Hello,
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     48 year old female
•     History of hysterectomy 5 year back.
•     Known case of vertigo, anxiety (14 years), neck spasm, blocked arteries and hypercholesterolemia
•     Smoking for 30 years and stopped smoking by cold XXXXXXX 65 days back because of medical reasons
•     Complaints of: difficulty in thinking, low mood, confusion, decrease smile, decrease conversation with others and fear of losing mind.
•     Currently on valium (Diazepam) 2 mg a day.

In history, you mention about the anxiety because of vertigo. But I would like to consider anxiety an independent diagnosis in your case as it is itself may associated with vertigo like symptoms and neck spasm. Valium primary is used for anxiety (used for short duration only) which also relieves muscle spasm due to anxiety.

Common symptoms of anxiety disorders: anxiety, nervousness, restlessness, dizziness, excessive worry regarding own wellbeing, tremor, muscle spasm, heaviness in body, headache, easy fatigability, palpitation, sleep difficulty and dry mouth. Many of your complaints may match with these symptoms.

Your current symptoms points toward the presence of depressive disorder. Following increases the chances of developing depression in your case:
•     History of anxiety
•     Stress in form of quitting smoking recently and its withdrawal symptoms.
•     Hormonal changes in your age (48yrs) group related to menopause.

You need treatment with psychiatrist to treat your depression. For treatment of depression disorder, cognitive behaviour therapy and drug therapy are used.

In drug treatment, two types of medicine used. For immediate relief of anxiety benzodiazepines group of medicines (like valium) are used and for long term relief in anxiety and depression most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect. Cognitive behaviour therapy also takes few weeks to show its effect.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups. Please accept my answer in case you have no follow up queries.

Regards,

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Hello again,

Your symptom is not only because quitting smoking. There are multiple factors as I already mentioned in previous answer which are affecting your current condition.

• History of anxiety
• Stress in form of quitting smoking recently and its withdrawal symptoms.
• Hormonal changes in your age (48yrs) group related to menopause.

Apart from that co morbid medical illnesses like blocked arteries and hypercholesterolemia also increases the chances of having depression.

Feeling of disconnected, tired and helpless are also symptoms of depression which you did not mentioned in primary query. So, seek treatment as early as possible.

I hope, this answers your query. Please accept my answer in case you have no follow up queries.

Wish you a speedy recovery.

Regards.
Dr Ashish Mittal, MD

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Hello again,

Nicotine withdrawal last only for 1-2 week. But as I told you stopage of nicotine can be a stress for you and may be contributing in development of depression.

I know you are very distressed because of symptoms of depression. It is better if you seek help for treatment as I mentioned in primary reply irrespective of cause of depression.

I hope, this answers your query. Please accept my answer in case you have no follow up queries.

Wish you a speedy recovery.

Regards.
Dr Ashish Mittal, MD

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