Q. I have fear of death with anxiety and depression. How to overcome it?

Answered by
Dr. Kumarshri Shriniwas Saraswat
and medically reviewed by iCliniq medical review team.
Published on Dec 15, 2019

Hello doctor,

I have always struggled with anxiety, depression, and panic attacks. I have several phobias and have recently acquired a new one, fear of death. I cannot stop thinking about it and it is seriously interfering with my life. I have trouble getting up in the mornings and going to work, I do not feel like doing anything anymore. This has been going on for over two weeks now and nothing feels the same to me anymore. I do not feel normal at all and nothing seems real.

I recently started on Prozac 10 mg and I am currently on day eight. I wake up with a lot of anxiety in the mornings and today I am just feeling very weird. Is this something someone can get over? I just want to go back to normal.

Dr. Kumarshri Shriniwas Saraswat

Psychiatry Psychologist/ Counsellor Psychotherapy Sexology Sleep Medicine
#

Hello,

Welcome to icliniq.com.

Your current symptoms of difficulty in waking up and loss of interest in work, with severe anxiety, is indicative of clinical depression. What you describe as death phobia involves obsessive thinking about death. So, it is more likely to be a symptom of OCD (obsessive-compulsive disorder) too. OCD and depression frequently coexist or obsessive symptoms are seen in depression too. Fluoxetine is not the preferred drug for anxious depression with OCD symptoms, because it increases anxiety initially in the first few weeks. You need to take a Benzodiazepine along with it in the initial few weeks (Clonazepam, Chlordiazepoxide, etc). Benzodiazepines work better than Vistaril (Hydroxyzine) PRN. Also, 10 mg per day is a starting dose. I would prefer using Fluvoxamine rather than Fluoxetine because it covers initial anxiety and it can be started at an effective dose.

To answer your question, it is not something that you can overcome on your own. You will need medicines. It will respond to regular and proper medication. Secondly, if you are feeling weird, talk to your doctor and ask if he can give you a Benzodiazepine. The initial anxiety on Fluoxetine gives a weird feeling. Also, ask if he can give a different antidepressant instead.

I hope this helps.


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Thank you doctor,

I have a referral to see a psychologist for therapy sessions. Yet. I see a psychiatrist who started me on my medications. Any recommendations on what to do until then? I feel like I am losing my mind and just want to get back to normal and I cannot get the thought out of my head. I feel like life is pointless now because I am just going to die anyway (I am not suicidal). I have been in a state of panic for a couple of weeks now and have no one to talk.

Dr. Kumarshri Shriniwas Saraswat

Psychiatry Psychologist/ Counsellor Psychotherapy Sexology Sleep Medicine
#

Hello,

Welcome back to icliniq.com.

There are a couple of options that you have :

1) If you can get hold of any Benzodiazepine (otc or through a family physician), start taking an initial dose daily. Etizolam or Tofisopam are available otc in some countries. You can take Etizolam 0.5 mg as needed. Tofisopam needs to be taken at 100 mg three times a day for anti-anxiety effect. 2) If you cannot get a Benzodiazepine, stop Fluoxetine for two to three days and see if the anxiety reduces a bit on its own. If the anxiety is because of Fluoxetine initiation, it will reduce. In that case, wait till your next appointment and ask your psychiatrist to switch to an alternative medicine. If there is no change in anxiety three days after stopping Fluoxetine, you can restart it and wait till your appointment.

I hope this helps.


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