[24F] With persistent dizziness and overwhelming fear of dying

Patient Description

A 24-year-old female has been experiencing persistent dizziness and disorientation for the past few months, rated as 8 out of 10 in severity. She also reports an overwhelming fear of dying, which started suddenly about 6 months ago after a panic attack induced by marijuana use. This fear is constant and significantly affects her daily life. Additional symptoms include shortness of breath, minor chest pain, palpitations, a racing heart, and a feeling of derealization. The patient is currently taking 10 mg of Paxil once daily and 10 mg of buspirone twice daily, which she believes may be contributing to her dizziness and drowsiness. She denies any loss of consciousness or seizures and has no known drug allergies. There are no other pre-existing conditions or chronic illnesses reported.

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Arora's Assessment

What might be happening

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

  • Panic Disorder: Given the sudden onset of your symptoms following a panic attack induced by marijuana use, it is possible you are experiencing panic disorder. This condition is characterized by recurrent panic attacks, which can include symptoms like dizziness, shortness of breath, chest pain, palpitations, and a fear of dying.

    • Treatment: Treatment often involves a combination of medication (such as SSRIs like Paxil) and cognitive-behavioral therapy (CBT) to help manage and reduce panic attacks.
  • Generalized Anxiety Disorder (GAD): Your persistent feelings of fear, dizziness, and disorientation could also be indicative of generalized anxiety disorder. GAD involves excessive, uncontrollable worry about various aspects of life, often accompanied by physical symptoms like those you are experiencing.

    • Treatment: Treatment typically includes medication (such as SSRIs or buspirone) and therapy, particularly CBT, to help manage anxiety symptoms.
  • Depersonalization/Derealization Disorder: The feelings of derealization and disorientation you described may be related to depersonalization/derealization disorder, which involves persistent or recurrent feelings of being detached from one's body or surroundings.

    • Treatment: Treatment often includes psychotherapy, particularly CBT, and sometimes medication to help manage symptoms.
  • Medication Side Effects: The dizziness and drowsiness you are experiencing could be side effects of the medications you are currently taking (Paxil and buspirone). Both medications can cause these symptoms, especially when first starting or adjusting dosages.

    • Management: It is important to discuss these side effects with your prescribing doctor, who may adjust your dosage or suggest alternative treatments.

What you can do

  1. Consult Your Doctor: It's crucial to discuss your symptoms and concerns with your healthcare provider. They can provide a formal diagnosis and adjust your treatment plan as needed.
  2. Therapy: Consider seeking therapy, particularly cognitive-behavioral therapy (CBT), which can be very effective in managing anxiety and panic disorders.
  3. Medication Management: Do not stop or adjust your medications without consulting your doctor. They can help you manage any side effects and find the most effective treatment plan.
  4. Lifestyle Changes: Engage in regular physical activity, practice relaxation techniques (such as deep breathing exercises or meditation), and maintain a healthy diet to help manage anxiety symptoms.
  5. Avoid Triggers: Since marijuana use triggered your initial panic attack, it may be best to avoid using it or any other substances that could exacerbate your symptoms.

What you should look out for

  • Worsening Symptoms: If your symptoms worsen or become unmanageable, seek medical attention promptly.
  • New Symptoms: If you experience new symptoms such as severe chest pain, difficulty breathing, or loss of consciousness, seek immediate medical attention.
  • Medication Side Effects: Monitor for any new or worsening side effects from your medications and report them to your doctor.

Remember, while this information can help guide you, it is essential to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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6 mo ago


People Also Ask


What are common side effects of Paxil and buspirone?

Common side effects of Paxil (an SSRI) include dizziness, drowsiness, nausea, dry mouth, and changes in weight or appetite. Buspirone can cause dizziness, headache, nausea, and nervousness. It's important to discuss any side effects with your doctor.


How can panic disorder be effectively managed?

Panic disorder can be managed through a combination of medication, such as SSRIs, and cognitive-behavioral therapy (CBT). CBT helps patients understand and change their thought patterns and behaviors that trigger panic attacks. Relaxation techniques and lifestyle changes can also be beneficial.


What is the difference between panic disorder and generalized anxiety disorder?

Panic disorder is characterized by sudden and recurrent panic attacks, often with physical symptoms like palpitations and a fear of dying. Generalized anxiety disorder (GAD) involves persistent and excessive worry about various aspects of life, often accompanied by physical symptoms like restlessness and fatigue. Both conditions can be managed with therapy and medication.


How can lifestyle changes help in managing anxiety symptoms?

Lifestyle changes such as regular physical activity, practicing relaxation techniques (like deep breathing or meditation), maintaining a healthy diet, and avoiding substances that can trigger anxiety (like caffeine or drugs) can help manage anxiety symptoms and improve overall well-being.


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