Chronic Dizziness: Is It Related to Anxiety Disorders?

Feeling dizzy all day... Could this also be due to autonomic nervous system dysfunction?

Anxiety medication: Anban 1 tablet daily (half a tablet before napping at noon), Mirtazapine half a tablet before bed.
Duration of medication: Started around November last year, nearly a year.
The issues are as follows: Dizziness has persisted for over 2 months, almost 3 months.
I have visited the neurology department of major hospitals 3-4 times, and tests including EEG, auditory evoked potentials, and electromyography were all normal.
Eventually, I couldn't tolerate the dizziness anymore and paid out of pocket for an MRI of the brain and full spine, which also showed normal results.
However, after returning home, I still felt dizzy all day (at that time, symptoms included neck and shoulder stiffness + dizziness).
Recently, the dizziness has been accompanied by excessive belching, whether I eat or not; standing, sitting, or lying down, I always feel bloated and uncomfortable, struggling to fall asleep.
The next day, I wake up and immediately start feeling bloated again.
The increased gastric bloating exacerbates the dizziness, making me feel that living is incredibly difficult.
Not to mention work or going out, even normal life feels painful.
However, I had an endoscopy a few months ago, which showed mild gastroesophageal reflux.
The doctor said it shouldn't cause such severe belching, and Helicobacter pylori was not detected.
At that time, I was prescribed 40 mg of Pantoprazole and another anti-anxiety white capsule for three months.
Initially, it was effective, and I didn't experience bloating or belching, but within a month, the symptoms returned to baseline.
The neurologist at Chang Gung Memorial Hospital in Kaohsiung suggested that anxiety might be influencing my condition (I informed all doctors that I had been diagnosed with generalized anxiety due to hyperventilation).
Currently, I am experiencing constant dizziness and gastric bloating with belching.
Even when my stomach is empty, I still belch acidic gas, but at least my mind feels clearer.
I used the rare moments of clarity to buy convenience store rice balls, but shortly after eating, all those familiar feelings returned...
so my appetite has worsened.
My sleep has also been difficult to regulate.
After a hyperventilation episode at the end of October last year, I felt very fatigued and easily fell asleep, with no recollection of dreaming.
However, starting in March-April this year, I began to have vivid dreams, waking up feeling even more exhausted.
I feel like my mind is still disturbed by dreams (or subconscious meanings or memories from long ago).
Since then, I have gradually felt that I am not resting well; even when awake, I experience a sense of heaviness.
I have seen various specialists, but the situation has only worsened.
In the meantime, I have felt useless, had emotional breakdowns, and cried, but I don't know if it's due to medication suppression (my psychiatrist says the medication is mild) or nervous exhaustion.
When emotions rise, I feel so tired...
My dizziness feels like a lack of sleep (dullness from forehead to the top of my head) and somewhat like the sensation after riding a pirate ship at an amusement park (not spinning), lasting all day.
For the past few months, it has been accompanied by dry and blurry eyes, stiff neck and shoulder muscles, or gastric bloating with belching...
I would like to ask if you have encountered similar cases in clinical practice.
Despite reading many books on combating anxiety and trying to learn floating and adaptation techniques, I still feel like each day drags on.
My physical strength is increasingly unable to meet work demands, and seeing my home environment, which has been messy for a long time, makes me feel powerless to clean.
I wonder how to go on living; I have lost confidence in my body and recovery...
Thank you, doctor, for patiently reading my concerns.
TT_TT

Mu, 30~39 year old female. Ask Date: 2020/08/02

Dr. Huang Xiaoxian reply Psychiatry

Dear ruderchi, thank you for your question.
Many of the physical discomfort symptoms you mentioned seem to align with those of anxiety disorders.
Anxiety can generally affect the autonomic nervous system and various aspects of the body, which may explain the dizziness, stiffness, and bloating you described.
I recommend discussing with your physician the possibility of prescribing serotonin-related medications for anxiety, as well as arranging psychological counseling to address potential sources of stress.
Wishing you all the best.

Reply Date: 2020/08/02

More Info

Chronic dizziness can be a complex and multifaceted issue, particularly when it is intertwined with anxiety disorders. Your symptoms, which include persistent dizziness, gastrointestinal discomfort, and emotional distress, suggest a potential interplay between physical and psychological factors.
Firstly, it is important to understand that dizziness can arise from various causes, including vestibular disorders, neurological conditions, and even gastrointestinal issues. In your case, extensive testing, including MRI and other neurological evaluations, has ruled out significant neurological disorders. This is a positive sign, as it suggests that your dizziness may not be due to a serious underlying condition.

The relationship between anxiety and physical symptoms is well-documented in medical literature. Anxiety disorders can manifest with a range of physical symptoms, including dizziness, palpitations, and gastrointestinal disturbances. The phenomenon of "somatic symptom disorder" describes how psychological distress can lead to physical symptoms that may not have a clear medical explanation. In your situation, the chronic anxiety you have experienced could be contributing to your ongoing dizziness and gastrointestinal symptoms, such as bloating and belching.

Your mention of experiencing excessive air swallowing (aerophagia) and gastrointestinal discomfort aligns with common manifestations of anxiety. Stress and anxiety can lead to changes in breathing patterns, which may exacerbate feelings of dizziness and contribute to gastrointestinal symptoms. The sensation of a "lump" in the throat or increased belching can also be linked to anxiety, as stress can affect the muscles of the esophagus and stomach.

Regarding your medication regimen, it is crucial to communicate openly with your healthcare provider about the effectiveness of your current treatment. While medications like anxiolytics can provide relief, they may not address all symptoms, particularly if anxiety is intertwined with physical health issues. Cognitive-behavioral therapy (CBT) is often recommended for individuals with anxiety disorders, as it can help modify thought patterns and behaviors that contribute to anxiety and its physical manifestations.

Sleep disturbances, such as difficulty falling asleep and experiencing vivid dreams, can further complicate your situation. Poor sleep can exacerbate anxiety and contribute to feelings of fatigue and cognitive impairment. Establishing a regular sleep routine, practicing relaxation techniques, and creating a conducive sleep environment can be beneficial.

In terms of managing your symptoms, consider the following strategies:
1. Mindfulness and Relaxation Techniques: Practices such as deep breathing, meditation, and progressive muscle relaxation can help reduce anxiety and improve your overall sense of well-being.

2. Regular Physical Activity: Engaging in regular exercise can help alleviate anxiety and improve mood. Even gentle activities like walking or yoga can be beneficial.

3. Dietary Adjustments: Since you mentioned gastrointestinal symptoms, consider keeping a food diary to identify any potential triggers. Eating smaller, more frequent meals may help reduce bloating and discomfort.

4. Professional Support: If you haven't already, consider seeking support from a mental health professional who specializes in anxiety disorders. They can provide tailored strategies to help you cope with your symptoms.

5. Social Support: Connecting with friends, family, or support groups can provide emotional support and reduce feelings of isolation.

In conclusion, while your symptoms are undoubtedly distressing, it is important to remember that they can be managed with the right combination of medical treatment, psychological support, and lifestyle adjustments. Continue to work closely with your healthcare providers to find a comprehensive approach that addresses both your physical and emotional health needs.

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