Managing Anxiety and Panic: Symptoms and Treatment Options

Anxiety/Panic-related

Hello Doctor, my issue began over a year ago.
Initially, I frequently experienced rapid heartbeats, shortness of breath, tingling in my scalp, and anxiety, which required me to lie down for a while to recover.
The situation escalated after a workout when I couldn't calm down, leading to hyperventilation, dizziness, and a loss of vision that only showed black and white outlines, prompting me to take an ambulance to the emergency room.
For several days, I had these symptoms, causing me constant panic and anxiety, and I often ended up in the emergency room, where I was only told that I had autonomic nervous system dysfunction, which couldn't be treated.
Eventually, I sought help from a psychiatrist and received some medications that provided relief.
Before these issues arose, I could drink a little alcohol, but now, just 30cc of 40-proof liquor triggers the aforementioned symptoms.
I would like to know what advice you have regarding alcohol consumption.
After starting psychiatric treatment, I was able to return to a somewhat normal life, but I still occasionally experience palpitations, increased heart rate, cold sweats, scalp tingling, dizziness, and headaches, which require me to take Xanax or Lexapro to recover.
I would like to ask how to adjust the dosage of these medications if one pill is insufficient, and what the safe dosage is.
Since February of this year, I have frequently experienced unexplained nausea, regardless of the time or whether I have eaten.
This condition does not accompany dizziness but often occurs when I haven't had enough sleep.
Could you explain why this happens and what recommendations you might have? Currently, I am taking Kinax (with dinner), Zoloft (before bed) once daily, and Xanax as needed for discomfort.
However, I sometimes feel a bit anxious before it's time to take my medication.
Should I take Xanax in this situation, or should I wait until it's time to take Kinax and Zoloft?
Additionally, I have no issues chatting online or with friends over voice calls, but I become inexplicably anxious and symptomatic when I go out to eat or socialize with friends.
What could be causing this, and how can I improve this situation? Lastly, how might smoking affect my condition? Thank you for your patience in reading this, and I look forward to your response.

Jack, 20~29 year old female. Ask Date: 2023/11/12

Dr. Wu Enliang reply Psychiatry

The issue truly escalated after a certain exercise session when I couldn't calm down, experiencing hyperventilation, dizziness, and seeing only black and white outlines, which led me to take an ambulance to the emergency room.
For several days, I had these symptoms, causing me constant panic and anxiety, often resulting in trips to the emergency department, where I was typically told it was just autonomic nervous system dysregulation with no treatment available.
Eventually, I sought help from a psychiatrist and received some medications that provided relief.
Before these symptoms appeared, I could drink a little alcohol, but now even about 30cc of 80-proof liquor triggers the aforementioned symptoms.
I wonder what advice the doctor can give me regarding alcohol.
A: It is advised not to drink alcohol.
After visiting the psychiatrist and starting medication, I was able to return to a somewhat normal life, but I still occasionally experience palpitations, rapid heartbeat, nervousness with cold sweats, scalp tingling, dizziness, and headaches, requiring me to take Xanax or Lorazepam to recover.
I would like to ask the doctor how to adjust the dosage if one pill is not enough, and what the safe dosage is.
A: If the effect is insufficient, it is recommended to return to the clinic and discuss it with your doctor rather than self-adjusting the medication.
Since February of this year, I have frequently experienced unexplained nausea, regardless of the time or whether I have eaten.
This condition does not accompany dizziness but still makes me feel nauseous, usually when I haven't had enough sleep.
I wonder if the doctor can explain why this happens and what advice I might receive.
A: First, see a gastroenterologist to check for any gastrointestinal issues.
If no problems are found, it could also be anxiety-related.
Currently, I am stable on Kinax (at dinner), Zoloft (at bedtime) once daily, and I take Xanax when I feel uncomfortable.
However, I sometimes experience mild anxiety before it's time to take my medication.
Should I take Xanax in this situation, or should I wait until it's time to take Kinax and Zoloft? A: If possible, try to wait it out and use relaxation techniques such as diaphragmatic breathing to calm yourself.
I usually have no problem chatting with friends online, which is relaxing, but whenever I plan to go out for meals or gatherings, I inexplicably start to feel anxious and exhibit symptoms.
I would like to ask the doctor what this issue is and how I can improve this situation.
Also, how does smoking affect my condition? A: Similarly, learn relaxation techniques such as diaphragmatic breathing to help calm your mind.
Smoking is harmful to the body, and once addicted, not smoking can increase anxiety, so it is not a good method.
Dr.
Wu Enliang

Reply Date: 2023/11/12

More Info

Managing anxiety and panic can be a complex process, especially when symptoms manifest in both physical and psychological forms. Based on your description, it seems you are experiencing a range of symptoms that are commonly associated with anxiety disorders, including panic attacks. These symptoms can include rapid heartbeat, shortness of breath, dizziness, and feelings of impending doom, which can understandably lead to significant distress.

Symptoms of Anxiety and Panic Disorders
1. Physical Symptoms: These can include heart palpitations, sweating, trembling, shortness of breath, dizziness, and gastrointestinal issues such as nausea or vomiting. You mentioned experiencing a heightened state of anxiety after consuming alcohol, which is not uncommon as alcohol can exacerbate anxiety symptoms.

2. Psychological Symptoms: Feelings of fear, worry, and apprehension are prevalent. You may also experience a sense of detachment from reality or a fear of losing control. The fact that you feel more anxious in social situations, such as dining out with friends, suggests a possible social anxiety component.

Treatment Options
1. Medication: It appears you are currently on a regimen that includes Zoloft (an SSRI) and Xanax (a benzodiazepine). SSRIs are often prescribed for long-term management of anxiety disorders, while benzodiazepines like Xanax can be effective for acute anxiety episodes. However, it’s important to use Xanax judiciously due to its potential for dependence.
- Dosage and Safety: You should follow your doctor’s guidance regarding the dosage of Xanax. If you feel that one dose is insufficient, consult your healthcare provider before increasing your dosage. They can provide you with a safe and effective plan tailored to your needs.

2. Therapy: Cognitive Behavioral Therapy (CBT) is highly effective for anxiety disorders. It helps you identify and challenge negative thought patterns and behaviors that contribute to your anxiety. Additionally, exposure therapy can help you gradually face and reduce your fear of social situations.

3. Lifestyle Modifications: Regular physical activity, a balanced diet, and adequate sleep can significantly impact your anxiety levels. Avoiding alcohol and nicotine is also crucial, as both can worsen anxiety symptoms.
4. Relaxation Techniques: Incorporating mindfulness, meditation, or breathing exercises into your daily routine can help manage anxiety symptoms. These techniques can help ground you during moments of panic.

Addressing Your Specific Concerns
- Alcohol Consumption: Given your heightened anxiety symptoms after consuming alcohol, it may be best to avoid it altogether. Alcohol can interfere with your medications and exacerbate anxiety symptoms.

- Nausea and Vomiting: The nausea you experience, especially when sleep-deprived, could be related to anxiety itself or a side effect of your medications. It’s essential to discuss this symptom with your healthcare provider to rule out any underlying issues.

- Social Anxiety: Your discomfort in social settings may indicate social anxiety disorder. Gradual exposure to these situations, combined with therapeutic support, can help you build confidence and reduce anxiety.

- Smoking: Smoking can negatively affect your anxiety levels. Nicotine is a stimulant that can increase heart rate and exacerbate feelings of anxiety. Quitting smoking can lead to improved mental health and overall well-being.

Conclusion
It’s crucial to maintain open communication with your healthcare provider regarding your symptoms and treatment plan. Regular follow-ups can help ensure that your medications are effective and that any side effects are managed appropriately. Consider seeking therapy to complement your medication and develop coping strategies for your anxiety. Remember, recovery is a process, and with the right support and treatment, you can manage your anxiety effectively.

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