
Suggest Treatment For Anxiety And Panic Disorder

counseling session by a psychiatrist may be needed
Detailed Answer:
Hi XXXXXXX
Thanks for writing to us.
I read your current as well as previous questions. I saw your pic also.
From narration it seems that you are much over concerned regarding a minor unimportant thing.
Yes, being a young lady you should be concerned regarding your look.But here a tiny bald spot(according to me it is normal) is bothering you, which is not at all of concern from medical point of view.
You have mentioned that you have anxiety disorder. I would like to know from your side,"Is it due to this concern or is it already there before?, If yes, are you taking any treatment in form of pharmacotherapy and/or psychotherapy?"
If you have anxiety disorder already before this, current problem/symptom is just a part of anxiety disorder and you can ask your treating doctor to help you for this by counseling or medicine.
If your anxiety disorder is only due to this current concern and it is not affecting your daily schedule, routine work or social life, it can be relieved by just reading this answer of assurance that you do not have any major problem or just after detail counselling session by a psychiatrist whom you need to consult.
However if this problem is bothering you much and affecting your personal life, I would like to put some differential diagnosis in likely ore first in order.
1. Obsessive Compulsive Disorder: Obsession of having bald spot and compulsion to ask everyone about that.
2. Body dysmorphic Disorder: Persistent unnecessary concern about defect or abnormality in body part or look.
3.Hypochondriasis: constant feeling of having something wrong in the body and treatment of which is not done as doctors are not able to find the cause.
Exact diagnosis can be done after detail history and mental status examination only. In that case also you need consultation of psychiatrist.
Waiting for your reply to help you further,
Regards,
Dr.Chintan Solanki.


You are not balding at all
Detailed Answer:
Hi young lady,
Thanks for detail for the medicines.
Stress causes hair loss but not balding like spot, it will be like scattered hair loss and density will decrease. However this stress induced hair loss is completely reversible as soon as stress relieved.
From your photograph I can say you have sufficient hair.Hair density depends upon genetic pattern,hormonal changes,diet and lifestyle. Worrying about that tiny spot make your self more anxious which can cause some stress induce hair loss.So try to relax your self that you do not have any balding pattern.Your current hair loss is normal according to pattern of hair cycle.
Medicines you are taking are good for anxiety disorders.If your thoughts about balding more and you do not have control over it, you can ask your psychiatrist to give klonopin 0.25 mg round clock three times a day temporary for reducing anxiety and excessive thoughts.
In counseling for anxiety disorder, Cognitive Behavior Therapy(CBT) is extremely useful.You can ask your therapist to start with that.In which you should try to following.Stop asking others about your concern.Whenever thought of balding comes in to mind, just assure yourself that," I have consulted doctor online and he had told that there is nothing like baldness there and I am completely ok." By repeatedly responding to your negative thoughts in this positive manner, you are actively facing them and gradually its frequency will be reduced and will stop ultimately.
Continue healthy diet including milk,eggs, vegetables, fruits and coconut water.Make your sleep and exercise schedule regular.This will help you to remain stress free and by that also improving hair density than current status.
Hope this answer would help you, I will be glad if any query is still there.
regards,
Dr.Chintan Solanki.


Read books or solve puzzles, rozac 20
Detailed Answer:
Hello,
You are not able to go to job that is an important factor.lack of thinking of other activities allows negative thoughts to come out more frequently and you are also giving push to those thoughts by checking persistently. I guess you are now case of OCD in this regard.
CBT would sure help. As your thought has increased , dose of prozac is needed to be increased to 20 mg. In OCD up to mg prozac is needed.
Current stress factor is foot injury and not able to do the job.To tackle that you can read books, solve puzzles-sudoku which will keep your brain working and frequency of negative thought regarding your baldness decreased.I recommend one book "Feeling Good" by XXXXXXX Burn, it is book for depression and anxiety treatment and includes part of CBT also.
So try to be active mentally though not physically and not allow yourself to sit and worry as much as you can.
All the best and Regards,I will be glad to answer if still any confusion.
Dr.Chintan Solanki.


Avoid checking and try to resist as much possible
Detailed Answer:
Hello Dear,
You are not at all annoying to me. I have seen many patients with such type of complaints. It is my duty to listen you non judgmentally, carefully and patiently.
You can ask me thousand times and I will reply as calmly as I replied in first answer.
Your thoughts of concern about alopecia are obsessions and to check details of eyebrows ,scalp are compulsions. Your OCD seems to be without insight, means your mind is not able to believe that your obsessions are wrong,intrusive and illogical.
Until you keep doing compulsive act of checking hairs , your negative thoughts of alopecia will continue and may increase in frequency.Though you have been distracted during doing puzzles, you must continue efforts to do that, as initially it is difficult but after repeating efforts your mind will be distracted form baldness thoughts.
One think you can do right now: take klonopin 0.25 mg(1/4th of your 1 mg) three times a day, until you can see your doctor in personal. It will reduce your anxiety and thoughts to some degree, however with 0.25 if you are not satisfied you can go for 0.5 three times though it can cause some sedation.
Try to avoid seeing of eyebrow of others as much as you can. Though it is not needed but I think consultation with dermatologist once will be helpful.Discuss about our talk to dermatologist and assurance form dermatologist will clear your all doubts.
You are always welcome for your queries.Never hesitate to ask. I will be happy to help you further.
Wish you early stability,
Dr.Chintan Solanki.


Yes you can reduce prozac, Eyebrow seems normal
Detailed Answer:
Hi dear,
No sorry please.You are always welcome.
In OCD maximum dose of prozac is 80 mg. It is not good to jump to 80 from 10 in short period.It is going to cause uncomfortable side effects as you feel.
In My patients, I generally increase the dose gradually, depending upon severity and response, 20 mg every week to 15 days.
As you were already on 10 mg,each day you can increase 10 mg and reach up to 40 mg and wait for 10 days at least to see effects. if you do not find any change, increment in the dose will be needed.
In my opinion you should continue klonopin as I mentioned before for early symptomatic relief.
Yes I have seen your latest photo.I compared it with previous photos.I did not find any significant difference in between them means not worsening.
Your concern is more about later(outer) side of eyebrow hair. But in my opinion it is normal.Yes hair density is lower than that of medial(inner) side, but that is normal variant.Please send me old(which you feel normal) clear pic to check and opine. otherwise your dermatologist will going to assure you.
Hope I have answered satisfactorily,I will be glad to answer more
Regards,
Dr.Chintan Solanki.


Just relax, problem is not significant
Detailed Answer:
Hello XXXXXXX
Thanks for pics. I still believe that there is no significant hair loss from eyebrows that it can be called pathological. In most of the people lateral side eyebrow hair density is less always than that of medial.
Please send your thyroid tests results to check as I could not get clear idea from narration. And remember that hair loss from eyebrow is not the only symptom of hypothyroidism.There will be lethargy,weight gain,constipation etc.
I think due to your anxiety your calorie burnt in thoughts which causes relative nutritional deficiency which ultimately results in stress related hair loss. I suggest to take vitamin and mineral supplement particularity Vitamin B12, Vit D and zinc and magnesium.
Take milk, eggs , high protein diet including pulses specifically soyabin as well as fruits and vegetables.
One normal reason for hair loss is hormonal disturbance.If your menstrual cycles regular, that factor is also ruled out.
I again assure you that , I don't think you have significant pathological hair loss.
Relax and take care.


Klonopin will help,Dermatoogist assurance needed
Detailed Answer:
Hi dear,
I can understand your pain and anxiety. But again I would like to mention that you are not in problem. Your thyroid seems to be normal. No hormonal disturbance is there. So only reason is psychosomatic concern.
Please take klonopin as soon as possible to relieve anxiety. 1 to 2 mg of klonopin will help in sleep. You must sleep otherwise your anxiety fetuses will worsen.
Try to avoid see your face and looking at eyebrow and try to say yourself repeatedly,"Amanda you are normal just relax". Do not touch eyebrow.
Have you consulted dermatologist or not? If not just take one seating and find out what is there! Dermatologist assurance will be final. After that we can go for psychosomatic approach if not relieved.
All the best, try to relax your self by deep breathing, medication or soft music.
Feel free to ask if any query is still there.
Regards,
Dr.Chinatn Solanki.


Good. Continue your efforts as discussed
Detailed Answer:
Hello
In this last question you seems to be sound good. I guess if you revise our discussion frequently and try to follow Do's and Don't, you will be relieved much before the appointments.
And yes ask your hair stylist to set hair in the way which look like dense, otherwise you will go into thinking.
Wish you early stability,
Take care.
Dr.Chintan Solanki.


Project for my sister i found a pic where i feel like mt brows are morw rounded (maybe its just me, photo is attached) and this totally set me off to seeing my brows now as just short lines and that i have lost TONS of area since the photo in 2012 (im on the left in the photo with the white sash ). Sorry i just cant ask my husband to look at the pic. He is at the end of his rope with me
Good going,keep it up, photo is not there
Detailed Answer:
Hello Dear,
Sorry for delayed response.
Thanks for following suggestions. Klonopin will help for sure.
It is really good that you have controlled your urge to see eyebrow though whatever the way. Just keep continue trying to avoid seeing at eyebrow and thinking about it.try to make yourself busy with some stuff as you have done with that project.If you can do it for a week or so, you will not need much medicines.
I can not find any recent photo with white sash in attachment, so I can't comment on that. Please try to re attach the same.
Regards,
Dr.Chintan Solanki.


not much diffrence with current status
Detailed Answer:
Hi XXXXXXX
Yes pic is there with beautiful smile.It is difficult to judge about comparison with current pic in photographs.Someone can give the best opinion by seeing personal. However I found little bit difference that is of no significant. Just relax and try to follow suggestions from our discussion and become stable soon.
Regards,
Dr.Chintan Solanki.


It is totally normal
Detailed Answer:
Hi XXXXXXX
Please do not say sorry.
Our hair grow in cyclic stages. During telophase it is normal to have fall of hair.5 to 10% of total hair normally in this stage at a time in an individual,so this much hair fall after wash is quite normal and happens in most of the people.Because of not able to wash for few days make its quantity more otherwise its quite ok. So relax and try to enjoy weekend.
Take care,
Dr.Chintan Solanki.


take klonopin 0.5 mg three times a day
Detailed Answer:
Hi XXXXXXX
Sorry for delayed reply.
I can understand your pain and anxiety.Your husband is not understanding that is also drawback.
You will not lose your eyebrow , just relax. Until you see dermatologist, take klonopin 0.5 mg three times a day to fight with anxiety features. you can take 1 mg at night if sleep disturbance is there with 0.5 mg.
And in next appointment with psychiatrist ask your husband to come also for counseling and make him understand about you so he can understand your situation and support you.
Regards,
Dr Chintan Solanki.

Answered by

Get personalised answers from verified doctor in minutes across 80+ specialties
