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Why am I stressed a lot and unhappy too?

Why am I stressed a lot and unhappy too?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At May 31, 2017
Reviewed AtJanuary 18, 2024

Patient's Query

Hello doctor,

I am a 26-year-old male. My weight is 130 pounds, and my height is 5 feet 8 inches. I grew up with great responsibility for my family, but never fulfilled it up to the mark, besides living my life in fear from society. I managed good academics and achieved some standards over time. But, I have also developed very poor social skills, dependency to some extent, and fear while facing anything new. I do not want to move from a situation where I have fixed myself. Three years ago, I had a breakup and was also idle without a job. This caused me severe stress and crying episodes about which I did not share with anyone. I got a job but did not feel happy about it. The emptiness and worry followed me. I got into another relationship, which was lovely. I got involved in alcohol drinking and smoking. I faced a time where job stress overwhelmed me every day, and I detached myself from everyone, felt emotionless even with my family, experienced drowsiness, and had no sense of reality. I became so casual that the only thing I wanted is nothing should worry me. If anything worried me, I tried to solve it immediately with a step that might be job-threatening. I lived without any pleasure, confidence, goal, and routine. I did live my life, but never felt any connection as I have become a robot. Forgetfulness, short-term memory loss, and no attention or interest at all. Today I have improved myself and do not drink regularly; I do exercises, talk with family and some friends, watch television, and got a better job. But still, I am not happy. My forgetfulness and excessive worry are still with me. I find that my brain is continuously busy with something, but I am not aware of that. I feel very tired and lazy. I am socially frightened, poor, and I am not clever enough. However, I am very polite, helpful to others, and have good moral values. I found that I have not added strong value and get easily convinced, irritated, and people make a fool of me. It is like I have gotten stuck and trapped, and I have not moved on. I want to put an end to this. Please help me.

Hi,

Welcome to icliniq.com.

I have gone through your query in detail and would like to summarize your current symptoms: Feeling sad, excess worries, poor cognitive abilities (memory and thinking), social anxiety (fear of people), reduced energy levels (lazy and tired), low self-confidence and feeling of guilt and worthlessness are all typical symptoms of depression (major depressive disorder). Your past history suggests that you are suffering from this for almost three years and it was more severe in between with symptoms of lack of motivation, lack of pleasure, indulging in smoking and drinking. The simple and effective way out of depression is antidepressant medicines. They are safe, will act quickly and help in majority of cases. There are lots of the other option like counseling (cognitive behavior therapy) and electroconvulsive therapy, but medicines are most practical for your current condition. For symptoms of depression along with anxiety including social anxiety, selective serotonin reuptake inhibitors (SSRI) classes of antidepressants are most effective. I would like to start you on Escitalopram 10 mg and wait for 15 days and then adjust dose accordingly. Clonazepam needs be taken at a dose of 0.5 mg for 15 days alongside and then stopped. Along with medicines, here are few tips for better results: Stay away from alcohol as it will cause as well as worsen depression. Do 30 minutes of physical activity like cycling, jogging and swimming daily. It increases the levels of feel good hormones in your brain. Do deep breathing techniques like the 4-7-8 technique which you can find on the internet. Practice it for a minute, do four to five times a day. Devote some time for a hobby which gives you a sense of pleasure.

I hope this information will help you. Please revert in case of further queries.

Thank you.

Differential diagnosis

The differential diagnosis is social anxiety disorder.

Probable diagnosis

The probable diagnosis is major depressive disorder.

Treatment plan

The treatment plan is antidepressant medicines and lifestyle changes.

Preventive measures

The preventive measures are to avoid alcohol and increase physical activity.

Patient's Query

Hello doctor,

Thank you for the reply.

I took the medicine which has been suggested to me. However, one breakup occurred in taking medicine. There has been very much improvement. I feel only slight clarity, but memory and clear thinking still disturbing. This has happened after a long time that for one or two moment I felt connected to myself, but it happened only one or two times. I feel slight improvement in laziness, but still suffering from procrastination. There is slight improvement in moods, but it is totally instable. Maximum time I am not sad but serious, bored, disturbed, frustrated and sometimes sad too. At this point, I cannot comment on my social anxiety. There is slight improvement in excess worry. My brain feels relaxed some of the time which was not there before. I do not know whether I feel guilty or not. Self-confidence remains the same. Above all, I am still lost and not able to find myself as there is a shadow in my brain which is stopping me to have the clarity. Improvement is there which is a happy feeling for me. I am looking forward for your advice.

Hello,

Welcome back to icliniq.com.

It is nice to hear that you are improving. This is known as a response. You are improving, but far from being completely better. This much is expected in 15 days. Now, the next step is to double up the dose of Escitalopram, take 20 mg at night from today. Also half the dose of Clonazepam, which means half tablet of 0.5 mg at night. Try to abstain from drinking as much as possible and follow up after another 15 days.

I hope this has helped you.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I have been given Nexito forte which consists of Escitalopram 10 mg and Clonazepam 5 mg in a single tablet. How can I double Escitalopram and take half of the Clonazepam tablet? Another prescribed tablet is Folic acid. Kindly guide.

Hi,

Welcome back to icliniq.com.

The Clonazepam (0.5 mg) tablet can be broken and taken half, while the Escitalopram 20 mg tablet should be taken. Along with this, I will also suggest some vitamin tablets next time.

I hope this has helped you.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I took the medicine that was prescribed to me, and here are the improvements I've noticed: there is a significant improvement in my weak eye condition, and I feel more awake now. My laziness has decreased, providing me great relief as I am more active. There is some improvement in clarity, and my mood stability in terms of emotions has also somewhat improved. However, I am still experiencing issues with concentration and getting trapped in thoughts. Overall, the experience has been positive, as even a little increase in activity has been a great relief and is helpful for my work. My primary concern now is achieving thoughts clarity, regaining self-confidence, a positive attitude, and being more attentive. There is a constant flow of thoughts in my mind, whether I am working, resting, or sleeping. It feels like I am constantly talking or teaching myself about what is going on and how I am feeling. I wonder if this is a symptom of major depressive disorder or a side effect of the medication. The continuous stream of thoughts hampers my concentration, making it difficult to focus. Nevertheless, I have noticed overall improvement, making it easier to work on my issues, stay calm, and give myself time to understand things better. I am grateful for the help so far and look forward to further advice.

Hello,

Welcome back to icliniq.com.

It is great to hear that you are doing well. Regarding your excessive and uncontrollable thinking, here are my inputs: It will also improve gradually to some extent as the medicines continue. The most effective way to achieve a quiet mind is through meditation. There are many methods of meditation, but my favorite is mindfulness meditation as it trains your mind to concentrate on the here and now. Start practicing it, and in a month or so, you will find better mental control. If meditation does not help, then we will consider adding some medication. I would suggest you to take 0.125 mg of Clonazepam (half of your current dose) for 15 days and then discontinue Clonazepam and continue with 20 mg of Escitalopram only.

Patient's Query

Hello doctor,

I participate in mindfulness meditation and also take prescribed medicine. It is a little frustrating that after the initial help, it has just stopped. I am very relaxed. My mind is a little clearer. My laziness has improved. But I am totally emotionally numb. I am not sad, angry, or anything, neither am I happy, nor excited about anything. It seems that all the achieved improvements are good but do not fulfill me. I am not lost anymore, but I am not connected to my heart. I am totally emotionally numb. Please advise.

Hello,

Welcome back to icliniq.com.

Inability to feel emotions is known as emotional blunting. It is seen in some people taking selective serotonin reuptake inhibitors or SSRI such as Nexito (Escitalopram). It is treated with dopamine boosting medicines. We have a couple of options. I suggest you take tablet Solaze (Amisulpride 50 mg) half tablet at night time along with Nexito. Take it for seven days and update me on the progress. We will consider dosage adjustments and other medicine (if needed) during next follow up depending upon your progress. Continue doing mindfulness, the positive benefits will increase with regular practice.

I hope this has helped you.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I took the prescribed medicine, and here is the resulting progress: I am feeling good and active now. There are no major issues presently, and I am not emotionally numb anymore. However, I noticed that when some kind of pressure comes on me, everything seems to return back. I feel a little bored, and the chatter in my mind still goes on, but it is not that much disturbing. I am still a little far from getting completely better. Please advise on the issue and also on the ongoing medicine. It has been of great help.

Hello,

Glad to know that you are doing well.

It is apparent from your update that your depressive symptoms and emotional blunting are under control. You currently have anxiety in response to stressful situations. I would advise you to continue your sports and meditation. I would also like to start you on tablet Buspin (Buspirone) 10 mg in the morning and night, in addition to your current medications. It will not give you immediate relief, but you will gradually feel relaxed in three to five weeks' time. I will send you the prescription soon.

Patient's Query

Hello doctor,

Thank you for the reply.

I am feeling good, my anxiety has come down and depressive symptoms also on ease. Good things are happening and I am also expecting total control in near future. Some issue I am highlighting here:

  1. My cognitive abilities still needs improvement as forgetfulness and memory issue still not recovered.
  2. Chatter still goes on in my mind and foggy situation occurs in some cases where I find myself not attentive and focused.
  3. Anxiety level has improved but in a very slow manner.

Above all it feels that my all symptoms are at ease but they are still present there. Looking forward for your advise.

Hello,

Welcome back to icliniq. com.

I am very pleased to know that you are doing well. Regarding your residual symptoms, this is my advice: Buspirone works gradually for anxiety. So, you will see more and more improvement as the weeks pass by. Your mental chatter could also be related to your anxiety. The dose of Buspirone needs to be increased to 15 mg twice a day (one and a half tablets of Buspin 10mg twice daily) for four days, and then to 20 mg (two tablets of Buspin 10mg) twice a day. This should give you better relief from anxiety. Regarding the cognitive symptoms of forgetfulness, lack of attention, mental fog, easy distractibility, and memory issues, I would suggest taking a multivitamin, multi-mineral, and omega-3-rich formulations twice a day after meals. These vital constituents are frequently deficient in depression and contribute to memory and attention issues. Hopefully, these should help you with the remaining symptoms. Continue with the lifestyle modifications that you are doing, and you will see further improvement in your mental health.

Probable diagnosis

The probable diagnosis is residual symptoms of depression.

Regarding follow up

Follow-up if you have any queries.

Patient's Query

Hello doctor,

Thank you for the reply.

After initial help or partial help ,it is not working anymore. I am giving up on these medicine. Kindly help.

Hello,

Welcome back to icliniq.com.

It happens in depression that after some time, the dose of medicines falls inadequate. This requires adjustment of doses or a change in medications if required. This is no reason to give up on medicines. Remember that meds helped you for some months when you had lost hopes of improvement. I will need detailed information regarding your current symptoms, the previous meds helped you for what symptoms, what symptoms still needed improvement, your current sleep schedule, work conditions, and more. I would recommend a video consultation if possible. If not, at least an audio consult. A written query is inadequate to garner sufficient information as I cannot ask you relevant questions.

Patient's Query

Hello doctor,

Thank you again for your time; I greatly appreciate it.

I have benefited from following symptoms:

  1. Weighted eye condition has improved.
  2. Daydream-like condition improved but not 100 percent.
  3. Clarity in thinking achieved but not 100 percent.
  4. Laziness has improved.
  5. I do not worry much.

All these things have improved, and initially, I was guessing that I would attain 100 percent improvement, but it has become constant. No further improvement. I lack self-confidence and joy, which earlier seemed possible after the initial help of medicine. I don't like anyone and am becoming dissociative slowly. I do not have interest in my job or any other activity. I still think about so many things in my mind continuously from morning till I sleep. I also lack courage. Please suggest.

Hello,

Welcome back to icliniq.com

I would like to change your medications. You can stop your Escitalopram, and I will send a fresh prescription tomorrow morning. We will target your chief complaints of lack of self-confidence, enjoyment, and mental chatter with the newer prescription. I suggest you take the tablet Daxid (Sertraline) 50 mg in the morning after breakfast, and we will increase it to 100 mg after a week if you tolerate it well. I am assuming that you are eating and sleeping well and no longer drink.

I hope this has helped you. Please feel free to reach me again, in case of further queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for the reply.

I am eating well, no issue and I do not drink now. Regarding sleeping, I take a sufficient number of hours of sleep (7 to 8 hours); however, I do not feel refreshed in the morning and feel a need for more sleep.

Hello,

Welcome back to icliniq.com.

It is good to know that you are sticking to a routine and have quit drinking. You will receive your prescription soon. Follow up after two weeks.

Patient's Query

Hello doctor,

Thank you for the reply.

Cannot say much but I find myself at little peace compare to before. I guess medications are working. I am waiting for them to be full effective.

Hello,

Thank you again for your time; I greatly appreciate it.

It takes about 15 to 20 days for medications to start working. You seem to be tolerating the dose well. So, I will be increasing the dose of Sertraline and Buspin (Buspirone) this time (I will be sending your prescription soon). Continue with your efforts.

Patient's Query

Hello doctor,

Thank you so much for your help.

I have started to feel early improvement at least I think so. I have very good energy, not tired. Working speed has increased. I feel motivated towards task. I am feeling all these improvement for last three days only. It may be temporarily but I am feeling a little more push and I will make it. I finding difficulty in life due to lack of reasoning or confused mind due not able to understand others emotions and even my own emotion. Ambiguity in decision as not able to decide which side I want to be. So, cognitive abilities are my concern. Will it improve by time?

Hello,

Welcome back to icliniq.com.

It is good to know that you have started feeling better. I assume that you are on 100 mg of Sertraline. If this improvement halts in between, we will think of making further adjustments in dose. The improvement in depression is gradual and it continues into years. So, I would like to assume that these residual symptoms will disappear with time. Hang in there, it only gets easier with time.

Patient's Query

Hello doctor,

Thank you for the reply.

I am on 150 mg, and the only side effect I am facing is disturbed sleep. One more thing I would like to point out is that sunlight gives relief to my tired eyes and a good sense of feeling, like an active sensation in my body. My body does not feel lazy and cold when exposed to sunlight. I am also taking a particular depression test online, and my scores are improving. According to that, I fall into the mild to moderate depression category. This is just to inform you, as I kept the source the same and went through the same set of questions. I also find myself connected to my past life occasionally, where my hidden emotions sometimes come to the surface, but I do not give them much attention as most of them are negative in nature. However, they seem like the real me, and I feel connected to myself. Should I analyze them? Or should I just ignore the negative feelings? Please advise.

Hello,

Welcome back to icliniq.com

Sunlight has mood lifting properties, particular in morning time. Physical exercise also has a similar positive impact on mood. Past ruminations are both a symptom of depression as well as contributing factor to depression. Ignoring and diverting from such thoughts is always better. With time, the ruminations will reduce as well. Repressing negative memories from coming to surface is a practical approach to dealing with a negative past. Good to know that you are monitoring your depression scores objectively. Take sertraline as early in morning as possible to prevent sleep disturbance. Exposure to sunlight early in morning also helps to regulate sleep cycle. If sleep still remains a problem, message me and I will recommend a suitable medication.

I hope this has helped you.

Thank you.

Patient's Query

Hello doctor,

I am feeling much more in control, and I also feel that I was not able to describe my symptoms properly. I have some doubt if you went through all my symptoms that I briefed from the beginning:

  1. First conversation: I described that I faced a time where job stress killed me every day, and I detached myself from everyone, felt emotionless even with my family, drowsiness, and no sense of reality. I also described that I did live my life, but I never felt a connection as I have become a robot. Forgetfulness, short-term memory loss, no attention at all.
  2. Second conversation: I described that I am still lost and not able to find my true self as there is a shadow in my brain that is stopping me from having clarity.
  3. Third conversation: I described that the only important concern to me now is to have thoughts clarity, get back self-confidence, positive attitude, and be attentive.

I am thinking about all of this because I came across a blog that I find very similar to the situation I was/am in. I am copying the blog below: Anxiety-induced depersonalisation and derealisation - One of the most unpleasant symptoms of my anxiety was the very surreal feeling of not really being part of the world anymore. I had feel spaced out, not with it, and like I was not real or present in my day-to-day actions and experiences. This was often coupled with feeling dizzy, light-headed, and a constant need to rest or sleep in a darkened room. I felt like a numbness had crept over my body and mind, the world no longer seemed to be in 3D. Instead, it would become flat, grey, and dull. All I could keep thinking was, 'something has to be wrong with my brain.' It took several years until I realized what was going on; I was experiencing anxiety-induced depersonalization and derealization. In today's post, I am going to be looking at both of these conditions in some detail, why they are experienced by many anxiety sufferers, and how to stop them from occurring. What is depersonalization and derealization?

  1. Depersonalization: It is where you do not feel real, and your mind feels disconnected from your body. Your body and especially your limbs do not feel like a part of you; they often seem different and out of place. You feel withdrawn, numb, and often as if it is not you performing the actions you are doing. Many liken it to watching their life through a film in which they are not the participant.
  2. Derealization: It is where the world around you does not feel real. Objects and colors do not seem as you remember them, and they can often appear to change in shape and color or become fuzzy or blurry. You often get tunnel vision, and the things outside your peripheral view seem strange or out of place. The world can seem grey, flat, and 2D, and the people in it do not feel real, like they are robots or automatons.

So, what is going on? Your sense of reality or 'being' is all controlled within your mind. The world only exists to you because of your thoughts, feelings, perceptions, and memories. I had my thoughts, feelings, perceptions, and memories become disconnected; you lose your sense of identity and who you are. The way you view yourself, your actions, and the world you inhabit changes, and you become 'dissociated' from reality. You feel like your mind and body are two separate entities. I had felt the same but not with much intensity. I didn't have any out-of-body experience. Today, I am at great relief as the medication relieved my derealization symptom. By tracking online, I fall under the category of mild depression only, but I also fall under moderate anxiety. I am looking for your view on this. Please advise.

Hello,

Welcome back to icliniq.com.

Interesting observation. If you feel that your experience at the beginning of illness is similar to the disturbingly unreal perception of reality and yourself (derealization or depersonalization) described in the article, then it very likely was derealization or depersonalization that you were experiencing. Good to hear that you are doing well currently. Depression and anxiety are like siblings. Initially, I believed that your anxiety was a symptom of your depression, but now I feel that anxiety is more likely a comorbidity (illness occurring together) to your depression. Sertraline helps with both these conditions. So, it does not warrant any change in treatment. Deep breathing, yoga, exercise are all the practices which will help you in further dealing with anxiety.

Patient's Query

Hello doctor,

Thank you for your prompt reply.

What should I do now? Everything seems fine now besides forgetfulness. I cannot remember things like past conversations, and I forget things after putting them in some places. I also find myself inattentive. Please advise.

Hello,

Welcome back to icliniq.com.

I suggest you take medicines containing a combination of L-methylfolate with Acetylcysteine and Methylcobalamin, like capsule Tetrafol NAC or capsule Nexfolin, one capsule every evening till our next follow up. It will help with attention and memory issues.

Patient's Query

Hello doctor,

Thank you for the reply.

I am very much better as improvement rate steady but my concern is ,at the same time it is slow. Can something else be added with my current medication to boost energy and wakefulness.

Hello,

Welcome back to icliniq.com.

Daxid (Sertraline) itself increases energy, motivation, interest and alertness. We can uptitrate your dose to 200 mg in the morning. Continue at this increased dose and follow up with your progress after 15 days.

Patient's Query

Hello doctor,

Thank you for your prompt reply.

I am also feeling good this year as there are overall positive signs. I am doing well, but there are things that worry me. About ongoing life problems and even after thinking too much, I am not able to win/take control of the situation or confident decision because for the last month, I sleep with new energy and wake up with dull energy. This dull energy also makes me smoke more. Maybe there is not much going well in my life, and I am moving towards nicotine addiction. Right now, it looks like a bad path to me because I know when I start this kind of behavior, it will take me back to the point from where I started seeking treatment. Please advise.

Hello,

Welcome back to icliniq.com.

I am assuming that you are taking 200 mg Sertraline with Buspirone 20 mg. When you say that you wake up with a dull feeling, how long does it last? How is your energy, motivation, and interest these days? I would recommend taking Sertraline as early in the morning as possible (even with tea, if you do not have hyperacidity). It will keep you energetic in the morning.

Patient's Query

Hi doctor,

Thank you again for your time; I greatly appreciate it.

I take 150 mg of Sertraline and 20 mg Buspar, I didn't went for 200 mg because it changes my mood in other way. I feel laziness in morning and want to sleep longer in morning , here it doesn't matter at what time I went to bed, this will only help me In getting eye opened but no warmness in body to act. after that I take tea to pin myself up through out day. however in evening I started exercise for last two days and also having healthy food and enough rest.

Hello,

Welcome back to icliniq.com.

I will add Bupropion XL (extended-release) to your current medicines. It should help you in waking up fresh and energetic. Take it early in morning. I will send you a prescription tomorrow. Also, have some sun in the morning (around 1 hour). It will compensate for the winter dullness. I would like to know in your next message what do you mean by Sertraline worsening your mood at 200 mg and any other medicine or supplement that you might be taking.

Patient's Query

Hello doctor,

Thank you again for your time; I greatly appreciate it.

I have been taking medication as prescribed and results seems to be good. I am eating well, however it was never a problem. I do exercise and mindfulness meditation too. Now I am able to get up early in morning with energy whenever I have good sleep as I am struggling to get sleep after going to bed. I get sleep after 1.5 to 2 hour from bed time. I take medication before 8 A.M. Regarding 200 mg Sertraline, it makes my head heavy and I had difficulty in concentrating. Regarding other supplement, I am taking protein supplement , vitamin D3, omega-3 and melatonin too. I feel good now as I was totally lost. Now it is like I am waking up from deep sleep. I am hoping and praying that this combo should work for me. Please advise further action.

Hello,

Glad to have you back!

I am here to help you get the best medical advice.

Good to hear that you are doing well. I suggest you take tablet Ramitax (Ramelteon) instead of melatonin to reduce the sleep latency. Other than that, we will continue current prescription (Do mention the current medicines and doses in each message. It makes it easier for me to suggest changes).

Patient's Query

Hello doctor,

I feel sorry for late response.

I am presently taking 150 mg Buropion, 150 mg Sertraline and 20 mg Buspar and other supplements are omega-3 and vitamin D. This is working fine for me but I find myself, lost in random thoughts and not attentive and a little impulsive too. That is without giving much thoughts I take decision, sometime. delayed sleep and restless morning mind is concerned for me now. I am not taking melatonin and any other supplements. However, somehow I am able to manage things. Please advise.

Hello,

Welcome back to icliniq.com.

In such a case, it would be advisable to stop Bupropion for the time being. I will send a prescription with a couple of other changes by afternoon. (adding Toficalm (containing benzodiazepine) for the time being).

Patient's Query

Hello doctor,

Thank you for your prompt reply.

I started to feel much more better after adding Bupropion.

Hello,

Welcome back to icliniq.com.

In such a case, we will continue your Bupropion. I am adding another medicine for anxiety and increasing dose of Buspin (Bupropion).

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Saraswat Kumarshri Shriniwas
Dr. Saraswat Kumarshri Shriniwas

Psychiatry

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