How to treat a 23-year-old male with a generalized anxiety disorder?

Hi doctor,

I am a 23-year-old male weighing 145 lbs and height five feet 11 inches. I was diagnosed with GAD (generalized anxiety disorder) and am taking 20 mg of Escitalopram.

My symptoms are mentioned below,

Eight months ago- I woke up one morning with constant pressure behind my eyes and internal dizziness, which would not subsidize; it would tend to be stronger while lying down. One afternoon at once, I began to feel constant pins and needles, along with a slightly decreased sensitivity on the left side of my body from head to toe.

Seven months ago - Internal dizziness finally subsidizes. I am left with a slight sensation of decreased sensitivity on the left side of my body and a slight feeling of stiffness on my left hand and foot.

Six months ago - Numbness and hand and foot stiffness subsidize, and I feel completely fine except for a slight sensation of stiffness on my forearm.

Five months ago- Constant internal dizziness comes back and remains constant throughout the day; however no pressure behind the eyes. Also developed a very stiff neck.

Four months ago - Constant slight pins and needles and decreased sensitivity came back, and I began experiencing muscle twitches across my body. Also, internal dizziness subsidizes.

This month - Slight pins and needles and decreased sensitivity on the left side finally subsidize. However, I am left with stiffness in both my hands and feet.

I took the following examinations,

1. 2 Head CT Scans - All clear.
2. 1 Brain MRI - All clear.
3. 1 Cervical MRI - All clear.
4. 1 Bloodwork - All clear.
5. 1 EMG - Showed left ulnar nerve entrapment and left peroneal motor nerve entrapment

I have all images, documents, and reports, which can be provided as requested.

My questions:

1. What are some possible diagnostics, or what could be causing these symptoms?
2. Are the EMG findings common, or should I be concerned about such findings?
3. Do these symptoms point to some autoimmune disease?

Hi doctor,

I will answer your questions in the order given.

1. I most recently, about two weeks ago, began having shooting pains in my arms and feet; however, they are very brief and minor. I have also not experienced visible joint swelling or anything I can interpret as swelling.

2. I do not have a history of photosensitivity.

3. I occasionally get mouth ulcers, but they are not something I would consider frequent.

4. I recently began experiencing constant eye dryness about three years ago, which I assumed may have been due to contacts, but after switching back to glasses, I noticed my eyes are still very dry.

I will send all reports as soon as I get home. I would also like to add a few notes in case they may be useful to you.

1. I had a similar sensation of shooting pain in my ribcage area about two years ago that lasted for a month. The only testing was a lung x-ray which showed no abnormalities.

2. I have had periods of joint stiffness, but they usually are not pain-inducing and will subsidize eventually.

3. Right when the eye dryness began, I also began having a constantly dry mouth which brought on breath problems. Oddly, I never had an issue with dryness, and this came on suddenly.

4. I have been experiencing intense brain fog for two years.

Thank you.