Is It Just Panic Disorder or Are There Other Symptoms Involved?

Is this purely a panic disorder, or are there other comorbid symptoms?

Hello, Director Ding.
I am a patient with panic disorder and have been taking half a tablet of Sertraline daily as prescribed by my doctor.
I also take half a tablet of Alprazolam during emergencies.
I would like to understand if my current symptoms are solely related to panic disorder or if there are other underlying mental health issues.
During a panic attack, I experience palpitations, rapid heartbeat, facial flushing, hyperventilation, and numbness.
However, I also have other symptoms that do not resemble the typical quick onset and resolution of panic attacks; instead, they can last for several hours.
Before an episode, I often experience shoulder and neck numbness and headaches, followed by full-body shaking (which has lasted as long as an hour and a half), slurred speech or inability to speak, localized or generalized numbness, walking very slowly or hunched over, and controlling my hands in the opposite direction of my intention, among other symptoms.
Strangely, sometimes these episodes seem triggered by psychological factors, while at other times they occur unexpectedly.
What could be the issue with these symptoms? I find it difficult to understand my doctor's explanations, so I am seeking your help.
Additionally, are there any group therapy options for panic disorder in Taipei? I would like to meet others with similar experiences, as I do not have friends who understand what I am going through, and I hope to learn and grow through sharing.
Thank you for your attention.

jiaz, 20~29 year old female. Ask Date: 2016/03/02

Dr. Ding Shuyan reply Psychiatry

Hello, you are 24 years old, and since the content does not mention any physical illnesses, we can assume that your health check-up is generally normal.
Apart from the typical symptoms of panic attacks, some individuals with anxiety disorders may also exhibit the other symptoms you mentioned.
The causes of these physical sensations are primarily due to autonomic nervous system dysregulation, as well as muscle tension and difficulty concentrating caused by anxiety.
It seems that your issues are quite varied, but they all fall under the broad category of anxiety.
Treatment should not be too difficult or complicated; by collaborating with your physician, you should see improvement quickly, so there's no need to worry.
Of course, if you have any physical illnesses or are undergoing medication treatment, it would be advisable to consult an internist or surgeon regarding the physical manifestations you mentioned.
I am located in Changhua and am not very familiar with the medical environment in Taipei.
Your physician is likely also based in Taipei, so consulting them would provide more clarity.
I would suggest practicing yoga, meditation, or qigong, as these can help with relaxation and regulating the autonomic nervous system.
Additionally, if you are not currently exercising, developing a habit of enjoyable physical activity can also be beneficial.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2016/03/02

More Info

It sounds like you are experiencing a complex set of symptoms that may not be limited to panic disorder alone. Panic disorder is characterized by recurrent, unexpected panic attacks, which are sudden periods of intense fear or discomfort that peak within minutes. Common symptoms include heart palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain, nausea, dizziness, chills, or hot flashes, numbness or tingling sensations, feelings of unreality or detachment, and fear of losing control or "going crazy."
However, the symptoms you describe—such as prolonged episodes of discomfort, shoulder and neck numbness, headaches, and tremors—suggest that there may be additional factors at play. It's not uncommon for individuals with panic disorder to experience symptoms that overlap with other anxiety disorders or even somatic symptom disorders, where psychological distress manifests as physical symptoms.
Your experience of prolonged symptoms that last for several hours, as opposed to the quick onset and resolution typical of panic attacks, raises the possibility of other underlying conditions. For instance, generalized anxiety disorder (GAD) can lead to persistent anxiety and physical symptoms that may not fit neatly into the panic attack framework. Additionally, symptoms like tremors, difficulty speaking, and altered motor control could indicate a heightened state of anxiety or even a dissociative response, where the mind and body react differently under stress.

It's also important to consider the role of stress and how it can exacerbate both physical and psychological symptoms. Chronic stress can lead to a variety of physical health issues, including tension headaches, muscle tension, and fatigue, which can further complicate the clinical picture.

Given the complexity of your symptoms, it would be beneficial to have a thorough evaluation by a mental health professional who can assess for co-occurring disorders. This may include anxiety disorders, mood disorders, or even somatic symptom disorders. A comprehensive assessment can help clarify the nature of your symptoms and guide appropriate treatment.

In terms of treatment, it sounds like you are already on a medication regimen that includes Prozac (an SSRI) and Xanax (a benzodiazepine). While these medications can be effective for managing anxiety and panic symptoms, it's crucial to follow your doctor's guidance on how to use them, especially regarding the timing and dosage. Regular follow-ups with your healthcare provider will allow for adjustments based on your response to treatment.

Regarding your interest in finding a support group in Taipei, many cities have resources for individuals dealing with anxiety and panic disorders. You might want to reach out to local mental health organizations, hospitals, or community centers that offer group therapy or support groups. Connecting with others who share similar experiences can provide valuable support and insights into managing your condition.

In summary, while panic disorder may be a significant component of your experience, the presence of additional symptoms suggests that a more comprehensive evaluation is warranted. Working closely with a mental health professional will help you navigate your symptoms and develop a tailored treatment plan that addresses both your psychological and physical health needs.

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