Autonomic Nervous System Disorders: Anxiety and Panic Attacks

Autonomic nervous system dysfunction, anxiety, panic?

Hello Doctor, in April of this year, after exercising, I suddenly felt dizzy, my heart was racing, and I experienced palpitations as if I was about to faint.
I went to the emergency room where I underwent blood tests and an electrocardiogram.
Initially, my heart rate was a bit slow, but since that day, I feel like something is off with my entire being.
I live in fear every day, worried that there might be something that hasn't been checked.
I have undergone several tests including EEG, ECG, echocardiogram, auditory evoked potentials, X-rays, blood tests, and lower limb nerve conduction studies, all of which came back normal.
Later, a nurse told me that I might be experiencing autonomic nervous system dysregulation and panic disorder.
Since that emergency visit, my symptoms have included dizziness (not a spinning sensation, but I feel unsteady while walking), headaches (a tight feeling in my temples), difficulty breathing (sometimes deep breaths cause my hands and feet to tingle), gastrointestinal discomfort (stomach pain and frequent burping), eye strain, tingling in my hands, feet, and scalp, and sometimes a feeling of unreality in whatever I do.
I have seen almost all the neurologists in Kaohsiung, and I am now consulting a psychiatrist.
Doctor, do I need to undergo any further tests? I constantly suspect that I might have a serious illness.
Currently, I am taking psychiatric medications: Xanax (one at night), Seroquel (one before bed), and Lexapro (two before bed).
I have been on these medications for about 1-2 months.
Should I continue taking them, or do I need to see another specialist? Does this count as autonomic nervous system dysregulation? I used to be very easily stressed, walked quickly, and lived a very tense life.
Before the onset of my symptoms, I was very lively, but now I am hesitant to go out, always fearing that I might faint outside.
I apologize for bothering you and hope you can respond.
Thank you.

Ren Zhang, 20~29 year old female. Ask Date: 2021/11/28

Dr. Yu Quanxun reply Psychiatry

Hello, based on your description, it seems that you are experiencing symptoms of anxiety and panic.
The medications you are currently taking, Xanax, Cymbalta, and Lexapro, can help with these symptoms.
I recommend that you continue to see a psychiatrist, maintain your medication regimen, and attend regular follow-up appointments.
In addition to medication treatment, you may also ask your psychiatrist for a referral to a psychologist for breathing exercises or relaxation training.
With ongoing treatment, you should see good results.
Thank you for your message, and I wish you a speedy recovery!

Reply Date: 2021/11/28

More Info

Hello! Thank you for sharing your experience and concerns regarding your health. Based on your description, it seems that you are dealing with a complex interplay of symptoms that may be related to autonomic nervous system (ANS) dysfunction, anxiety, and panic attacks.
The autonomic nervous system is responsible for regulating involuntary bodily functions, including heart rate, blood pressure, respiration, and digestion. It consists of two main branches: the sympathetic nervous system, which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system, which promotes 'rest and digest' activities. When there is an imbalance in this system, it can lead to various symptoms, including those you are experiencing.

Your symptoms of dizziness, palpitations, tightness in the temples, difficulty breathing, gastrointestinal discomfort, and feelings of unreality can all be manifestations of anxiety and panic disorders. These conditions often lead to heightened awareness of bodily sensations, which can exacerbate feelings of fear and anxiety. The fact that you have undergone extensive testing, including EEG, EKG, echocardiogram, and other evaluations, and that all results came back normal is reassuring. It suggests that there is likely no underlying organic disease contributing to your symptoms.

The medications you are currently taking—such as Xanax (alprazolam), Seroquel (quetiapine), and Lexapro (escitalopram)—are commonly prescribed for anxiety and panic disorders. Xanax is a benzodiazepine that can provide quick relief from acute anxiety symptoms but is not intended for long-term use due to the risk of dependence. Seroquel is an atypical antipsychotic that can help with mood stabilization and anxiety, while Lexapro is a selective serotonin reuptake inhibitor (SSRI) that can help improve mood and reduce anxiety over time. It typically takes several weeks to notice the full effects of SSRIs.

Given your history of anxiety and the recent onset of panic attacks, it is crucial to continue working closely with your psychiatrist or mental health professional. They can help you assess the effectiveness of your current medication regimen and make adjustments as needed. It is also important to communicate any side effects or concerns you may have about your medications.

In addition to medication, consider incorporating therapeutic approaches such as cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety and panic disorders. CBT can help you identify and challenge negative thought patterns and develop coping strategies for managing anxiety symptoms. Mindfulness practices, relaxation techniques, and regular physical activity can also be beneficial in reducing anxiety and improving overall well-being.

As for further testing, if your symptoms persist or worsen, it may be worthwhile to discuss with your healthcare provider whether additional evaluations or referrals to specialists (such as a psychologist or therapist) are necessary. However, based on your current symptoms and the normal results of your previous tests, it seems that your condition may be primarily related to anxiety and autonomic dysfunction rather than a serious underlying medical issue.

In conclusion, it appears that you are experiencing symptoms consistent with autonomic nervous system dysfunction and anxiety. Continuing your current treatment plan while exploring therapeutic options can help you manage your symptoms effectively. Remember to reach out for support from healthcare professionals, family, and friends as you navigate this challenging time. Your health and well-being are important, and there are effective strategies available to help you regain a sense of normalcy and control in your life.

Similar Q&A

Understanding Anxiety, Panic Attacks, and Autonomic Nervous System Disorders

Hello, doctor. From April to June, I experienced four episodes of shortness of breath, chest tightness, and rapid heartbeat, which led me to the emergency room. After examination, the doctor concluded that these symptoms were caused by anxiety and were close to panic symptoms. Af...

Dr. Zhang Gengjia reply Psychiatry
Dear Sir/Madam, From your letter, it is clear that you are experiencing discomfort and distress due to the pressures of both anxiety and panic disorders. 1. Facing an uncertain future, anxiety disorders are common in modern society. This is a chronic condition that requires lo...

Understanding Autonomic Nervous System Dysfunction and Panic Symptoms

Hello, Dr. Jiang. Last year, I experienced palpitations and discomfort, and after seeing a cardiologist, I was diagnosed with mild benign arrhythmia. A subsequent evaluation by a psychiatrist revealed moderate to severe autonomic nervous system dysregulation, which later led to p...

Dr. Jiang Junyi reply Neurology
Hello: The autonomic nervous system shows moderate to severe dysregulation. It may be important to understand the relative changes between the sympathetic and parasympathetic nervous systems in order to determine where adjustments are needed. Generally, the autonomic nervous syst...

Managing Autonomic Nervous System Disorders and Panic Attacks

Hello, Doctor! At the end of last year, I experienced numbness and weakness in my left hand, foot, and face (I have a history of hypertension), and I was taken to the emergency room and hospitalized at Yadong Hospital. After undergoing a CT scan, MRI, and a consultation with a ne...

Dr. Song Chengxian reply Psychiatry
Hello, regarding your panic disorder, regular treatment can lead to recovery, especially when medication is combined with non-pharmacological therapies for better results. As for whether to incorporate cognitive therapy or behavioral therapy in addition to medication, please cons...

Understanding the Differences Between Autonomic Nervous System Disorders and Anxiety Disorders

I would like to ask the doctor what the difference is between autonomic nervous system dysfunction and anxiety disorders such as pathological lying anxiety disorder. How can a doctor differentiate between these two? Can autonomic nervous system dysfunction be diagnosed through ph...

Dr. Chen Wenyu reply Psychiatry
Hello, Sky: In response to the two letters regarding autonomic nervous system disorders and neuroasthenia, it is important to note that these conditions often involve some degree of depression or anxiety, and thus, these terms are no longer commonly used in psychiatry. What makes...