Can Involuntary Muscle Movements Trigger Panic Disorders? - Psychiatry

Can involuntary muscle movements trigger panic disorder?

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Hello, doctor.
Four years ago, I underwent surgery for scoliosis.
Initially, everything was fine after the operation, but seven months later, my former supervisor called and asked if I could return to the company to help out.
I felt my body could handle it since it was just administrative work, and finding a job in our area is quite difficult, especially after spinal surgery, so I agreed to go back to work in the north.
I’m not sure if it was due to the increasing workload, spending too much time sitting in the office, or the immense pressure from my supervisor, but I often felt very unhappy due to the unfair treatment at work.
After more than a year, my back started to involuntarily twitch.
Initially, I could hide it, but it became more frequent.
Once I completed my tasks, I resigned and went home.
At first, the muscle twitching only occurred when I stood up, but later it happened even when I lay down.
Last summer, I wanted to bring cold drinks to my brother who was working outside, but I couldn't find him, so I went home.
At that time, I wanted to have a coffee smoothie (which I rarely drink), and after just a few sips, I felt very sleepy and went to lie down, but I couldn't sleep.
Suddenly, my heart started racing, and I felt weak all over.
I had to rely on my willpower to go downstairs and ask my family to take me to the emergency room.
I was diagnosed with low potassium levels.
After making an effort to eat potassium-rich fruits, a few days later, while I was out buying lunch, I suddenly felt weak in my legs and arms.
I hurried home after buying my meal, thinking I was just too hungry, but after eating, I started experiencing palpitations and felt like I couldn't catch my breath.
Eventually, I couldn't take it anymore and went to the emergency room again.
The doctor checked my potassium levels, which were normal, and suggested that it might be psychological, recommending I see a psychiatrist.
Although my mother took me to see a doctor, she thought it was depression and didn't want to take me back for follow-ups.
There were several days without any episodes until one day when I went out to buy lunch around 1 or 2 PM.
As soon as I parked my scooter, I felt weak again.
I thought I should eat something quickly to feel better, but I felt so unwell that I couldn't eat.
I had to ask the shopkeeper to call an ambulance.
After another examination, everything was normal again.
For several months, I didn’t have any episodes, but the muscle issues persisted.
I kept asking my spinal doctor about it, but they always gave me official responses and sent me away.
I don’t know if it’s because the muscle twitching has become more intense, but I often feel like I’m struggling to breathe, sometimes feeling like I can’t get enough air, and my sleep quality has been poor.
I usually toss and turn for several hours before falling asleep.
Since I have a 3-year-old child at home who needs to wake up early for kindergarten, I often get woken up early by him.
I used to switch to another room where it was quieter to continue sleeping.
Later, my father planned to have knee surgery to replace one joint due to degeneration.
I don’t know if it was because I was frequently going to the hospital early in the morning and not getting enough sleep, but my back started to twist more severely, and I even began to feel short of breath, getting tired after just a few steps.
One time, when I bent down to get ice for a cold pack, I stood up and felt dizzy, almost unable to stand.
I had a history of severe anemia, but after receiving iron supplements, I ruled out anemia as the cause.
I used to be able to ride my scooter to buy breakfast or go to the dentist, but after my father’s surgery, as I took care of him, I gradually found it hard to ride my scooter.
Whenever I was exposed to the sun, I felt restless, and I would feel uncomfortable in stuffy environments.
I couldn’t even stand for five minutes without starting to breathe heavily, feeling completely unable to calm down.
Eventually, I felt so unwell that I thought I was going to faint and went to the emergency room again.
They couldn’t find any issues; my EEG, ECG, nerve conduction studies, and X-rays were all normal.
My heart showed mild mitral valve prolapse.
I am currently taking anti-anxiety medication to help calm my emotions.
Initially, I took it because I felt uncomfortable, but recently, whenever I wake up, the muscle twitching starts, leading to difficulty breathing, shortness of breath, and an inability to stand still.
I find myself pacing around, my shoulders and neck feel stiff, I constantly feel thirsty, and I get dizzy in crowded spaces.
There was a time when I felt uncomfortable due to hunger, experiencing shortness of breath and dizziness, and my abdomen has been uncomfortable as well.
Just a few hours after eating, I would feel hungry again.
I initially thought I might have diabetes, but my blood sugar levels were normal.
I am currently taking Riluzole prescribed by a neurologist, but after taking one before bed, I felt fatigued for two days, so I only take it every other day.
Although I’m not sure if that’s a bad idea, after taking it, I feel tired and want to sleep, but the muscle twitching is less intense, and I can tolerate sunlight better.
Even if I feel hungry, the discomfort eases somewhat, but if I stop taking the medication, the episodes start again.
I would like to ask the doctor if this could be classified as panic disorder.
Is medication the only way to manage it? I’m afraid of becoming dependent, so I only take it when I feel unwell.
Additionally, if I cannot escape the sources of stress, will this condition never improve? I often try not to think about it or listen to it, but because of family arguments, I frequently feel agitated.
My sister-in-law often expresses that she sees me as a burden and talks negatively about me to others.
I’m afraid that if I ride my scooter halfway, I might have an episode, so I always ask my mother to accompany me when I go out.
However, they don’t understand the fear this condition brings me.
They often tell me to learn to be independent, but I feel they don’t try to understand my suffering and only see me as someone who relies on others.
If possible, I want to be independent and move away from here, but I’m afraid that I can’t take care of myself right now.
If I remain in this cycle of stress, will my condition become harder to improve? Thank you, doctor.

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Joi, 30~39 year old female. Ask Date: 2017/08/27