Persistent Symptoms: Seeking Answers for Mental Health Struggles

Please provide an answer?

Ten years ago, I experienced episodes of tachycardia and a sensation of distortion, prompting me to visit the emergency room.
Since then, similar episodes have occurred about four or five times, but I have not experienced them again for the past three years.
However, since the first episode, I have been troubled by symptoms such as fatigue, difficulty concentrating, and dizziness.
I have consulted many doctors, including traditional Chinese medicine practitioners, and undergone numerous tests, including over ten blood tests, more than ten resting electrocardiograms, three exercise electrocardiograms, two portable electrocardiograms, three electroencephalograms, six carotid ultrasounds, five echocardiograms, one CT scan, and two MRIs, all of which returned normal results.
Following this, I was advised by doctors to see a psychiatrist, but despite intermittent medication, my symptoms have not improved.
Two years ago, I started jogging to strengthen my body and relieve stress, but the results have been unsatisfactory.
Recently, my condition has worsened, with severe balance issues, hallucinations of tilting and spinning, dizziness triggered by moving objects (like watching TV or driving), extreme fatigue, increased distractibility, and poor appetite.
Last month, I visited a neurologist again, but the doctor still concluded that it was a psychiatric issue.
Two weeks ago, I switched to a psychiatrist, and after taking the prescribed medication (Xanax 0.5mg) before bed, my condition remains unchanged.
I would like to ask the doctor: what kind of illness do I have that causes such unbearable suffering, and what do you suggest I should do?

Hukou, 40~49 year old female. Ask Date: 2004/12/20

Dr. Tang Xinbei reply Psychiatry

Dear friend,
It seems that your distress has been ongoing for quite some time.
You feel confused about your condition and unsure of what to do, which leaves you feeling helpless and hopeless.
Based on your description, it is possible that you are experiencing "panic disorder." The Xanax (0.5mg) prescribed by your psychiatrist is a commonly used and effective medication for treating panic disorder, although the dosage and duration will need to be reassessed.
Panic is an inexplicable state of emotional tension and anxiety.
When this state occurs repeatedly and affects the individual's daily life, functional performance, and interpersonal relationships, causing distress in various aspects of life and emotions, it is classified as "panic disorder." Generally, panic disorder is episodic, with each episode lasting typically between 10 to 30 minutes, rarely exceeding one hour.
The primary psychological symptoms include intense fear or a feeling of impending death.
Patients often cannot articulate what they are afraid of; they experience confusion and difficulty concentrating.
Physiological symptoms include: rapid heartbeat, palpitations, shortness of breath, and sweating.
According to the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association in 1994, a patient must experience intense fear or discomfort during a specific period, suddenly manifesting at least four or more of the following symptoms, reaching their peak within ten minutes: palpitations or accelerated heart rate, sweating, trembling or shaking, feelings of shortness of breath or choking sensations, feelings of choking, chest pain or discomfort, nausea or abdominal distress, dizziness or unsteadiness (feeling faint), feelings of unreality (feeling detached from reality) or depersonalization (feeling detached from oneself), fear of losing control or going crazy, fear of dying, abnormal bodily sensations (numbness or tingling), chills or hot flashes.
The most effective treatment for panic disorder currently involves a combination of medication and cognitive-behavioral therapy.
After long-term follow-up, approximately one-third of individuals will recover; about half will continue to experience mild symptoms that do not significantly impact their lives; one-fifth will have persistent severe symptoms; and more than half of patients may also have comorbid depression.
If you are experiencing similar distress, please continue to seek care from a psychiatrist.
Wishing you peace and joy!

Reply Date: 2004/12/20

More Info

It sounds like you have been experiencing a complex array of symptoms that have significantly impacted your quality of life. Based on your description, it appears that you have been dealing with persistent physical and psychological symptoms, including fatigue, difficulty concentrating, dizziness, and a sense of disconnection from reality. These symptoms have persisted despite extensive medical evaluations, which have ruled out various physical health issues.

From a medical perspective, your symptoms could be indicative of several potential mental health conditions, including anxiety disorders, depression, or even post-traumatic stress disorder (PTSD), especially considering the history of panic-like episodes you mentioned. The fact that you have experienced episodes of rapid heartbeat and feelings of unreality suggests that you may have had panic attacks in the past, which can lead to ongoing anxiety about experiencing similar episodes again. This can create a cycle of anxiety and physical symptoms that can be very distressing.

The persistent fatigue, difficulty concentrating, and feelings of dizziness you describe could also be related to a condition known as "somatic symptom disorder," where psychological distress manifests as physical symptoms. This is not uncommon, especially when individuals have experienced significant stress or trauma in their lives.
Given that you have already sought help from various healthcare providers, including specialists in neurology and psychiatry, it is important to continue advocating for your health. Here are some steps you might consider taking:
1. Comprehensive Evaluation: If you haven't already, consider seeking a comprehensive evaluation from a psychiatrist who specializes in anxiety and mood disorders. They can help determine if there is an underlying condition that has not yet been identified.

2. Medication Review: Since you mentioned taking Xanax, it may be worth discussing with your psychiatrist whether this medication is the best option for you. Sometimes, medications like SSRIs (selective serotonin reuptake inhibitors) or other classes of antidepressants can be more effective for long-term management of anxiety and depression.

3. Therapeutic Approaches: In addition to medication, therapy can be incredibly beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders and can help you develop coping strategies for managing your symptoms. Mindfulness and relaxation techniques can also be helpful in reducing anxiety and improving your overall sense of well-being.

4. Lifestyle Modifications: While you mentioned that running has not yielded the desired results, regular physical activity is still important for mental health. Consider incorporating other forms of exercise that you enjoy, as well as ensuring you have a balanced diet and adequate sleep.
5. Support Systems: Engaging with support groups or talking to others who have experienced similar issues can provide comfort and understanding. Sometimes, sharing your experiences with others can help alleviate feelings of isolation.

6. Follow-Up: Regular follow-up with your healthcare providers is crucial. If you feel that your symptoms are worsening or not improving, do not hesitate to reach out for further assistance.
In conclusion, your symptoms are complex and multifaceted, and it is essential to approach them holistically. Mental health conditions can often be challenging to diagnose and treat, but with the right support and treatment plan, improvement is possible. Please remember that you are not alone in this journey, and seeking help is a strong and positive step towards recovery.

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