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What Causes Fear Of Death And Anxiety After A Successful Heart Surgery?
Question: Dear Doctor,
In October 2014, I was diagnosed with PVC-induced cardiomopathy and was told I had a very short time to live and would probably die very suddenly.
In December 2014 I had heart surgery which cured me. I was told I was totally recovered and would lead a normal life. Somehow, though, instead of being grateful and happy, I became instantly terrified that I was either not cured or that I would get sick again. I had sadly accepted that I was dying soon and when that was no longer the case, I became much more afraid. I have not been able to rejoin life and spend my days in fear.
I am particularly terrified of water retention because water was wrestled from my hand in the hospital and I was told my body could not handle water. I am so afraid of that most benign and necessary entity: water.
I became gravely ill when I was losing my mother and my marriage was ending. So much trauma and sadness.
How do I start to believe that I am healthy again and rejoin life? I feel like a ghost walking around with living people I can't relate to. I measure every drop I drink and end up in the ER at least once a month. I'm a total wreck.
Is this PTSD? Will it start to relent? I want to laugh and be happy again. I am in therapy with an OCD specialist and see a psychiatrist for medication: prozac, buspar, and xanax.
Will it just take more time? Will I ever feel normal again?
In October 2014, I was diagnosed with PVC-induced cardiomopathy and was told I had a very short time to live and would probably die very suddenly.
In December 2014 I had heart surgery which cured me. I was told I was totally recovered and would lead a normal life. Somehow, though, instead of being grateful and happy, I became instantly terrified that I was either not cured or that I would get sick again. I had sadly accepted that I was dying soon and when that was no longer the case, I became much more afraid. I have not been able to rejoin life and spend my days in fear.
I am particularly terrified of water retention because water was wrestled from my hand in the hospital and I was told my body could not handle water. I am so afraid of that most benign and necessary entity: water.
I became gravely ill when I was losing my mother and my marriage was ending. So much trauma and sadness.
How do I start to believe that I am healthy again and rejoin life? I feel like a ghost walking around with living people I can't relate to. I measure every drop I drink and end up in the ER at least once a month. I'm a total wreck.
Is this PTSD? Will it start to relent? I want to laugh and be happy again. I am in therapy with an OCD specialist and see a psychiatrist for medication: prozac, buspar, and xanax.
Will it just take more time? Will I ever feel normal again?
Brief Answer:
it can be helped; please telk the dosage and duration of each medicine
Detailed Answer:
Hello,
welcome to health care magic!
I have read your question carefully and from that I feel that you have anxiety symptoms and ocd symptoms as well. You are already working with an ocd speacialist and taking medicines. You have mentioned the meds but not the dosages.
- I would like to tell you that it is a common clinical presentation where after a life threatening event, person is unable to get back into life like before. Here in such cases I have found that a combination of both therapy and medicines works best.
- As you have asked if its ptsd or not- according to my clinical knowledge: You may take it to be something which can fit in there. It had almost come as a shock to you (the diagnosis of cardiomayopathy and there was an imminent threat to life) , that news could have disturbed most of the people. So, as far as I think- it can be taken as ptsd.
- However, now when you have luckily and completely recovered- its important that you come back to life again...
If I had had a similar case in my clinic I would have asked him to enter in a cognitive behaviour therapy to change the disturbed cognitions.
When meds are not showing good relief then I usually try to either raise the dose or change the medicine to a better one.
- Its always good to rule out certain metabolic abnormalities as well- like thyroid problems and liver and kidney status, vitamin deficiencies. If there are any deficiencies in them- correcting them usually helps in recovery.
I think you may talk to your treating team about all this.
You also seem to have an ocd component as well and its good that you are working on it.
If you want to discuss the medicines please write the dosages that you are presently taking. Without knowing the dosage and duration from which ypu are taking each medicine its difficult to give a correct opinion on the prognosis of illness.
I hope the reply helps you.
Feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
it can be helped; please telk the dosage and duration of each medicine
Detailed Answer:
Hello,
welcome to health care magic!
I have read your question carefully and from that I feel that you have anxiety symptoms and ocd symptoms as well. You are already working with an ocd speacialist and taking medicines. You have mentioned the meds but not the dosages.
- I would like to tell you that it is a common clinical presentation where after a life threatening event, person is unable to get back into life like before. Here in such cases I have found that a combination of both therapy and medicines works best.
- As you have asked if its ptsd or not- according to my clinical knowledge: You may take it to be something which can fit in there. It had almost come as a shock to you (the diagnosis of cardiomayopathy and there was an imminent threat to life) , that news could have disturbed most of the people. So, as far as I think- it can be taken as ptsd.
- However, now when you have luckily and completely recovered- its important that you come back to life again...
If I had had a similar case in my clinic I would have asked him to enter in a cognitive behaviour therapy to change the disturbed cognitions.
When meds are not showing good relief then I usually try to either raise the dose or change the medicine to a better one.
- Its always good to rule out certain metabolic abnormalities as well- like thyroid problems and liver and kidney status, vitamin deficiencies. If there are any deficiencies in them- correcting them usually helps in recovery.
I think you may talk to your treating team about all this.
You also seem to have an ocd component as well and its good that you are working on it.
If you want to discuss the medicines please write the dosages that you are presently taking. Without knowing the dosage and duration from which ypu are taking each medicine its difficult to give a correct opinion on the prognosis of illness.
I hope the reply helps you.
Feel free to ask more questions for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much, doctor. I am taking Prozac 20 mg, Buspar 30 mg bid, Xanax .5 tid.
I have been tested for everything and all is normal although I never believe it and always feel right after a test that I have deteriorated.
Prozaz was restarted 3 1/2 months ago. I have been on it, off and on, mostly on, for 20 years. I had not been on an antidepressant from December 2014- May 2015. In the past, 20 mg has helped very much, even for severe postpartum depression but I am terrified of weight gain so cannot tolerate a higher dose.
Do you believe with time, I can function normally again? I feel like I am watching the world but am no longer a part of it. I don't laugh or enjoy anything at all. I feel worse than when I was actually critically ill. I just want to feel like a human being again.
I am so scared of dying that I have become afraid of life. Will these feelings ever end? My body is in prime health by objective measures and I feel physically healthy but I feel as if there is a gun pointed at me. How can you enjoy anything when you just feel terror all the time? Thank you, dr.
I have been tested for everything and all is normal although I never believe it and always feel right after a test that I have deteriorated.
Prozaz was restarted 3 1/2 months ago. I have been on it, off and on, mostly on, for 20 years. I had not been on an antidepressant from December 2014- May 2015. In the past, 20 mg has helped very much, even for severe postpartum depression but I am terrified of weight gain so cannot tolerate a higher dose.
Do you believe with time, I can function normally again? I feel like I am watching the world but am no longer a part of it. I don't laugh or enjoy anything at all. I feel worse than when I was actually critically ill. I just want to feel like a human being again.
I am so scared of dying that I have become afraid of life. Will these feelings ever end? My body is in prime health by objective measures and I feel physically healthy but I feel as if there is a gun pointed at me. How can you enjoy anything when you just feel terror all the time? Thank you, dr.
Brief Answer:
can raise the prozac or change the drug; stop tea coffee
Detailed Answer:
Hello,
Thanks for replying back. I will try to answer all your queries.
1. Yes, I do think thay you can get better. Its difficult to say if 100% can be achieved but in similar cases I have seen very good recovery. So, please donot loose hope.
2. You have been on prozac on and off from past 20yrs.. it means that you have had depression or anxiety since a long time...and needed help. This also helps in making sense that as to why you had such a reaction after diagnosis of cardiomyopathy. Its ok.. there was a predisposing element already present which got colored by the illness.
--You have had good response to prozac in past - indicating a good prognosis.
3. As far as my clinical knowledge is concerned- If I were treating you- I would like to raise the dosage of prozac to 40mg. I can understand that it gave you weight gain but we have to get well first. Other things come later..
If my patient would still objects to go for raising the drug for the fear of weight gain then: I generally change the molecule . I have seen very good response in similar cases with venalafaxine or paroxetine. They are better than prozac and have a difderent mechanism of action.
If you want you should discuss these points with your treating team.
Paroxetine has an additional benefit of sedation. So the need of night time xanax or any sedative is less and patient is able to stop it completely after a week or two.
4. Right now you are having anhedonia and hopelessness helplessness and feeling of worthlessness...all of these will respond and you can feel much better.
5. cutting down on tea coffee and cold drinks and eating more veggies and nuts have seem to help my patients. Adding a supplememnt of tetra hydrofolate have brought an early response in many of my patients. I generally start with adding 7.5mg of the same in morning time.
I hope the reply brings you hope and peace.
wish you a speedy recovery!
Feel free to ask more queries for clarirfication.
Dr. Manisha Gopal
MD Neuropsychiatry
can raise the prozac or change the drug; stop tea coffee
Detailed Answer:
Hello,
Thanks for replying back. I will try to answer all your queries.
1. Yes, I do think thay you can get better. Its difficult to say if 100% can be achieved but in similar cases I have seen very good recovery. So, please donot loose hope.
2. You have been on prozac on and off from past 20yrs.. it means that you have had depression or anxiety since a long time...and needed help. This also helps in making sense that as to why you had such a reaction after diagnosis of cardiomyopathy. Its ok.. there was a predisposing element already present which got colored by the illness.
--You have had good response to prozac in past - indicating a good prognosis.
3. As far as my clinical knowledge is concerned- If I were treating you- I would like to raise the dosage of prozac to 40mg. I can understand that it gave you weight gain but we have to get well first. Other things come later..
If my patient would still objects to go for raising the drug for the fear of weight gain then: I generally change the molecule . I have seen very good response in similar cases with venalafaxine or paroxetine. They are better than prozac and have a difderent mechanism of action.
If you want you should discuss these points with your treating team.
Paroxetine has an additional benefit of sedation. So the need of night time xanax or any sedative is less and patient is able to stop it completely after a week or two.
4. Right now you are having anhedonia and hopelessness helplessness and feeling of worthlessness...all of these will respond and you can feel much better.
5. cutting down on tea coffee and cold drinks and eating more veggies and nuts have seem to help my patients. Adding a supplememnt of tetra hydrofolate have brought an early response in many of my patients. I generally start with adding 7.5mg of the same in morning time.
I hope the reply brings you hope and peace.
wish you a speedy recovery!
Feel free to ask more queries for clarirfication.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, dr. Do you think 20 mg prozac may end up helping after more time? I have been on paxil and gained weight and felt agitated. I have not been on Effexor.
I see an OCD specialist who is starting ERP therapy. I see a psychiatrist for meds and talk therapy.
What is tetra hydrofolate? Does that affect glutamate levels which may help with OCD?
Sometimes I am afraid that I have a delusional disorder. All my doctors say I'm cured but I still think I'm dying.
Is some of this just needing time to get over all the trauma?
I see an OCD specialist who is starting ERP therapy. I see a psychiatrist for meds and talk therapy.
What is tetra hydrofolate? Does that affect glutamate levels which may help with OCD?
Sometimes I am afraid that I have a delusional disorder. All my doctors say I'm cured but I still think I'm dying.
Is some of this just needing time to get over all the trauma?
Brief Answer:
folate help serotonin pathway; can try effexor
Detailed Answer:
Hello,
I have read the follow up query and will try to help you-
1. If there is problem with paxil in past- had I been treating you I would have gone for effexor then.
2. You have been on prozac from past 3 and 1/2 months and there is no benefit- I think it will be better to either raise the drug or change it . Continuing it at same dosage for more time is unlikely to show further improvement..
3. Regarding tetrahydrofolate - its a supplement which improves the deficient folate levels in body. It enhances recovery and helps serotonin pathway that has a big role in recovery of depression or anxiety.
4. Delusion- is a false fixed firm belief which is held with complete conviction despite having contrary evidence. This is the definition of delusion. All the components must be fulfilled to establish a delusion. I cannot say right now if you have delusion or not (regarding this point), without interviewing you myself. It will be unwise of me to comment on that thing.
Your treating team can tell you best. If they also think that you have this delusional belief of being unwell( which is not uncommon in severe depression) it will be helpful to add anti psychotic in low dose.
Otherwise also I use antipsychotics in low dose as an adjuvant to antidepressants to enhance the efficacy and shorten the recovery time in my patients. It has a good result.
So, you should discuss this possibility of delusion with your doctor.
Wish you good luck!
Feel free to ask any query for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
folate help serotonin pathway; can try effexor
Detailed Answer:
Hello,
I have read the follow up query and will try to help you-
1. If there is problem with paxil in past- had I been treating you I would have gone for effexor then.
2. You have been on prozac from past 3 and 1/2 months and there is no benefit- I think it will be better to either raise the drug or change it . Continuing it at same dosage for more time is unlikely to show further improvement..
3. Regarding tetrahydrofolate - its a supplement which improves the deficient folate levels in body. It enhances recovery and helps serotonin pathway that has a big role in recovery of depression or anxiety.
4. Delusion- is a false fixed firm belief which is held with complete conviction despite having contrary evidence. This is the definition of delusion. All the components must be fulfilled to establish a delusion. I cannot say right now if you have delusion or not (regarding this point), without interviewing you myself. It will be unwise of me to comment on that thing.
Your treating team can tell you best. If they also think that you have this delusional belief of being unwell( which is not uncommon in severe depression) it will be helpful to add anti psychotic in low dose.
Otherwise also I use antipsychotics in low dose as an adjuvant to antidepressants to enhance the efficacy and shorten the recovery time in my patients. It has a good result.
So, you should discuss this possibility of delusion with your doctor.
Wish you good luck!
Feel free to ask any query for clarification.
Dr. Manisha Gopal
MD Neuropsychiatry
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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