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Why would I sometimes get a feeling like I am not present anymore and would this kind of anxiety go away?

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Posted on Mon, 13 Jan 2020
Question: One of the most disturbing problems I have is that when I am active and moving around getting things done, I often get the feeling that "I'm not there"....which improves only when I sit down in front of the computer or look at the smartphone, and try to get calm. Is this a symptom of anxiety, and will that ever go away? I worry that I have permanent brain damage or something.
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Answered by Dr. Alexander H. Sheppe (12 hours later)
Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

Yes, this is a common symptom of anxiety called depersonalization/derealization. It is entirely related to anxiety and should improve with treatment.

Dr. Sheppe


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (2 days later)
Now that I'm starting week 3 on Lexapro, while it seems like I'm no longer "bouncing off the walls" as much as I used to, what I've noticed is that I cannot seem to handle any stresss at all, even positive stress. I could be talking to someone about something that doens't even obligate me to do anything, I would nevertheless feel stress building up and then I have to cut the conversation short. If I do any routine housework, stress builds up, and then i have to take a break to try to calm down. This goes on all day. I am diagnosed with severe anxiety disorder, but my bad spells doens't seem to be triggered by any specific worry or fears. It's being triggered much more often now by simple stress. What is going on, and will I get over this?

Before all this, I had routinely handled stress all the time. But, in looking back, probably I was already beginning to suffer from reduced ability to handle stress, and I would end up taking it out on others that I believed was causing the stress.
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Answered by Dr. Alexander H. Sheppe (1 hour later)
Brief Answer:
Followup

Detailed Answer:
Generalized anxiety does not have to be triggered by any specific stress. It can happen anywhere at any time for no clear reason. The best treatment for this would be to continue Lexapro, consider with your psychiatrist a dose increase, and engage in 12 weeks of cognitive behavioral therapy. These interventions have a high success rate over time.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Alexander H. Sheppe (45 hours later)
What can I do about the fact I can't seem to enjoy anything at all, like going for short walks, watching movies on TV, making meals and having them, talking to friends, etc. I need some happiness to motivate me, but I can't seem to find any. Simple pleasures in life that makes living worthwhile seems missing. If I try to force myself to watch something on TV, it only seems to upset me even more. I cannot just sit still enough to relax and enjoy anything, even just to lay down. All I can do is to just sit in my office chair and do nothing.

Today I've started my 3rd week on Lexapro, upping the dose from 5 mg to 10 mg.
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Answered by Dr. Alexander H. Sheppe (4 hours later)
Brief Answer:
Followup

Detailed Answer:
It may be that you are demoralized from this long struggle. It may even be that you are clinically depressed. The good news is that Lexapro treats both anxiety and depression.

I see that your doctor has increased your dose to 10mg. This is good news. There is also plenty of room to increase the dose further if needed, as the maximum dose of this medication is 20mg daily.

Please remember that maximum benefit of the medication often takes 4 to 6 weeks after the most recent dose increase. It takes time but you are now well on your way.

Dr. Sheppe


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (23 hours later)
A number of my friends are pressuring me to hurry up and get well so that I can be with them again having a good time like we used to. While I am happy to know that I still have a rich life waiting for me once I recover, nevertheless it's making me more frustrated that I just can't leave the house and do the things I used to do. I have to tell them that this is going to take me a while, and I can only push for small progress each day, because otherwise my condition will blow up and I'll have to have a lot of alcohol to bring it down, and that's not good. My question to you is, should I take things slow and aim for small progress each day, or "go large or go home"? My friends are very impatient.

What I do know is that once my anxiety is at a mangeable level, then it becomes much easier to implement good CBT ideas. I absolutely hope that in a few weeks that this will more easily happen, as benefits from Lexapro start to accrue.
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Answered by Dr. Alexander H. Sheppe (25 hours later)
Brief Answer:
Followup

Detailed Answer:
You should absolutely take things slow and aim for small progress, because there IS NO fast progress with anxiety. Anything you do that you think will be fast will only hurt you (such as alcohol).

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Alexander H. Sheppe (1 hour later)
This morning, my psychiatrist said I shouldn't take Lavender Oil orally (sold as Calm Aid) because it "could have toxicity". I don't take Valerian, Ashwaghanda, Kava Kava, and I can't take L-Tryptophan with Lexapro. CBD is suspect. Alcohol is out. Certainly I don't want to take any benzodiazapines, nor things like Seroquel. I have prescribed clonidine, but I don't take that either. What's left? My psychiatrist says Lemon Balm is okay, and it does work, but I don't trust taking it all day. L-Theanine, from green tea, is calming, but works only if I'm already pretty calm.

Dr Sheppe, really, when I am having a prolonged bad moment, feelings of anxiety and restlessness that just won't quit, what can I do? It's difficult to even go outside and take a walk, even though I used to do that all the time. It can be difficult to even sit down in my chair and try to just chill. Every day is a long struggle to keep feelings of anxiety at bay. Isn't there anything at all that I can take to help alleviate the symptoms for the time being?
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Answered by Dr. Alexander H. Sheppe (12 hours later)
Brief Answer:
Followup

Detailed Answer:
I think overreliance on medications is part of the problem here. There is no evidence of supplements being helpful.

Lexapro will help, but it takes time. When you are feeling very anxious, you need to do an activity. Call someone, talk with someone, meet with someone. Go for a walk. Listen to music. Take a shower. Go for a run. Exercise. You need to stay engaged.

This is healthy and will help.

Dr. Sheppe


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (47 minutes later)
Yes, I cannot continue hoping that some medication or herb will relieve the symptoms. When my symptoms of anxiety gets mild enough, then it's going to be much easier to do those positive non-medicated steps. I hope today will be better than yesterday, and I'm trying to stay engaged, even if right now I need to just sit in my chair and talk to people by phone, text, or emails. Try to get some work done. If I get too ambitous and try to do too much, it can cause a bad flare-up of feelings of anxiety, so I have to be very measured in what I do. Very short walks at a time, certainly not a "run"---that will definitely send me off in a prolonged spree of high anxiety. It was only a couple of months ago when I did go on jogs, but right now I just cannot do it safely. Waiting for the benefits of Lexapro to accrue for right now.

I am still bewildered and frightened about what's happened to me, and I keep thinking I must be brain damaged. My question for you today is, I know of at least 2 people close to me that have been alcoholics for well over a decade, and yet they say that it only took them "2 weeks" to get over quitting (with some medical help and rehab). This is the reason why they keep telling me to "just snap out of it, go to a rehab somewhere for anxiety, come out a new man 2 weeks later". How is that just a a few months ago I was normal and not abusing any medication or substance, and now this is going to take me months to recover? The message seems to be, "you're better off being an alcoholic than having a bad nervous breakdown from anxiety".
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Answered by Dr. Alexander H. Sheppe (4 minutes later)
Brief Answer:
Followup

Detailed Answer:
Yes, the difference is that alcoholism can kill you. Anxiety will not.

It wouldn't be a terrible idea to go to alcohol rehab. It is important to be on Lexapro at the same time.

Dr. Sheppe


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (2 hours later)
Please give your URL again so that I start a new thread. I will close this discussion, after asking one more question:

When alcoholics stop drinking, and after the expected withdrawal period of about two weeks, don't they often experience ongoing problems with anxiety which can sometimes take months to get over? And that is one major reason for relapse?

Fortunately, I don't believe I'm an alcoholic, although I do have to be very careful now not to become one. I've always been a very moderate drinker.



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Answered by Dr. Alexander H. Sheppe (8 hours later)
Brief Answer:
Followup

Detailed Answer:
Alcohol can cause or mask underlying anxiety issues. One thing we know for sure is that ongoing alcohol use makes anxiety much much worse in the long term.

The web address is:

tinyurl.com/DrSheppeAnswers


Above answer was peer-reviewed by : Dr. Remy Koshy
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Dr. Alexander H. Sheppe

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Practicing since :2014

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Why would I sometimes get a feeling like I am not present anymore and would this kind of anxiety go away?

Brief Answer: Consultation Detailed Answer: Hello, and thanks for your question. Yes, this is a common symptom of anxiety called depersonalization/derealization. It is entirely related to anxiety and should improve with treatment. Dr. Sheppe