Should You Consult a Psychiatrist for Ongoing Anxiety Symptoms?

Q: Should You Consult a Psychiatrist for Ongoing Anxiety Symptoms?

Hello： First, welcome your letter. <br>According to what you mentioned in your correspondence, you may be experiencing psychosomatic disorder. <br>The term "psychosomatic disorder" does not solely refer to a "mental illness." Generally, it can be divided into two main categories：

Do you need to see a psychiatrist for treatment?

Several years ago, after a family member was diagnosed with cancer, I began experiencing symptoms such as dizziness, palpitations, and anxiety.
A neurologist conducted an EEG and concluded that it was merely anxiety.
I was prescribed Xanax (0.25 mg) and Inderal, taking one of each daily for nearly a year, which helped me recover my health.

In July of this year, after completing a very stressful project, I started experiencing discomfort in my eyes.
An ophthalmologist found slightly elevated intraocular pressure but no other abnormalities.
Subsequently, I began to experience dizziness, numbness in my left hand, and pain in my shoulders and neck.
A neurologist arranged for a cervical MRI, which showed no signs of nerve compression.
The doctor then prescribed Xanax (0.25 mg) twice daily and Inderal.

At the same time, due to palpitations and poor sleep, I underwent an echocardiogram, which revealed a slight mitral valve prolapse.
Later, I had a chest examination due to chronic cough; an X-ray showed no abnormalities, but mild asthma was detected.
Consequently, the neurologist discontinued Inderal, and I continued with Xanax.

Before taking the medication, I often experienced numbness in my hands and feet, even in my face, but this would ease after taking the medication.
The shoulder and neck pain improved with physical therapy.
In November, my father passed away, and after dealing with that, I began to see flashes of light in my vision.
An eye exam showed no issues, and the neurologist's tests, including an EEG and optic nerve examination, also revealed no problems.
The doctor believed it was still anxiety.

The multiple examinations have caused me significant worry, leading to poor sleep and a lack of appetite.
Last week, I had a routine breast examination, and the doctor mentioned tiny calcifications, which heightened my anxiety and affected my sleep.
Fortunately, the report came back clear two days ago, and I thought I could finally relax, but I still feel no improvement.
I feel tense all day long; my heart rate, while not particularly fast, feels shaky, and my muscles are tight.
I feel sore and uncomfortable all over, have trouble sleeping at night, and wake up very early.

Taking Xanax helps somewhat, but it seems that the relief doesn't last long.
Should I consider seeing a psychiatrist again? I am continuously experiencing discomfort, and the ongoing examinations are overwhelming me.
I would appreciate any advice you could provide.
Thank you for your help.

jessica, 50~59 year old female. Ask Date: 2012/12/20

Dr. Li Zhengfeng reply Psychiatry

Hello: First, welcome your letter.
According to what you mentioned in your correspondence, you may be experiencing psychosomatic disorder.
The term "psychosomatic disorder" does not solely refer to a "mental illness." Generally, it can be divided into two main categories: (1) Individuals who already have a physiological condition, such as peptic ulcers or migraines, may experience emotional changes when facing life stressors, which can indirectly exacerbate the symptoms of their existing conditions, leading to more severe issues like intense abdominal pain or headaches.
(2) Individuals who do not have any organic diseases may still experience symptoms such as bloating, chest tightness, pain, or palpitations.
Patients with psychosomatic disorders often have comorbid depression or anxiety.
If there is no significant improvement after treatment by a family physician or internist, a referral to a psychiatrist may be necessary for further treatment.
Wishing you a speedy recovery, thank you.

Reply Date: 2012/12/20

More Info

It sounds like you have been experiencing a significant amount of distress and discomfort due to ongoing anxiety symptoms, particularly following a series of stressful life events, including the loss of a family member. Your symptoms, such as dizziness, heart palpitations, muscle tension, and sleep disturbances, are common manifestations of anxiety disorders. Given the complexity and persistence of your symptoms, it is indeed advisable to consult a psychiatrist or a mental health professional.

Anxiety disorders can manifest in various ways, including physical symptoms like those you described. These can include muscle tension, headaches, gastrointestinal issues, and sleep disturbances, alongside psychological symptoms such as excessive worry, fear, and irritability. The fact that you have undergone multiple medical evaluations and tests, which have not revealed any significant physical health issues, suggests that your symptoms may be more closely related to anxiety rather than a physical condition.

The medications you have been prescribed, such as Xanax (alprazolam) and Inderal (propranolol), are commonly used to manage anxiety symptoms. Xanax is a benzodiazepine that can help alleviate acute anxiety and panic symptoms, while Inderal is often used to manage physical symptoms of anxiety, such as rapid heart rate and tremors. However, reliance on these medications can sometimes lead to concerns about dependency or tolerance, especially if they are used over an extended period. It’s important to have a thorough discussion with your psychiatrist about the long-term management of your anxiety, including the potential need for therapy in conjunction with medication.

Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for anxiety disorders. CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. It can provide you with coping strategies to manage your anxiety more effectively, especially in stressful situations. Additionally, mindfulness and relaxation techniques can also be beneficial in reducing anxiety symptoms and improving overall well-being.

Given your ongoing symptoms and the impact they are having on your daily life, seeking a psychiatric evaluation would be a prudent step. A psychiatrist can provide a comprehensive assessment of your mental health, discuss your symptoms in detail, and help develop a tailored treatment plan that may include medication, therapy, or a combination of both. They can also help monitor your progress and make adjustments to your treatment as needed.

It’s understandable to feel overwhelmed, especially after experiencing significant life stressors and health concerns. Remember that seeking help is a sign of strength, and you do not have to navigate this alone. Support from mental health professionals, as well as friends and family, can be invaluable during this time. Prioritizing your mental health is crucial, and taking the step to consult a psychiatrist can lead to significant improvements in your quality of life.

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