Dr. Goyal, I am glad that this post caught your attention. More than anybody, you are the right person to comment on this and please share your experiences of those people who had panic attacks and how they were cured !
an anxiety disorder charecterised by repeated episode of panic attacks. .
Thanking you my dear friends Dr(s) Mangla, Rajpal, Goyal, and Jagtp. I agree with you all !
Thanks, Dr(s) Nath, Sushant, Mahesh and Gayathri ! I agree with you all !
Thanks for sharing
Dr. Preeti, I am glad that you appreciate my post and I agree with your comment.
A disorder with common aggravation in patient with free floating anxiety and Type A personality where they are severely debilitated by a feeling of Impending Doom.
Can somebody .. Share the success story ... Of z particular treTment effective in PNic Disorder ?
Nice post sir
res sir very great post I have seen sach pt many time's bt female are very pron to pd mainly newly married and those who had sadantory life thnx for post
Cases that would interest you
- Login to View the image
Anxiety is an emotion characterized by an unpleasant state of inner turmoil. Everyone feels anxious now and then. It’s a normal emotion. For example, you may feel nervous when faced with a problem at work, before taking a test, or before making an important decision. Anxiety disorders are different, though. They are a group of mental illnesses, and the distress they cause can keep you from carrying on with your life normally. For people who have one, worry and fear are constant and overwhelming, and can be disabling. But with treatment, many people can manage those feelings and get back to a fulfilling life. Types of Disorders Anxiety disorder is an umbrella term that includes different conditions: Panic disorder. You feel terror that strikes at random. During a panic attack, you may also sweat, have chest pain, and feel palpitations (unusually strong or irregular heartbeats). Sometimes you may feel like you’re choking or having a heart attack. Social anxiety disorder. Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You fixate about others judging you or on being embarrassed or ridiculed. Specific phobias. You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations. Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little or no reason. HOMOEOPATH Phosphorus: People needing this may be bright-eyed, social, loving, and empathic—but when frightened, they are excitable, suggestible, “spaced out, ” easily vexed, fearful of robbers, and in need of reassurance. They gulp cold water (but then either vomit it or get nauseated by it) and are much worse at night. Their anxiety often has something to do with love; they worry endlessly about the object of their attachment not returning their affections. They can be very angry about rejection and obsess on it. Pulsatilla: Sensitive, easily upset people who need a great deal of consolation and reassurance and are as changeable as an April day. They tend toward childish rumination and pouting if they don’t get the attention and emotional security they crave, quickly becoming fearful of rejection. Dependent on others for reassurance. Worse in warm rooms, being covered in bed, and after eating rich foods; better from fresh air, mild exercise, and consolation. Silica: Lack self-confidence and fearful of new undertakings, especially speaking in public. Yielding, yet obstinate. Overly conscientious/anxious about trifles (obsessive); they overwork and exhaust themselves to avoid failure. Chilly, thirsty, chronically constipated, and better with consolation and sympathy. Stramonium: Night terrors, both in sleep and waking states. The person is anxious, obsessive-compulsive, and feels forsaken or alone in the wilderness (similar to Pulsatilla); but a mild demeanor may mask violence of thought or action. Mania, delirium, or diabolical delusions may be present. HOMOEOPATH HOMEOPATH HOMEOPATHY BEST HOMEOPATHIC DOCTOR BEST HOMEOPATHIC PHYSICIAN HOMOEOPATHIC DOCTOR PSYCHOLOGIST BEST HOMEOPATHIC PSYCHOLOGIST BEST CHILD PSYCHOLOGIST SEXOLOGIST BEST HOMEOPATHIC SEXOLOGIST. For more info visit us at http://www.drthakkarhomoeopath.in/updates/anxiety-is-an-emotio/5c149a949449bf00011c00a0?utm_source=facebookpageDr. Kalpesh Thakkar5 Likes3 Answers
- Login to View the image
#HolisticMedicine #CCAUpdates ANXIETY AND DEPRESSION Here is an article of a list of all the major medications of anxiety disorder and the problems they address. Each of the major problems (panic attacks, generalized anxiety, and so forth), with descriptions of the commonly recommended medications for that difficulty has been described. BENZODIAZEPINES alprazolam (Xanax) panic, generalized anxiety, phobias, social anxiety, OCD clonazepam (Klonopin) panic, generalized anxiety, phobias, social anxiety diazepam (Valium) generalized anxiety, panic, phobias lorazepam (Ativan) generalized anxiety, panic, phobias oxazepam (Serax) generalized anxiety, phobias chlordiazepoxide (Librium) generalized anxiety, phobias BETA BLOCKERS propranolol (Inderal) social anxiety atenolol (Tenormin) social anxiety TRICYCLIC ANTIDEPRESSANTS imipramine (Tofranil) panic, depression, generalized anxiety, PTSD desipramine (Norpramin, Pertofrane and others) panic, generalized anxiety, depression, PTSD nortriptyline (Aventyl or Pamelor) panic, generalized anxiety, depression, PTSD amitriptyline (Elavil) panic, generalized anxiety, depression, PTSD doxepin (Sinequan or Adapin) panic, depression clomipramine (Anafranil) panic, OCD, depression OTHER ANTIDEPRESSANTS trazodone (Desyrel) depression, generalized anxiety MONOAMINE OXIDASE INHIBITORS (MAOIs) phenelzine (Nardil) panic, OCD, social anxiety, depression, generalized anxiety, PTSD tranylcypromine (Parnate) panic, OCD, depression, generalized anxiety, PTSD SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) fluoxetine (Prozac) OCD, depression, panic, social anxiety, PTSD, generalized anxiety fluvoxamine (Luvox) OCD, depression, panic, social anxiety, PTSD, generalized anxiety sertraline (Zoloft) OCD, depression, panic, social anxiety, PTSD, generalized anxiety paroxetine (Paxil) OCD, depression, panic, social anxiety, PTSD, generalized anxiety escitalopram oxalate (Lexapro) OCD, panic,depression, generalized anxiety, social anxiety, PTSD, generalized anxiety citalopram (Celexa) depression, OCD, panic, PTSD, generalized anxiety SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) venlafaxine (Effexor) panic, OCD, depression, social anxiety, generalized anxiety venlafaxine XR (Effexor XR) panic, OCD, depression, social anxiety, generalized anxiety duloxetine (Cymbalta) generalized anxiety, social anxiety, panic, OCD MILD TRANQUILIZER buspirone (BuSpar) generalized anxiety, OCD, panic ANTICONVULSANTS Valproate (Depakote) panic Pregabalin (Lyrica) generalized anxiety disorder Gabapentin (Neurontin) generalized anxiety, social anxiety A. Panic Attacks For panic attacks, the greatest benefit that medications can provide is to enhance the patient's motivation and accelerate progress toward facing panic and all of its repercussions. For a drug to help in this area, it must help in at least one of the two stages of panic. The first stage is anticipatory anxiety: all the uncomfortable physical symptoms and negative thoughts that rise up as you anticipate facing panic. The second stage is the symptoms of the panic attack itself. Both current research and clinical experience suggest that certain medications may help reduce symptoms during one or both of these stages for some people. However, if a medication can specifically block the panic attack itself, many patients no longer anticipate events with such anxiety and can overcome their phobias more quickly. The primary medications used today for panic disorder are several types of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), and the benzodiazepines (sometimes in combination with these SSRIs). The selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed drugs for panic today and offer fewer side effects than the tricyclic antidepressants. These include fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro). In studies of patients with panic disorder, 75 to 80% of those placed on an SSRI significantly improve. This rate is equal to the success rate of the tricyclic antidepressants that have proven helpful. The serotonin-norepinephrine reuptake inhibitor (SSNR) venlafaxine (Effexor) has also been shown to help control panic attacks, as has the mild tranquilizer buspirone (BuSpar). The most common benzodiazepines for panic attacks are alprazolam (Xanax), alprazolam XR (Xanax XR), and clonazepam (Klonopin). They block panic attacks quicker than the antidepressants, often in a week or two. They are also used as needed before a panic-provoking situation. They tend to have fewer side effects than the antidepressants. However, they can cause withdrawal symptoms as you taper off them. Because alprazolam is quicker acting than clonazepam, its withdrawal effects can be stronger as well. In studies on panic disorder, 43% of patients on alprazolam improved after eight weeks on less than 4 mg per day, and 30% get better on 4 to 6 mg per day. The quick acting nature of alprazolam makes it an ideal medication to take as needed just before panic-provoking events. It takes about 15 to 20 minutes to offer you its anxiety-reducing benefits. If you place it under your tongue to dissolve (called sublingual), it can offer benefits within 5 to 8 minutes. Be ready for its bitter taste! Clonazepam and is the extended release (XR) formula of alprazolam last longer in the body than alprazolam. This allows you to dose twice a day for a full 24-hour coverage, while alprazolam requires four or five dosings for the same period. Some investigators believe they are a better choice than alprazolam during those times because their primary effects are not as strong and also wear off more slowly. When you are practicing the skills of facing your fears, if you notice the effects of a medication, you may tend to attribute your successes more to the medication than to your own efforts. Medications should serve as helpers to your own courage and skills and not get all the credit for good results. Because alprazolam XR’s and clonazepam's effects can be less noticeable, you will be more likely to say, "Hey, I did it!" instead of saying, "Boy, that drug really works well. Thank goodness it was there to save me!" However, some patients don't like how long the effects last. No reliable studies support the use of other minor tranquilizers such as oxazepam (Serax), chlordiazepoxide (Librium) or clorazepate (Tranxene), although these drugs may make the patient feel somewhat calmer. Of the antidepressants, the tricyclic antidepressant drug imipramine (Tofranil) has the longest track record for treating panic attacks. Other tricyclic antidepressant drugs that can help control panic attacks are desipramine (Norpramin or Pertofrane), nortriptyline (Aventyl or Pamelor), amitriptyline (Elavil), doxepin (Sinequan or Adapin), trazodone (Desyrel) and clomipramine (Anafranil). In studies of patients with panic disorder, 75 to 80% of those placed on an antidepressant significantly improve. Monoamine oxidase inhibitors (MAOIs) are another family of antidepressants that manage the symptoms of panic. Research studies support extensive clinical experience that shows phenelzine (Nardil) as the preferred MAOI. Tranylcypromine (Parnate) is also sometimes effective. The antidepressants amoxapine (Asendin) and maprotiline (Ludiomil) are not generally effective for panic disorder. Bupropion (Wellbutrin) does not have enough evidence yet to verify its effectiveness for panic. If a physician recommends a combination of a benzodiazepine and an antidepressant, two approaches are possible. One is to take the antidepressant daily and use a benzodiazepine as needed for increased periods of anxiety or panic. Another method is to use the benzodiazepine with the antidepressant during the first month or two of treatment. As the primary effects of the antidepressant begin, after 4 to 8 weeks, the patient then slowly tapers off the benzodiazepine. B. Obsessive-Compulsive Disorder For those suffering from obsessive-compulsive disorder (OCD), medications can reduce the degree of intensity of the worries and their corresponding distress. Medications do not prevent obsessions from occurring. However, when the medication lessens the strength of the worries, the patient can then use self-help skills to control them. The SSRIs appear helpful in treating OCD, as well as the antidepressants clomipramine (Anafranil) and venlafaxine (Effexor). The anti-obsessional benefits of any of these medications may not be fully apparent until 5 to 10 weeks after treatment starts. Imipramine, monoamine oxidase inhibitors (MAOIs), venlafaxine, alprazolam and the mild tranquilizer buspirone (BuSpar) also show some indications of being useful for certain individuals. In addition, some patients with OCD may also have an underlying mood disorder and can benefit by the drug lithium. About 20% of individuals with OCD also have tics, which are sudden, uncontrollable physical movements (such as eye blinking) or Tourette’s syndrome, which includes vocalizations (such as throat clearing). The atypical antipsychotics such as risperidone, clozapine and quetiapine, and the blood pressure drugs clonidine and guanfacine, can help with these tics and Tourette’s symptoms. Your physician can help determine what medications can be used in combination with any of these. Tricyclic antidepressants and Monoamine oxidase inhibitors (MAOIs) have not been shown to be helpful for OCD. C. General Anxiety For those with general anxiety, medications help reduce some of the symptoms of anxiety. All of the SSRIs appear beneficial, as well as many of the tricyclic antidepressants. Other commonly prescribed drugs are buspirone (BuSpar), trazodone, venlafaxine and several of the benzodiazepines, such as diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), oxazepam (Serax) and chlordiazepoxide (Librium). D. Simple Phobias For those with simple phobias, medications can help to reduce the tensions associated with entering the fearful situation. A patient can take a low dose of a benzodiazepine about one hour before exposure to the phobic stimulus to help reduce anticipatory anxiety. If this is not sufficient, the physician can prescribe a higher dose for the next time. A chemically dependent patient who is not currently abusing drugs might benefit from one that is not attractive to drug abusers, such as oxazaepam (Serax) or chlordiazepoxide (Librium). It is important to note that medications are not a successful primary treatment of simple phobias. The treatment of choice involves many of the steps you have read about in this book-- learning skills of relaxation and gradually approaching your feared situation while applying those skills. Consider medications only as an option to assist you in your efforts. In a novel approach to treating anxiety, researchers are exploring the use of d-cycloserine, an antibiotic, to enhance learning and memory during cognitive behavioral treatment. Small studies with individuals experiencing specific phobias or social anxiety have shown that, taken one hour before "exposure" treatment, this prescribed drug improved subjects’ success rate. E. Social Anxieties and Phobias For those with social anxieties, medications can help to reduce the tensions associated with entering the fearful situation, to bring a racing heart and sweaty palms under control, and to reduce some shyness. Physicians use several classes of medications that are beneficial, individually or in combination. These include the beta-blockers, benzodiazepines, venlafaxine, the SSRIs and trazodone. The drugs with the longest history of use with social anxiety are the beta adrenergic blocking agents, also known as beta blockers. The most commonly used are propranolol (Inderal) and atenolol (Tenormin). The patient can take propranolol as needed or in dosages of 10 to 20 mg three to four times a day, or atenolol in dosages of 25 to 100 mg once daily. Surprisingly, controlled research studies have not supported the widespread anecdotal reports of success with beta blockers. It's possible that their best use is for occasional mild social anxieties associated with performance. The high potency benzodiazepines clonazepam (1-4 mg per day) and alprazolam (1.5 to 6 mg per day) may also be effective. A combination of a beta blocker and low dosages of clonazepam or alprazolam could be best for some individuals. Current research suggests that the monoamine oxidase inhibitors (MAOIs), especially phenelzine, are most highly effective medications for treating those with the more generalized form of social anxiety. In studies, about 70% of subjects improve significantly within four weeks. Occasionally, however, a social phobic can experience an exaggerated response to an MAOI and become too talkative, outgoing or socially uninhibited. In that case the prescribing physician will lower the medication dosage or stop it altogether. One approach to drug treatment that experts recommend for social fears is to begin by taking a medication only as needed. If patients are anxious only about specific events and if they experience primarily physical symptoms (sweating, racing heart, etc.), then about one hour before the event, they can take propranolol or atenolol. Propranolol seems to work better for occasional problems, while atenolol may work better for continued problems. If their symptoms are more cognitive (they worry about their performance or the judgment of others), then they can take alprazolam one hour before the event. If they have a mix of these symptoms then a combination of these medications may be more helpful. Benefits of these drugs should last about four hours. If the social anxiety is more general, unpredictable and widespread, then patients may need to take venlafaxine, an MAOI such as phenelzine, or an SSRI such as sertraline. Keep in mind that these medications take several weeks to work. Bupropion (Wellbutrin) does not have enough evidence yet to verify its effectiveness for social anxiety disorder. As mentioned in the previous section, researchers are currently experimenting with the use of d-cycloserine, an antibiotic, to enhance learning and memory during cognitive behavioral treatment. Small studies have shown its benefit with specific phobias and social anxiety. F. Anxiety or Panic with Depression For those suffering from a combination of depression and anxiety or panic, certain antidepressant medications can help reduce the depressive symptoms while simultaneously helping to control the panic attacks. The physician can prescribe one of the tricyclic antidepressants with sedating effects, such as imipramine or one of the MAOI's. It is also possible to combine the use of a tricyclic antidepressant with buspirone or the benzodiazepine alprazolam. G. Post-traumatic Stress Disorder (PTSD) Medications can be effective in treating PTSD, acting to reduce its core symptoms as well as lifting depression and reducing disability. The SSRIs appear to be the medications of choice, with some study showing the benefits of tricyclic antidepressants, MAOIs and some anticonvulsants. However, research into the pharmacotherapy of PTSD lags behind that of the other anxiety disorders. In the years to come, other medications or newer drugs may prove to be more effective.Sushmita Haodijam0 Like2 Answers
- Login to View the image
A 26 years old female presenting with sudden onset of palpitations. O/E - Tachycardia. Rest - NAD. No retrosternal pain or chest pain. Please , comment on ECGDr. Parveen Yograj0 Like28 Answers
- Login to View the image
m/49 presenting c episodes of severe restlessness c tachycardia and fear of death off / on since 6 months. CBC , rbs, rft, lft, lipid profile are normal .2decho is wnl .no h/o drug addiction,smoking,alcoholism. reports attached .plz give ur valuable opinionDr. Mandeep Kumar2 Likes11 Answers
- Login to View the image
When our patients talk about Dizziness , What do they mean ? Please note :This is not an exhaustive text on the topic, but only meant to create awareness Most of us might have had a feeling of unsteadiness or a spinning sensation in their heads at some point or other in Our lives. It is also called as Giddiness by a few of them. I always feel giddy and nauseous whenever I am in the amusement parks and if I were to climb those great wheels or those turnarounds , I am definitely going to become sick and debilitated for the rest of the evening. For that matter, I am also a victim of motion sickness, even spinarounds and being driven on up and down hills can make me giddy and sick. You might laugh if I say that I feel dizzy even when I am standing at edge of high heights like from a building or a cliff. Dizziness or Giddiness is a broad term that can mean different things to different people. It's a common complaint, but it can be serious. Dizziness has no specific medical meaning, but there are four common conditions that can be considered types of dizziness: VERTIGO : The feeling of motion when there is no motion, such as one feels spinning or the environment spinning. Spinning yourself round and round, then suddenly stopping, can produce temporary vertigo. But when it happens in the normal course of living, it signals a problem with the vestibular system of the inner ear -- the body's balance system that tells you which way is down and senses the position of your head. About half of all dizziness complaints are vertigo. LIGHTHEADEDNESS : Also called near syncope, lightheadedness is the feeling that you are about to faint. It is commonly felt by standing up too quickly or by breathing deeply enough times to produce the sensation( hyperventilation). I,myself had this problem during my school days, standing in the school assembly for long periods. DISEQUILIBRIUM : A problem with walking. People with disequilibrium feel unsteady on their feet or feel like they are going to fall. ANXIETY: People who are scared, worried, depressed, or afraid of open spaces may use "dizzy" to mean frightened, depressed, or anxious. Frequent dizziness sufferers may complain of more than one type of dizziness. For instance, having vertigo may also make them anxious. Dizziness can be a one-time event, or it can be a chronic, long-lasting problem. Nearly everyone who is dizzy will get better over a period. This is because a person's sense of balance is a complex interaction between the brain, each ear's separate vestibular system, sensors in the muscles, and sense of vision. When one component breaks down, the others usually learn to compensate. What Causes Dizziness? Vertigo can be caused by many things: INFECTIONS, such as the ones that cause the common cold can cause temporary vertigo via an ear infection. This inner ear infection is generally viral, harmless, and usually goes away in one to six weeks, but drugs are available if it is severe. Benign Paroxysmal Positional Vertigo -- Positional Vertigo( BPPV ) is caused by movement of an otolith -- a tiny calcium particle the size of a grain of sand -- from the part of the ear that senses gravity to the part that senses head position. The person feels as if their head is turning when it isn't. A two-minute therapy, Epley maneuver done in the proper way can move the otolith back where it belongs and fix the problem. This therapy cures vertigo 80% of the time. MENIERE's disease is a disorder characterized by long-lasting episodes of severe vertigo. Other symptoms of Meniere's disease are tinnitus (ringing in the ear), hearing loss, and pressure or fullness in the ear. DANDY's syndrome is a feeling of everything bouncing up and down. It can happen to people who take an antibiotic that is toxic to the ear. It usually improves over time.Less common, deadly diseases can also cause vertigo, such as tumors or stroke. Lightheadedness is usually caused by some surrounding circumstances impairing blood flow to the brain when a person is standing up. Blame this problem on our ancestors who learned to walk upright -- putting our brain above our heart. It's a challenge for the heart to keep the brain supplied with blood( auto regulation mechanism) and it's easy for this system to break down. When blood vessels in the brain become dilated, or expand, due to high temperature, excitement, or hyperventilation, alcohol consumption, or prescription medications such asantidepressants, a person can become lightheaded. There can also be more serious causes, such as astroke and heart disease. DISEQUILIBRIUM can be caused by: A kind of arthritis in the neck called Cervical spondylosis, which puts pressure on the spinal cord. Parkinson's disease or related disorders that cause a person to stoop forward. Disorders involving a part of the brain called the cerebellum. The cerebellum is the part of the brain responsible for balance and coordination. Diseases such as diabetes that can lead to loss of sensation in the legs,as in advanced cases of neuropathy. Dizziness in the form of anxiety is often, but not always, caused by depression. It can also be due to an anxiety disorder or phobia or a panic disorder. Various medications can also cause dizziness as a side effect. ref:webmd.Dr. Chakradhar Nannapaneni14 Likes11 Answers