can discuss with your doctor for these drugs.

So don't remain distressed, you will recover fully.

Thanks, Hope this helps you. Please don't hesitate to ask again for more doubts.

Take care
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Seikhoo Bishnoi 18 hours later
Thank you so much Dr. Bishnoi for your timely and detailed response. Are you saying that because of my panic attack that I had on the 21st of XXXXXXX that I am now in a state of perpetual anxiety that is "beyond my control"? What I mean by this is it a problem that I now have a chemical imbalance due to the severe panic attack I had? I know that I always had an anxiety disorder of sorts, but nothing like this. I enjoyed life....I was happy, I was sad, I could cry if I wanted to... I loved... I feared....I was able to respond emotionally to stressors... but now I just feel like I am almost in an empty state of nothing and I try to fill my day up with stuff that does nothing for me so that I can take my Remeron, got to sleep and hope tomorrow will be a better day. Are you saying that I am in a depressive state due to the anxiety. Could this be because my "panic state" used up more serotonin than my body could replace? Thank you again for your time.
doctor
Answered by Dr. Seikhoo Bishnoi 4 hours later
Brief Answer:
Panic disorder results in persistent anxiety and depressive symptoms

Detailed Answer:
Hello again and thanks for asking a follow up question

Yes a lot of individuals who suffer panic attacks develop persistent anxiety and depressive symptoms eventually. Panic attacks result in severe anxiety which cause anticipation and fear that the attacks will occur again. This anticipation and fear cause the symptoms like apathy, lack of enjoyment etc. Yes the panic state cause the complication into depressive stage. Both depression and panic are associated with dysfunctional serotonin balance. But its not like that the panic state used up more serotonin. Apart from serotonin and other neurotransmitters behavioural factors are also involved in this. So continue to take medicines and you will feel better in some time.

Thanks, Still have more doubts please ask again. Take care
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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