Am I Experiencing Panic Disorder, Depression, or Something Else?

Do I have panic disorder? Or depression? Or...?

Hello, doctor.
I currently have mitral valve prolapse and a benign fibroma in my chest.
Recently, I felt unwell and wasn't sure which specialist to see, so I first visited a family medicine doctor.
After discussing my symptoms, the doctor initially suspected it might be panic disorder.
However, he mentioned that I should see other specialists for further evaluation.
He also suggested that it could potentially be depression.

Two years ago, I experienced a heavy feeling in my chest and a rapid heartbeat.
At that time, I didn't think much of it and assumed it was due to staying up late, so I tried not to worry and went to sleep.
After that, I felt fine.
However, a few months ago, those symptoms reappeared, accompanied by a sensation of blurred vision.
I also experienced tingling in my scalp and hands, feelings of anxiety, and a sense of impending faintness.
I felt a bit sleepy and dozed off for a few seconds before waking up.
I felt somewhat better afterward, but I was in my parents' car and didn't dare to tell them for fear of worrying them.
Later, I considered taking traditional Chinese medicine to help with my condition.
After a while, I felt much better.
However, recently, while preparing for a national exam, I felt a lot of pressure.
Even after the exam, my body remained tense and tight.
After the exam, the symptoms returned, and for about a week, I experienced ongoing feelings of tension and fear, along with shaking hands and sore legs.
Eventually, I returned to normal and felt fine, but then I started experiencing dizziness again.
For several days, I felt fatigued, and upon waking in the morning, I would feel a bit dizzy, as if I hadn't slept enough.
Sometimes, I felt like I was about to faint, with a sensation of darkness flashing before my eyes.

I then saw a doctor who said my dizziness was caused by tension and described it as peripheral dizziness.
The doctor advised me to relax.
After taking medication for a few days, the dizziness finally improved.
However, after the dizziness subsided, I began to experience a sensation of distortion in my vision.
Sometimes, I felt a sense of unfamiliarity with familiar people or even with myself, and I felt strange in familiar environments.
Although I had discomfort during the onset of the distortion, I still trusted myself and didn't overthink things.
I could still feel joy when I was happy.
But once the distortion returned to normal, other issues emerged.
For instance, I sometimes found myself asking trivial questions and suddenly became concerned about intuitive matters.
At times, I felt like I wasn't myself and experienced a sense of unfamiliarity when looking at myself.
Now, I'm quite confused about my situation and have become very insecure.
I often find myself overthinking and pondering nonsensical questions, wondering why I feel this way or have these thoughts.
Sometimes, I feel like I lack focus when doing tasks and experience a sense of helplessness.
Recently, I've been feeling down and unmotivated, as if I've become a different person.
What should I do? I also want to ask if I might be experiencing depersonalization.
I'm very worried.
Thank you, doctor!

Niming, 20~29 year old female. Ask Date: 2012/09/07

Dr. Song Chengxian reply Psychiatry

Hello, it seems that many of your physical discomfort symptoms indeed resemble those of panic disorder.
Panic disorder is often accompanied by physical manifestations related to autonomic nervous system dysregulation.
If previous medical examinations have shown no abnormalities, I recommend that you continue treatment with a psychiatrist or in a psychosomatic clinic.
It is common for panic disorder to be associated with depressive symptoms.
However, a combination of medication treatment, cognitive therapy, breathing exercises, and relaxation training has shown good results.
I hope you seek medical attention soon and recover quickly! Dr.
Song

Reply Date: 2012/09/07

More Info

It sounds like you're going through a very challenging time, and I want to acknowledge the distress and confusion you're experiencing. Based on your description, it seems you may be dealing with a combination of anxiety and depressive symptoms, possibly exacerbated by the stress of preparing for exams and the physical health issues you've mentioned, such as mitral valve prolapse and benign fibromas.

Panic disorder is characterized by recurrent and unexpected panic attacks, which are sudden periods of intense fear or discomfort that peak within minutes. Symptoms can include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes, as well as feelings of unreality or detachment from oneself. Your experiences of feeling lightheaded, having a racing heart, and feeling a sense of unreality or unfamiliarity with your surroundings could align with panic disorder, especially if these episodes occur unexpectedly and cause significant distress.

Depression, on the other hand, often presents with persistent feelings of sadness, loss of interest in activities once enjoyed, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness or excessive guilt, and difficulty concentrating. Your feelings of low mood, lack of motivation, and the sense that you are not yourself could indicate depressive symptoms. The fact that you are experiencing fluctuations in your mood and feelings of self-doubt further supports this possibility.

The feelings of derealization or depersonalization you mentioned—where you feel disconnected from your environment or yourself—can occur in both anxiety and depressive disorders. These experiences can be distressing and may lead to increased anxiety about your mental state, which can create a cycle of worry and further exacerbate your symptoms.

Given the complexity of your symptoms and their impact on your daily life, it is crucial to seek professional help. A mental health professional, such as a psychologist or psychiatrist, can provide a comprehensive assessment to determine the nature of your symptoms and develop an appropriate treatment plan. This may include therapy, such as cognitive-behavioral therapy (CBT), which is effective for both anxiety and depression, and possibly medication if deemed necessary.

It's also important to address your physical health concerns, as they can contribute to your mental health symptoms. Regular check-ups with your healthcare provider to monitor your heart condition and any other physical issues are essential. Managing stress through relaxation techniques, mindfulness, and physical activity can also be beneficial.

In terms of confidentiality, healthcare providers are required to maintain patient confidentiality, so you can feel secure discussing your concerns without fear of your information being disclosed without your consent.

Lastly, I encourage you to reach out to supportive friends or family members about what you're going through. Sharing your feelings can help alleviate some of the burdens you're carrying. Remember, you are not alone in this, and there are resources available to help you navigate through these difficult times. Seeking help is a sign of strength, and taking that first step can lead to significant improvements in your well-being.

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