Managing Anxiety and Panic: Medication Options and Symptoms Explained

Q: Managing Anxiety and Panic: Medication Options and Symptoms Explained

Hello, online friend： You now understand that "panic" and "worrying about panic leading to anxiety" are two different things. <br>In fact, "panic" is not very common and primarily requires prevention. <br>"Anxiety," on the other hand, is a persistent adversary that you need to ov

I haven't had an episode recently, but I feel very anxious?

Hello Dr.
Liao, I am experiencing anxiety and panic due to heart palpitations.
I have been taking 20 mg of Cymbalta (duloxetine) twice daily, along with Xanax (alprazolam) as needed, 1-2 tablets per year.
Despite taking these medications for over a year, I still experience intermittent anxiety and panic.
I would like to know if I can discuss switching medications with my primary physician, or if the mild effects of Cymbalta are considered a normal phenomenon.

Additionally, I often feel anxious in the mornings and struggle to get out of bed due to my anxiety and heart palpitations, which leads to late nights.
Sometimes I experience dizziness and a feeling of heaviness; could these symptoms also be related to anxiety? Given my recent increase in anxiety, would it be appropriate for me to take one Xanax in the morning and one at night to help relax? Will taking one in the morning and one at night lead to dependency if I stop taking them later?
Moreover, I often panic over minor physical symptoms, such as a slight pain in my heart making me fear a heart attack, or feeling a bit dizzy and worrying about fainting.
Are these symptoms indicative of autonomic nervous system dysregulation? Lastly, does the medication Effexor (venlafaxine) have a stronger effect than Cymbalta? Thank you, and I hope to receive your valuable professional insights.
Wishing you safety!

Xiao Yu, 20~29 year old female. Ask Date: 2021/07/27

Dr. Liao Dinglie reply Psychiatry

Hello, online friend: You now understand that "panic" and "worrying about panic leading to anxiety" are two different things.
In fact, "panic" is not very common and primarily requires prevention.
"Anxiety," on the other hand, is a persistent adversary that you need to overcome.
Medications like "Xibin" are mainly used to manage "panic." If you haven't experienced frequent episodes recently, it indicates that there is no issue with the medication itself, and there is no need to change it.
Regarding "anxiety," you are experiencing symptoms such as heart discomfort, dizziness, feelings of heaviness, and difficulty getting out of bed in the morning, which may also affect your interpersonal relationships.
These symptoms should be discussed with your physician, and arranging for psychological counseling may also be beneficial.
"Buspirone" is a medication used to treat anxiety, and you should discuss it with your doctor to develop a comprehensive strategy for managing these symptoms.
Additionally, rTMS and TBS have the advantage of relatively fewer side effects, and you can consult at an outpatient clinic.
If you go to the Taoyuan Rehabilitation Hospital, you can schedule a consultation at the "rTMS Specialty Outpatient Clinic." Wishing you success in maintaining a calm mindset to manage your anxiety.
Dr.
Liao Ding-Lie.

Reply Date: 2021/07/27

More Info

Managing anxiety and panic disorders can be quite challenging, especially when symptoms persist despite medication. Based on your description, it seems you are experiencing a range of anxiety-related symptoms, including palpitations, fear of heart issues, and difficulty managing daily activities due to anxiety. Let's break down your concerns and provide some insights into your situation.

Symptoms of Anxiety and Panic Disorders
Anxiety disorders can manifest through both psychological and physiological symptoms. Common psychological symptoms include excessive worry, fear, and a sense of impending doom. Physiologically, individuals may experience palpitations, shortness of breath, dizziness, muscle tension, and gastrointestinal issues. In your case, the feelings of dizziness and the sensation of your heart skipping beats are classic symptoms of anxiety, which can exacerbate feelings of panic.

Medication Options
You mentioned taking Escitalopram (Lexapro) and Alprazolam (Xanax). Escitalopram is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for anxiety and depression. It generally takes several weeks to reach its full effect, and some patients may experience side effects such as nausea, fatigue, or sexual dysfunction. Alprazolam, on the other hand, is a benzodiazepine that provides rapid relief from acute anxiety symptoms but can lead to dependence if used long-term.

Given that you have been on these medications for over a year and still experience anxiety and panic, it may be worth discussing with your psychiatrist the possibility of adjusting your treatment plan. Sometimes, a combination of medications or a switch to a different class of antidepressants may be necessary to achieve better symptom control.

Concerns About Medication Dependence
You expressed concern about increasing your Alprazolam dosage to manage anxiety. While it can be tempting to use it more frequently for immediate relief, increasing the dosage without medical supervision can lead to tolerance and dependence. It’s crucial to have an open dialogue with your healthcare provider about your symptoms and any changes in your medication regimen.

The Role of Therapy
In addition to medication, cognitive-behavioral therapy (CBT) is highly effective for anxiety disorders. CBT helps individuals identify and challenge negative thought patterns and develop coping strategies for managing anxiety. Techniques such as mindfulness, relaxation exercises, and exposure therapy can also be beneficial.

Understanding Your Symptoms
Your fear of physical symptoms, such as heart pain or dizziness, can indeed be linked to anxiety and panic disorders. This heightened sensitivity to bodily sensations is often referred to as "somatic amplification," where normal bodily sensations are perceived as threatening. This can lead to a cycle of anxiety, where the fear of symptoms causes more anxiety, which in turn exacerbates the symptoms.

Comparing Medications
Regarding your question about whether Duloxetine (Cymbalta) is stronger than Escitalopram, it’s important to note that the effectiveness of antidepressants can vary from person to person. Both medications are effective for anxiety, but they work through different mechanisms. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) and may be more effective for some individuals, especially if they also experience chronic pain or fatigue.

Conclusion
In summary, it’s essential to communicate openly with your psychiatrist about your ongoing symptoms and concerns regarding your current medication regimen. Adjusting your treatment plan, possibly incorporating therapy, and addressing lifestyle factors such as sleep hygiene can significantly improve your quality of life. Remember, managing anxiety is often a multifaceted approach, and finding the right combination of therapies can take time. Don't hesitate to seek support from mental health professionals who can guide you through this process.

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