[19F] With sudden onset anxiety, irritability, and acne

Patient Description

A 19-year-old female has been experiencing intense anxiety and irritability for the past week. These episodes occur randomly throughout the day, lasting from 15 minutes to several hours, even during relaxing activities. The anxiety came on suddenly but may have been building up over time. The patient has not found any relief methods and reports difficulty falling asleep due to heat flashes, along with fatigue. Recently, she noticed three pimples on her chin, which is unusual for her typically clear skin, and she has also experienced hair loss and a lighter menstrual cycle than usual. Her medical history includes dissociation and manic depressive disorder diagnosed in March 2021, and postpartum rage two years ago. She previously took Lexapro and Zoloft but stopped years ago. She is not currently on any medications and has no known allergies or adverse reactions to medications. There have been no recent changes in diet, environment, or substance use.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Generalized Anxiety Disorder (GAD): This condition involves persistent and excessive worry about various aspects of life. Symptoms can include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Given your history of anxiety and depressive disorders, this could be a contributing factor.

    • Treatment: Treatment typically involves a combination of therapy (such as cognitive-behavioral therapy) and medications (such as SSRIs or benzodiazepines). Lifestyle changes, such as regular exercise and mindfulness practices, can also be beneficial.
  • Hormonal Imbalance: Changes in your menstrual cycle, sudden acne, and hair loss could indicate a hormonal imbalance. This can be influenced by stress, changes in diet, or underlying conditions such as polycystic ovary syndrome (PCOS).

    • Treatment: Treatment depends on the underlying cause and may include hormonal therapies, lifestyle changes, and medications to manage symptoms.
  • Postpartum Hormonal Changes: Even though it has been two years since you had your baby, postpartum hormonal changes can sometimes have long-lasting effects, including mood swings, anxiety, and changes in skin and hair.

    • Treatment: Similar to hormonal imbalance, treatment may involve hormonal therapies and lifestyle changes.
  • Dissociative Disorders: Given your history of dissociation, it's possible that stress or unresolved issues could be contributing to your current symptoms.

    • Treatment: Treatment often involves psychotherapy, such as cognitive-behavioral therapy or dialectical behavior therapy, to help manage symptoms and address underlying issues.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

  1. Practice Relaxation Techniques: Techniques such as deep breathing, meditation, and progressive muscle relaxation can help reduce anxiety and improve your overall sense of well-being.
  2. Maintain a Healthy Lifestyle: Regular exercise, a balanced diet, and adequate sleep are crucial for managing anxiety and overall health. Avoid caffeine and alcohol, as they can exacerbate anxiety.
  3. Keep a Journal: Use MDandMe to journal your symptoms, track your progress, and identify any potential triggers. This information can be valuable for your healthcare provider.
  4. Seek Support: Talking to friends, family, or a support group can provide emotional support and help you feel less isolated.
  5. Consider Professional Help: If your symptoms persist or worsen, consider seeking help from a mental health professional. They can provide therapy and discuss medication options if necessary.

What you should look out for

It's important to monitor your symptoms and seek medical attention if you experience any of the following:

  • Severe Anxiety or Panic Attacks: If your anxiety becomes overwhelming or you experience panic attacks, seek immediate medical attention.
  • Suicidal Thoughts: If you have thoughts of harming yourself or others, seek emergency medical help immediately.
  • Significant Changes in Mood or Behavior: If you notice significant changes in your mood, behavior, or ability to function, consult a healthcare professional.
  • Physical Symptoms: If you experience severe hair loss, significant changes in your menstrual cycle, or other concerning physical symptoms, seek medical advice.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. Take care, Mackenzie.

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5 mo ago

People Also Ask


What are the common symptoms of Generalized Anxiety Disorder (GAD)?

Common symptoms of Generalized Anxiety Disorder (GAD) include persistent and excessive worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.


How can hormonal imbalances affect mental health and physical symptoms?

Hormonal imbalances can lead to mood swings, anxiety, changes in menstrual cycles, acne, and hair loss. These imbalances can be influenced by stress, diet, or conditions like PCOS.


What are some effective relaxation techniques for managing anxiety?

Effective relaxation techniques for managing anxiety include deep breathing exercises, meditation, progressive muscle relaxation, and mindfulness practices.


How long can postpartum hormonal changes affect a woman's body?

Postpartum hormonal changes can affect a woman's body for months or even years after childbirth, potentially causing mood swings, anxiety, and physical changes like skin and hair issues.


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