Hello,

Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     22 year old female.
•     History of anxiety, /panic, and depression for decades.
•     Known case of sinus tachycardia.
•     Complaints of: feeling of arterial pulsation inside left lip.
•     Currently on Atenolol once per day and Clonazepam when needed.

Sinus Tachycardia can occur in Anxiety disorder too. You already have long duration symptoms related to anxiety, panic, and depression. All these disorders are associated with tachycardia and palpitation.

Feeling of arterial pulsation inside left lip may occur because of following reasons (in order of preference in your case):
•     Anxiety disorder: because of muscle twitch. Anxiety disorder commonly associated with somatic symptoms like multiple pain complaints, muscle spasm and twitch.
•     Aneurysm of artery: it is rare in labial artery.
•     Neuropathy.
•     Myopathy.

Anxiety disorder is one diagnosis which can explain almost all symptoms. Other common symptoms of anxiety disorders: anxiety, nervousness, restlessness, mild irritability, excessive worry regarding own wellbeing, tremor, muscle spasm/twitching, heaviness in body, easy fatigability, palpitation, sleep difficulty and dry mouth.

You may need treatment with Psychiatrist to treat your anxiety. It is not clear if you received any treatment in past apart from Clonazepam. As you are having multiple symptoms then combined treatment in form cognitive behaviour therapy and drug therapy will be best in your case.

In drug treatment of anxiety two types of medicine used. For immediate relief of anxiety Benzodiazepines group of medicines are used (like Clonazepam) for short term and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) are used. SSRI takes around 3-4 weeks to show its effect and cognitive behaviour therapy also takes weeks to show its effect.

Physical examination by a Physician will help to rule out any other local cause for pulsation in that area.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Regards,

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