Question:

Good afternoon
Sorry for the inconvenience, it is for a query related to the following:

I am 58 years old and I worked for 35 years in administrative tasks with function. For a long time, I didn’t eat properly because I dedicated a lot to my work. At the end of 2017 I had vertiginous syndrome for which I was diagnosed with long-term accumulated stress, anxiety disorders, depression, and panic attacks.

For this reason, I have prescribed sertraline 50 mg and diazepam 10 mg. For almost a year and a half I took sertraline 1 tablet in the morning and another at night; plidan diazepam 1 tablet at night. Then they cut it down to half of each for another year and a half or so.

Later, as I felt better, I continued with half sertraline and half diazepam whenever I needed it, between 10 and 15 days. I then discontinued the sertraline entirely and continued the diazepam.

I started to feel withdrawal symptoms. I went back to my doctor on Dec/21 and she prescribed me half of the sertraline every day and told me for 6 months. Which seemed like a lot to me because I wanted to get off the medication as soon as possible.

I continued like this with sertraline as the doctor told me, from Dec/21 to mid-March/22, and diazepam irregularly, sometimes 1/2 other days 1/4. But since I continued to have good days, days not so good, I decided to change my doctor in mid-March, who prescribed 1/4 of sertraline for 2 months and 1/4 of a diazepam pill for 1 month.

I did as instructed but now almost every day I feel like I’m going on a boat, sometimes with a little dizziness and headache, but the head is dull or swollen all the time and it’s very annoying. I’m even afraid that I’ll catch seizures or pass out because the only thing I’m left with is that feeling in my head.

I don’t know if it really is a consequence of the suspension of sertraline or diazepam. I took the antidepressant on my own, sometimes 1/4, other times 1/2, and the same with diazepam, but I really don’t know how to continue because it seems that this way irregularly doesn’t solve the issue of feeling dull or sore and dizzy. Please, I would greatly appreciate the Dr if she could advise me on what I can do or how to follow the treatment.

I tell you that a long time ago, simultaneously with medical treatment, mindfulness, and meditation helped me with the cause of my anxiety, depression, and panic attacks. And I also take magnesium chloride and B complex, sometimes omega 3 and vitamin D (I don’t know if I’m doing well with these supplements).

From now, thank you for your attention. I’m waiting for an answer, please.

Answer:

First of all, thank you for sharing your story, I am very sorry that you have gone through all this situation. From what you say, the best thing to do would be to carry out a complete psychiatric evaluation, with a detailed clinical and vital history to better understand all your symptoms, and how have been developed and thus be able to better guide management.

On the other hand, it is also important to know if, in the time that you mention having made these pharmacological adjustments, other doctors have evaluated you, for example, an otolaryngologist or an internist, and if analytical tests, brain scans, and/or electroencephalograms have been carried out. . All this because it is always better to rule out an organic cause for the symptoms and if nothing is found, to be able to carry out a therapeutic intervention with the certainty that nothing serious escapes in between.

With this, I explain the importance of making consultation and being able to help you in the best way.

A cordial greeting.

The Corona pandemic is a difficult period for many. The changed everyday life can affect well-being and mental health.

Anxiety about the risk of infection, along with isolation and distance, can lead to loneliness and symptoms of anxiety, stress and depression.

The corona pandemic wears on the psyche of many-from the young people who miss the parties with friends, to the lonely elderly people who feel extra alone when corona restrictions lead to cancellation of activities and events on a strip.

Loneliness fills a lot – especially for those that their social circle are people out in the city. It also affects people who normally invest a lot socially in their jobs, but now sit alone at home.

The disease also causes concern in many people: some fear being infected or infecting others with corona. Others stress that the pandemic does not have a known expiration date, with ’everything’ becoming normal again. Financial problems triggered by corona can also knock people off their feet.

It is natural to have worries during periods of pressure. There are many who feel the same way. In some, it can develop and go extra hard on the mental well-being.

Currently, great attention is paid to hygiene and other precautions against corona. For some, it can lead to compulsions, constantly washing hands and using hand alcohol, avoiding many everyday situations for fear of being infected or infecting others.

A rule of thumb for the boundary between the normal and the morbid is usually around one hour of daily activity with, for example, hand washing and hygiene. However, the limits of what is normal to do have shifted during the corona pandemic. What used to be considered morbid is normal now. It can go beyond common sense if one is unsure when enough is enough.

At the same time, there are several examples of suspicion and shame from self-appointed 'corona police officers' who mock others. It is very visible if you use facemasks and rubbing alcohol and keep your distance. But that does not mean that there is free rein to attack how other people behave.

The fear of being shamed can lead to anxiety, loneliness and excessive attention to hygiene.

Some people become ashamed and do not feel that they have taken proper care if they are hit by corona. But it is unreasonable to blame yourself or others, because it is a highly contagious virus that can affect everyone.

Fortunately, the pandemic has also brought out good sides in us: The helpfulness is great-to the delight of those who are helped, but also of those who help others. By supporting and helping others, one accomplishes something and makes a difference, and this can give a good sense of meaning and purpose in a difficult time.

People with mental disorders are generally more severely affected by the consequences of the corona pandemic and may feel extra lonely and sad. Many are, for example, expats and foreign students that already have difficulty establishing relationships due to the language barrier. The corona restrictions make it extra difficult to break the loneliness, and some have to do it without visiting their permanent residences.

 The fear of being infected with corona or infecting others can be debilitating. Obsessive-compulsive disorders such as OCD with excessive hand washing and alcohol spraying can flare up during pandemics such as corona.

 If you experience a worsening of your illness or become depressed, contact your doctor or your regular therapist/contact person.

Healthy habits can help you keep worries and reproaches at a distance.

1. Keep in touch with the outside world. Family, friends, colleagues, neighbors, etc. are of great importance to our mental health because they help to give us a sense of belonging with others. Keep up with each other's lives over the phone, video calls or on social media.

2. Pressure yourself to contact others if you feel lonely. Move your limit to what feels natural and send more text messages. Move social interaction into other surroundings if it is not possible to meet physically. Maybe you can meet online instead.

3. Talk about your corona challenges with others. Use family and friends to reconcile whether the pandemic takes up too much space in your life or the lives of others. But remember to talk about other things as well. Use each other to take a break from the worries.

4. You can introduce a 'worry time' if concerns about the corona are grinding around your head. Here you can let go of the thoughts - e.g. Friday between 15 and 16. If the worries appear at other times, you can reject them, because they already have a place in your calendar.

5. It's o.k. feeling sad or angry about what you lost during the corona pandemic - whether it's just a party or a vacation trip. Give way to the frustrations, but also remember the positive things. For example, write down at least one thing every night that you are grateful for – no matter how big or small it may be.

6. Do not blame yourself or others for getting infected with corona. The disease is caused not by people, but by a highly contagious virus that can affect everyone. 

7. Create structure in everyday life. Feel free to make a plan or schedule of activities for the day or week. Introduce routines that mark the course of the day. If you work at home, work when you have to work, and take time off when you have time off.

8. Sleep adequately and maintain a normal, regular circadian rhythm. If have slept well, you are less likely to worry and be anxious.

9. Eat healthy and varied. It provides energy and strength for everyday challenges-and room for a little pampering once in a while.

10. Stay physically active. It does not have to be strenuous – bike rides and walks also count. Daylight lifts your spirits. Come outside and move and get some fresh air daily.

11. Keep your brain going by doing various kinds of activities that require your concentration. Read a book or magazine, solve sudoku, puzzles, listen to music, play some games-or something completely different.

12. Talk to your doctor if anxiety about getting sick or related worries control your daily life and may also affect your surroundings. This applies, for example, if you are overly concerned with information about the disease or wash your hands all the time.

Depression manifests itself in many ways. Here you will find some of the typical signs of depression that are good to keep an eye on. When browsing the list, remember: You can easily have one or more of the signs without having a depression.

• You feel depressed and sad: Some days are good; others are not good at all. That is how it is in life. It goes up and down. We are all hit by adversity and downturns: Boyfriend brakes up, you fail exams or lose your job. However, as a rule, we know well (deep down) that we will probably will be ok again - eventually. With a depression, it is different. Here the sadness is experienced bottomless and endless. You feel that you cannot do anything to change things. Sometimes it is something specific that triggers a depression - for example, that you lose a person you loved very much. Other times, depression hits out of the blue without you knowing why.
• You do not feel the same joy about things: You just lost the desire for everything. You could not feel anything. Why should I go to school/work? Why should I live at all? Everything seemed indifferent and meaningless. Do you find that things that used to make you happy now feel empty and indifferent? Many also describe it as a feeling of emptiness inside. If you look at your life from the outside, you may well see things that you - on paper - should be happy about. You just cannot feel it. Things do not mean the same to you anymore.
• You feel drained, out of energy: You just cannot do nothing. You could not brush your teeth or take a shower. The only thing you could do is lie in your bed. Your body felt insanely heavy. A typical sign of depression is precisely that even small things in everyday life feel challenging. Many people therefore experience that they just want to sleep or lie in bed all the time.
• You feel worthless: I can never figure anything out. People would feel better without me. Nobody likes me. Do you know those kinds of thoughts? Maybe from inside your own head. Many who struggle with depression are super tough on themselves and feel unsuccessful and worthless.
• You sleep bad: Do you have difficulty falling asleep at night? Are you sleeping restlessly? Or do you wake up with a twitch at 4.04 and cannot fall asleep again? Sleep problems can be a sign of depression. Maybe you cannot calm down because thoughts and worries are constantly grinding around in your head. Or maybe your sleep rhythm is disturbed because you lie in bed a lot during the day.
• You eat more or less than you usually do: Like your sleep, your appetite also says a lot, about how you feel. Some people with depression find that they lose their appetite for food. Others eat more (and perhaps more unhealthily) than they usually do. Because the food gives them a short-lived feeling of calm and contentment in the body.
• You have a hard time remembering things and concentrating: Do you constantly forget things? Do thoughts rise in all directions when you do homework or want to read a book? Many people know that. However, if it happening a lot for you, then it could be a sign of depression.
• You blame yourself for feeling bad: "If only I had acted differently or been different, I would not feel this way." Do you know those kinds of thoughts? Many people with depression blame themselves for feeling bad. Maybe you also feel guilty because you do not have the surplus and energy to be there for others right now. Or maybe you go with a constant feeling of being in trouble. It is quite common to feel this way. But keep in mind: It's not your fault if you have depression. It is not something you have chosen yourself. And it's not something you deserve at all.
• You worry a lot: People with depression often find that their worries run wild. That they drive around day and night - and take up much more space than usual. Others keep returning to certain situations in the past, pondering things they have done or failed to do. ‘Why did I say or did that too?’ Or: ‘Why did I not seize that opportunity?’
• You have a hard time making choices: We all make strings of choices every day. When should I get up? Which sweater should I wear? What should I eat for breakfast? etc. And typically it just runs. We make decisions lightning fast and almost without thinking about it. A typical sign of depression, on the other hand, is that you have difficulty making decisions. You feel paralyzed. Even if it is only a tiny choice. Maybe because fear of choosing the wrong thing. Maybe because you simply cannot overlook the options and gather thoughts right now.
• You withdraw into yourself: Think about: Have you started keeping more and more to yourself? Do not have the same surplus to be with friends? Or can you not bear to be with people at all? We all have periods where we need time to be alone. This is perfectly normal. But it can be a sign of depression if your interest and desire to be with others have changed a lot lately.
• You get angry and annoyed more easily: It is perfectly normal to get angry and annoyed from time to time. But try to notice if you have changed. Do you get angry more easily or do you react more violently? We are all different: Some turn sadness and frustration inward and blame themselves for feeling bad. Others direct the frustrations outward. Do you have wild outbursts of anger. It may also be that you feel grumpy and easily get annoyed at people around you without showing it very clearly.
• You have thoughts about suicide: ‘It would be easier if I was not here.’ Or: ‘I do not want to live anymore.’ This is how many people struggling with depression think. This kind of thoughts can feel wild and scary. It is therefore important that you talk to someone if you have this kind of thoughts. It could be your relatives or a good friend, for example.

If you consider that, you or anyone you know have more than “few” of the signs described above it is extremely important to seek professional help. Depression is not just a state of mind. It is not something you can "think” away and it should be evaluated and addressed by professionals.