How to come out of anxiety, stress, and forgetfulness?

Question

Hi doctor,

I am suffering from severe anxiety and heart attack like debilitating panic attacks when presented with work deadlines, enclosed spaces such as subways, elevators and small airplanes. I have relationship fears. Nothing in my life provides me joy or relieves me of my symptoms. I had the same feeling six years ago after a break up. Now, symptoms return easily when in fear of life. I had Zolpidem for depression before to get sleep, but I stopped because of the side effect of brittle bone. I am fuzzy headed, stressed, forgetful, regretful of any decision I make and I cannot make decisions without fear. I do not have any friends. I do not belong anywhere. I am not a part of anything. I exercise outside every day. I eat only healthy foods. I am underweight. Please help me to come out of this.

Answer 1

Hi,

Welcome to icliniq.com.

From the available description, it is almost clear that you are having depression along with claustrophobia (fear of confined spaces). It is obvious that you are not enjoying anything, fallen down to social ladder, feel distressed, loss of pleasure in almost all activities and guilt feelings along with fear of closed spaces. If I need to assess the severity of your symptoms it will fall somewhere between moderate to severe depression along with functional impairment. Having said this there is definite need of treatment as moderate to severe depression almost never remits without medication. For a 45 year old woman, I feel Desvenlafaxine (Pristiq) will be the right choice followed by SSRI (selective serotonin reuptake inhibitor) group of medications. I understand your concern about the brittle bones and other side effects of these antidepressants. But, we need to consider both harms and benefits of medication as well as depression. If you consider both of them there are definite benefits with medications which outweigh the potential side effects. I like to assure you that antidepressants are not the harmful or dangerous medications as described over some online platforms. I think you understand better that how they helped you in past, what they can deliver when we are one of saddest person in the world (depression). Small dosage of Zolpidem can help you for sleep to some extent, but they do not help in depression which is our primary concern. I request you to see a psychiatrist for detailed evaluation and to discuss the right choice for your treatment. Thank you.