Q. I am suffering from anxiety. Please help.

Hi,

Welcome to icliniq.com.

Your description of symptoms is concise and specific, which makes it easy to diagnose your condition.

Mental illnesses are broadly classified into neurosis and psychosis.

In neurosis, a person does not lose contact with reality and understands that he has a mental issue known as insight into illness. The person is concerned about it and actively seeks help, just like you. All anxiety disorders fall under neurosis.

Conversely, in psychosis, a patient losses contact with reality for example false perception like voices talking or false belief like a delusion that people are planning to kill him.

These patients refuse to believe that they have a mental problem and they resist any sort of treatment. Schizophrenia is a classic example of psychosis.

Patients of neurosis do not convert into psychosis. Anxiety remains as anxiety no matter how severe or chronic it is. So, be assured that you are not going to become schizophrenic, lose your mind or land in a mental hospital.

Anxiety disorder has multiple presentations like generalized anxiety disorder, panic disorder, obsessive compulsive disorder, social anxiety disorder, etc.

Depersonalization also occurs in anxiety disorder. Frequently, these conditions coexist in varying severities at different points of time.

Your description suggests that at a certain level, you realize that your fear is irrational, but you still cannot get it out of your mind. This is likely to be an obsessive thought.

The characteristics of an obsessive thought are :-

1. It is automatic which pops automatically in your mind.
2. It is repetitive.
3. It is senseless or irrational.
4. It causes anxiety, uneasiness or disgust.

Despite this, you are unable to kick it out of your mind or prevent thinking about it. There is a proven helpful way of dealing with an obsessive thought.

• Do not blame yourself for having the thought. It is a part of your anxiety disorder and you are not thinking willfully about it.

• Do not try to resist it. Instead, label it as an obsessive thought and let it come into your mind and try to ignore it rather than resisting or removing it. Let it come, Let it go, do not blame yourself for having the thought and do not argue with the thought.

• Do not try to chase the thought by thinking about the content or meaning of that thought.

Try a deep breathing technique like the 4-7-8 technique (relaxed breathing) which you can find on the internet and use it whenever you feel more anxious.

Lastly, if you feel the need of taking medicine to deal with it, you should choose an antianxiety drug like Clomipramine or Fluvoxamine which has proven efficacy against obsessive symptoms as well.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome back to icliniq.com.

It is good to know that my answer helped you. Sometimes, knowing your problem itself is quite relieving.

• Yes, I will be happy to do CBT (cognitive behavioral therapy) this way.

• You can send me your distressing thoughts, the situation in which they arise in your mind, your reactions to those thoughts and whatever you do to release the anxiety in a detailed manner.

• I will send you the rational responses and techniques in the reply. I believe it will be helpful in curing your anxiety and worries.

Revert back with a detailed history to a psychologist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome to icliniq.com.

Your fear of losing control or becoming psychotic is an obsessional fear. We will label it as an obsession or symptoms of OCD (obsessive compulsive disorder).

When you have an obsession popping in your mind you Google to find it and how the symptoms will end, is actually called as compulsion. Though the compulsion gives you temporary relief from anxiety, it does not help in getting over the thought. In fact, that is the number one reason why your obsession becomes sticky and keeps popping in your mind.

At this stage I would like to suggest some ways to deal with the obsessive thought when you are actually experiencing them. This technique is basically changing the way you obsess. I will teach you three ways: Writing, singing, and changing images. All adults experience irrational worries from time to time. I want you to downgrade that obsession. Consider it as a momentary, anxiety-provoking event.

It is just a little glitch. It is not the actual obsession. It is your reaction to the obsession. So, hold a perspective that the content is not important, and it is not bad that you are obsessing. Free up your attention so that you can begin to modify the ways you obsess.

First thing to do is mentally step back and acknowledge that you have started obsessing. Next remind yourself that it is fine to have a momentary obsession. Do not start worrying about what the obsession means. Remind yourself that the obsessive content is not important. Do not get caught up in analyzing.

You engage in specific actions that will help you change your emotion about the obsessions. I will teach you three ways now. The goal is not to be worry free. The goal is to change your reaction to the obsessions.

The first is writing your worries. Carry a pencil and a small pad with you throughout the day. When you begin obsessing, write down your exact thoughts or a few phrases that describe your images or impulses. If you continue obsessing, keep writing. This does not mean a summary of what you said in your mind. This means a verbatim transcript of exactly what you are thinking. Act as though you are the stenographer in the courtroom. Every single utterance goes on paper.

As soon as you finish writing down the worry, if you think it again, you write it down again, even if it is verbatim what you just wrote down. Do not write down the theme; write down every single repetition of every single thing you think.

When you obsess, you tend to repeat the same content again and again. This is what you call as mental chatter.

When you write out the obsessions, you recognize how repetitive and senseless they are. This perspective weakens the obsessions. It is easy to say it in your head 400 times. But, writing is difficult. It begins to make the obsessions an arduous task.

Another way to begin changing your emotional response to your obsession is to sing your worried thoughts. You have to literally sing as in your mind the words you would usually say, like, I fear that I might lose control over my mind, I might go crazy or land in a mental hospital.

The process of singing your obsessions makes it difficult to simultaneously stay distressed. Yes, it is stupid and childish. Do it anyway.

Pick up a short phrase that summarizes your obsession. Ignore its meaning for a while. Continue to repeat the words, but do so within a simple melody. Keep up this tune for a few minutes.

I do not expect that you will start singing this little tune and instantly feel happy. In fact, it will probably be hard to feel anything but anxiety when you start singing. But stick with it. And while you are singing, work to become detached from the content of your song. Remember, that is our goal.

Whenever you feel less emotionally involved with these thoughts, let go of the tune and the words. Turn your attention elsewhere.

But what if the obsession is an image? In that case, you need to modify that picture in some way, or to replace it with another image. Since you have not mentioned anything about seeing an image, I will drop this idea. But, remind me if you see images as well.

Once you have made that shift away from your intense anxiety, by singing the obsession, writing it down, altering the imagery or any other changes that you create for yourself that would shift your emotion, then turn your attention to other activities in your life.

So, if you have got a bunch of nice, easy little thoughts and images, and then you have this thought that is terrifying, your mind going to go right back to what is fearful. So, turn your attention to some new activities.

It may take you a while before this technique gives you benefits. Some obsessions feel so strong that you will not be able to let go of them right away. Nonetheless, continue to practice this approach as a way to get some perspective on your irrational worries.

Now, try any of the three techniques suggested whichever you find easy, practice it for a couple of days. You will face some problem, no doubt. Convey me the problem and I will suggest the trick to overcome the hurdle in practicing this. It requires a bit of effort, but definitely worth it.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome back to icliniq.com.

First, I would like to reassure you that your OCD will never turn into any form of schizophrenia. I can guarantee you that.

Secondly, I would like to analyze your current symptom. You have the fear that you might become psychotic or lose control. This fearful thought pops up in your mind repeatedly. This causes anxiety.

To reduce the anxiety, you seek reassurance to confirm that you will not lose control or become schizophrenic.

• Your question this time is actually an attempt at seeking reassurance. In short, the thing that is troubling you is actually an obsession. Your worry is actually your main symptom.

• I guess you have tried to seek reassurance from google and me numerous times, but still this reassurance does not relieve your problem. So, rather than confirming or reassuring, the way out of this worry is actually identifying your obsession.

• As I mentioned in last mail, the content of the thought is not important, it is different in different people. But still causes anxiety in everyone. The way out is in treating your OCD.

The best solution for this is either CBT or anti OCD medications. If you find it difficult to follow the CBT session right now, the next best thing to do would be to take medicines for a few weeks till the symptoms have reduced to such a level that you can actually do CBT.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome back to icliniq.com.

Anafranil (Clomipramine hydrochloride) is regarded as gold standard for OCD.

Dosage is 25 mg at bedtime for first five days, then 50 mg at bedtime for next five days and then 75 mg in two doses that is 25 mg in morning and 50 mg at night. Further, doses can be increased in steps of 25 mg every five days.

The night dose is raised first and the morning time dose later. The maximum dose is up to 250 mg, but most patients experience benefit from 75 mg to 200 mg.

It is quite well tolerated. The common side effects are constipation, dry mouth, weight gain and sedation.

These disappear after a while and can be managed by simple measures like increasing fiber content in your diet for constipation, chewing sugar free gum or candy to keep the mouth wet and daily exercise and also cut sugar content in diet to prevent weight gain.

It usually takes three to six weeks for the obsessions to reduce, though your anxiety will reduce early.

I would advise you to start therapy after 15-20 days of taking Anafranil, so you will be more comfortable in doing it. With therapy, you will not need to take Anafranil for long.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome back to icliniq.com.

The second option is Fluvoxamine, a SSRI (selective serotonin reuptake inhibitor) which is specific for ocd. It has affinity at sigma-1 receptors, which makes it the preferred SSRI in OCD.

It has less sedation as compared to Clomipramine. It is generally considered that while Clomipramine is more effective, Fluvoxamine (Luvox) is more safe.

The dosage starts with 50 mg at night time, then raised to 50 mg twice a day after four days. The dose can gradually be raised to 200 mg in steps if needed and tolerated.

You might have to cut down on your tea or coffee intake, as some people report increase in anxiety with coffee while on it.

It might have transient sexual dysfunction, which reverses on discontinuation and can be treated with other medicine like Trazodone.

Paroxetine (Paxil) is the third choice in terms of efficacy. It causes more sexual dysfunction and has a withdrawal syndrome.

Fluoxetine (Prozac), comes next in efficacy, besides it could cause increase in anxiety symptoms in the beginning.

So, my recommendation would be Fluvoxamine amongst SSRI drugs. It is difficult to choose between Anafranil and Fluvoxamine, because both are preferred medicines. If you are a little worried of adverse effects then I will recommend Fluvoxamine.

For further information consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Saraswat Kumarshri Shriniwas

Experience: 19 + Yrs

Psychiatry

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