Urgent Help Needed: Managing Severe Depression and Panic Symptoms

Emergency issue!!! Please, doctor, help!

Dear Doctor,
My mother is suffering from what is known as psychotic depression, commonly referred to as "depression." Recently, she has been experiencing involuntary muscle spasms and weakness in her limbs (mild myoclonus), along with severe dizziness.
She has visited the hospital multiple times, including Chang Gung Memorial Hospital, provincial hospitals, and general clinics, but the prescribed medications have not alleviated these symptoms.
Additionally, she often needs to cover her nose with a plastic bag to reduce airflow due to panic attacks, which is also known as "acute hyperventilation syndrome."
Doctor, is it not possible to control this with emotions? In the past, she could manage it emotionally, but now she cannot self-regulate; the episodes occur suddenly and without warning.
What should I do? School is about to start, and I am really worried about returning to classes.
I live in Keelung and am studying architecture at National Ilan University.
I am very afraid that my mother might relapse when she is alone.

Could the professional doctors please explain the preventive measures for these symptoms and the emergency response methods during an episode? I would greatly appreciate your responses to this letter.
Thank you!

Lai, 20~29 year old female. Ask Date: 2004/08/24

Dr. Tang Xinbei reply Psychiatry

Dear Mr.
Lai Bo-Wen,
It is touching and admirable to see your deep concern and worry for your mother.
Based on the symptoms you mentioned regarding her condition, it is difficult to definitively determine whether she is experiencing "depression" or "panic disorder," as these two conditions often have some overlap and correlation.
Some patients with panic disorder may experience acute episodes of extreme anxiety, leading to symptoms such as shortness of breath, possible limb twitching, weakness in the extremities, and severe dizziness, which is referred to as "acute hyperventilation syndrome." This condition is caused by a low concentration of carbon dioxide in the blood, resulting in an imbalance in blood pH levels.

The occurrence of "acute hyperventilation syndrome" is indeed closely related to emotional states and often arises in situations involving separation, sudden loss, uncertainty, and acute anxiety.
As you are about to start school, if your mother is left alone at home, it may trigger feelings of emptiness, worry, fear, and unease in her.

I recommend that you continue to have her see a physician regularly, where you can discuss your family's situation and current circumstances.
Request the physician to arrange for psychological therapy or biofeedback treatment, and ensure that your mother adheres to the treatment plan and takes her medications on time.
Additionally, if possible, arrange for some friends or neighbors to assist in keeping her company.

Lastly, and perhaps most importantly, provide your mother with some "empathy" and "reassurance." Clearly express your concern for her well-being, let her know that you will call home every day, and plan to visit regularly (without long intervals).

Wishing you peace and success!

Reply Date: 2004/08/24

More Info

It sounds like you are going through an incredibly challenging time with your mother's severe depression and panic symptoms. It's understandable to feel overwhelmed and anxious about her well-being, especially with the added stress of school. Let's break down the situation and explore some potential strategies for managing her symptoms and your concerns.

Understanding the Symptoms
Your mother is experiencing a combination of severe depression and panic symptoms, which can manifest as physical symptoms like muscle weakness, dizziness, and panic attacks. The term "acute hyperventilation syndrome" refers to a condition where rapid or deep breathing leads to a decrease in carbon dioxide levels in the blood, causing symptoms like lightheadedness, tingling in the extremities, and feelings of panic. This can be particularly distressing and may feel uncontrollable, especially if it occurs without warning.

Importance of Professional Help
Given the severity of your mother's symptoms and the fact that previous treatments have not been effective, it is crucial to seek professional help. If she has not already been evaluated by a psychiatrist, this should be a priority. A psychiatrist can assess her condition more thoroughly and may recommend a combination of medication and therapy tailored to her specific needs.
1. Medication: Antidepressants and anti-anxiety medications can be effective in managing symptoms of severe depression and panic disorders. It may take some time to find the right medication and dosage, so ongoing communication with her healthcare provider is essential.

2. Therapy: Cognitive-behavioral therapy (CBT) is particularly effective for both depression and anxiety. It can help your mother develop coping strategies and change negative thought patterns that contribute to her symptoms.

Emergency Management
In the event of a panic attack or severe symptoms, there are several strategies that can be employed:
1. Breathing Techniques: Encourage your mother to practice deep breathing exercises. Inhale slowly through the nose, hold for a few seconds, and exhale slowly through the mouth. This can help regulate her breathing and reduce feelings of panic.

2. Grounding Techniques: Help her focus on her surroundings to distract from the panic. This could involve naming five things she can see, four things she can touch, three things she can hear, two things she can smell, and one thing she can taste.

3. Safe Space: Create a calming environment at home where she can retreat when feeling overwhelmed. This space should be quiet and free of distractions.

4. Emergency Plan: Develop a plan for what to do during a panic attack. This could include having a trusted friend or family member she can call, or a list of coping strategies she can refer to.

Supporting Your Mother
As a family member, your support is invaluable. Here are some ways you can help:
1. Open Communication: Encourage her to talk about her feelings without judgment. Sometimes, just having someone listen can make a significant difference.

2. Encourage Professional Help: Gently remind her of the importance of following through with therapy and medication, even when she feels resistant.

3. Self-Care: Take care of your own mental health as well. Supporting someone with severe depression can be draining, so make sure you are also seeking support, whether through friends, family, or counseling.

4. Stay Informed: Educate yourself about depression and anxiety disorders. Understanding her condition can help you provide better support and reduce your own anxiety about her situation.

Conclusion
While it may feel daunting, remember that severe depression and panic symptoms are treatable. With the right combination of professional help, coping strategies, and family support, your mother can work towards managing her symptoms effectively. It’s important to remain hopeful and proactive in seeking the help she needs. If you ever feel that her safety is at risk, do not hesitate to seek immediate medical assistance. Your concern for her well-being is a testament to your love and commitment, and that support will be crucial in her recovery journey.

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