Discussions By Condition: I cannot get a diagnosis.

Could it be more than anxiety? Please help!

Posted In: I cannot get a diagnosis. 31 Replies
  • Posted By: crackerjackamf
  • January 31, 2009
  • 09:54 PM

I'll try to explain this as clearly and in as few words as possible. For starters, I am twenty years old, female, 5'2", and 105 pounds. I am in fine shape, and get a decent amount of exercise riding horses three days a week. Primarily within the last two years, I have begun to experience a number of symptoms, which I'll list below. My family assumed that it was a mental health problem, what with sleeping a lot and being anxious, so I went to a psychiatrist and am now on 200 mg Zoloft and 300 mg Wellbutrin. I feel a little more stable emotionally, but I still fatigue easily, sleep a lot, and have all of these physical issues. Furthermore, the physical symptoms came some months before the anxiety and/or depression. I have now been to two physicians to try to determine whether there might be something more than anxiety going on, and both times was told that, no, there's nothing else. You'll just need to keep trying different medications. One physician did find that I had high blood pressure and gave me medicine that I took for a couple of months. My blood pressure seemed to stay a little more stable for awhile, but in the last month it had gone up, and so she put me on 5 mg Lisinopril, which has now caused my blood pressure to drop and sometimes make me feel even weaker and out of breath. I just can't shake the feeling that the doctors are missing something.


Current symptoms:

- Irregular sleep patterns, almost nocturnal
- Fatigue, excess sleep, though sometimes difficult to fall asleep
- Excessive sweating in underarms that does not coincide with anxiety, comes in waves and can occur even when I'm cold or inactive
- Also, I sweat head-to-toe when I'm exercising, and it makes me miserable
- Recent night sweats
- Slightly elevated blood pressure
- Rapid pulse, frequent resting heart rate of 85-110 bpm, heart rate seems to spike when I stand
- Shortness of breath, especially with exercise, also does not coincide with anxiety
- Chronic nasal congestion
- Irregular menstrual cycles, about every six weeks, but it varies
- Lightheaded, blurred vision often when I stand up, weakness
- Increased appetite
- Occasional chest pain on the left side, usually when I'm laying down
- Difficulty concentrating
- Occasional muscle twitches, especially in limbs
- Occasional jerking awake or thrashing in sleep
- Sometimes when I turn my body a certain way I get a shooting pain through my shoulders and can't move until it subsides, almost feels as though I might crack something
- Mild anxiety, secondary depression as a reaction to all this
- Worse anxiety/depressed feelings when I have my period
- Generally uncomfortable


Past and other symptoms that may be relevant:

- I had migraines from the time I was ten years old until I was eighteen, and then they mysteriously stopped, which I wouldn't think twice about except that it corresponds to the same time when the other symptoms started
- I get especially bad reactions to caffeine (ie. one latte will give me severe anxiety), and also to alcohol (ie. just a couple of drinks will now cause me to have a hangover until the next evening)
- I used to get dizzy spells every once in a while, about three years ago, that would come out of nowhere and fade after about a minute
- I get an anxious, shaken feeling if I'm even a little tired
- I developed panic attacks in the last year, but they have since stopped


I have had a negative test for thyroid problems, and have had normal results for all of the following: liver tests, kidney tests, calcium, creatinine, glucose, potassium, sodium, white blood count, hemoglobin, and platelets. My doctor also had me get an ultrasound of my heart, EKG, echo cardiogram, and an ultrasound of my kidneys a year ago when the high blood pressure started. All were clean.

Please help me if you can! Anything is appreciated. I've had to put my life on hold and take a year off of college to deal with these issues, and I just want someone to listen to me.

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31 Replies:

  • Look up Dysautonomia, or Postural Orthostatic tachycardia syndrome.Good LuckPam
    pamelasmc 82 Replies
    • January 31, 2009
    • 10:07 PM
    • 0
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  • I'll try to explain this as clearly and in as few words as possible. For starters, I am twenty years old, female, 5'2", and 105 pounds. I am in fine shape, and get a decent amount of exercise riding horses three days a week. Primarily within the last two years, I have begun to experience a number of symptoms, which I'll list below. My family assumed that it was a mental health problem, what with sleeping a lot and being anxious, so I went to a psychiatrist and am now on 200 mg Zoloft and 300 mg Wellbutrin. I feel a little more stable emotionally, but I still fatigue easily, sleep a lot, and have all of these physical issues. Furthermore, the physical symptoms came some months before the anxiety and/or depression. I have now been to two physicians to try to determine whether there might be something more than anxiety going on, and both times was told that, no, there's nothing else. You'll just need to keep trying different medications. One physician did find that I had high blood pressure and gave me medicine that I took for a couple of months. My blood pressure seemed to stay a little more stable for awhile, but in the last month it had gone up, and so she put me on 5 mg Lisinopril, which has now caused my blood pressure to drop and sometimes make me feel even weaker and out of breath. I just can't shake the feeling that the doctors are missing something.Current symptoms:- Irregular sleep patterns, almost nocturnal- Fatigue, excess sleep, though sometimes difficult to fall asleep- Excessive sweating in underarms that does not coincide with anxiety, comes in waves and can occur even when I'm cold or inactive- Also, I sweat head-to-toe when I'm exercising, and it makes me miserable- Recent night sweats- Slightly elevated blood pressure- Rapid pulse, frequent resting heart rate of 85-110 bpm, heart rate seems to spike when I stand- Shortness of breath, especially with exercise, also does not coincide with anxiety- Chronic nasal congestion- Irregular menstrual cycles, about every six weeks, but it varies- Lightheaded, blurred vision often when I stand up, weakness- Increased appetite- Occasional chest pain on the left side, usually when I'm laying down- Difficulty concentrating- Occasional muscle twitches, especially in limbs- Occasional jerking awake or thrashing in sleep- Sometimes when I turn my body a certain way I get a shooting pain through my shoulders and can't move until it subsides, almost feels as though I might crack something- Mild anxiety, secondary depression as a reaction to all this- Worse anxiety/depressed feelings when I have my period- Generally uncomfortablePast and other symptoms that may be relevant:- I had migraines from the time I was ten years old until I was eighteen, and then they mysteriously stopped, which I wouldn't think twice about except that it corresponds to the same time when the other symptoms started- I get especially bad reactions to caffeine (ie. one latte will give me severe anxiety), and also to alcohol (ie. just a couple of drinks will now cause me to have a hangover until the next evening)- I used to get dizzy spells every once in a while, about three years ago, that would come out of nowhere and fade after about a minute- I get an anxious, shaken feeling if I'm even a little tired- I developed panic attacks in the last year, but they have since stoppedI have had a negative test for thyroid problems, and have had normal results for all of the following: liver tests, kidney tests, calcium, creatinine, glucose, potassium, sodium, white blood count, hemoglobin, and platelets. My doctor also had me get an ultrasound of my heart, EKG, echo cardiogram, and an ultrasound of my kidneys a year ago when the high blood pressure started. All were clean.Please help me if you can! Anything is appreciated. I've had to put my life on hold and take a year off of college to deal with these issues, and I just want someone to listen to me.Hello. This sounds like the classic signs of anxiety (not all symptoms tho), i am on citalopram 20mgs for anxiety, iv had it for over 2 years. I get the same symptoms as you now and again, have you tried a counsellor.
    Anonymous 42,789 Replies
    • January 31, 2009
    • 10:16 PM
    • 0
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  • Look up POTS (Postural Orthostatic Tachycardia Syndrome) because a heart rate that increases by 30bpm or more when you stand is typical of POTS. Also severe fatigue, shortness of breath, feeling lightheaded and dizzy, weakness, headaches, even being intollerant to alcohol and caffeine that you mentioned are all symptoms of POTS. Good luck
    Anonymous 42,789 Replies
    • January 31, 2009
    • 10:18 PM
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  • Thanks for your quick responses! Wow, that's interesting if caffeine and alcohol intolerance are some of the characteristics of POTS. Anybody else?
    crackerjackamf 7 Replies
    • January 31, 2009
    • 10:24 PM
    • 0
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  • I thought I'd add that I'm having an adverse reaction to the Wellbutrin, which I only started a couple of days ago. It feels almost like I'm on speed, not that extreme, but that feeling. Does this mean my norepinephrine is already too high?
    crackerjackamf 7 Replies
    • January 31, 2009
    • 10:40 PM
    • 0
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  • Another thing excessive sweating or being unable to sweat is another symptom and copied this from wikipedia - Symptoms of POTS overlap considerably with those of generalized anxiety disorder, and a misdiagnosis of an anxiety disorder is not uncommon
    Anonymous 42,789 Replies
    • January 31, 2009
    • 10:43 PM
    • 0
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  • Generalized anxiety disorder or GAD is characterized by excessive, exaggerated anxiety and worry about everyday life events. Here are the following that cause GAD: Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families. Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety. Medizinprodukt
    Anonymous 42,789 Replies
    • February 1, 2009
    • 00:12 AM
    • 0
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  • I just wanted to add that I did some experimenting today, and measured my heart rate lying down and then standing. One time it went from 75 bpm to 132 bpm! I think I have my diagnosis. Now I just need a doctor.
    crackerjackamf 7 Replies
    • February 1, 2009
    • 11:44 AM
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  • Some of your symptoms could be from drug interactions or side effects themselves.
    richard wayne2b 1,232 Replies
    • February 1, 2009
    • 00:47 PM
    • 0
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  • Except that the symptoms started long before the medicine.
    crackerjackamf 7 Replies
    • February 1, 2009
    • 00:52 PM
    • 0
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  • So nothing changed at all?
    richard wayne2b 1,232 Replies
    • February 1, 2009
    • 01:10 PM
    • 0
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  • The orthostatic response you are describing is more likely to be associated with use of lisinopril. ACE inhibitors such as lisinopril work by interfering with the action of angiotensin II upon the vessel walls, which is designed to increase blood pressure. Under the influence of ACE inhibitor drugs, there is a capitated or threshold effect upon the ability of blood vessels to respond to acute changes in body position affected by gravity, ie head tilt up, sitting up and standing up. The body responds to these rapid changes by increasing cardiac force and cardiac rate, which is the most expedient method by the body to overcome hypotensive circumstances. Also realize that drugs like Sertriline or Zoloft act on the sympathetic and parasympathetic nervous system and can produce vasodilation, causing hypotensive states. Wellbutrin is also known to produce orthostatic hypotension in some patients. I would also comment here that clincial depression, with anxiety features, very commonly produces features associated with autonomic dysregulation but does not constitute formal dysautonomia. The combination of medications presently being taken is entirely sufficient to produce symptoms of orthostatic hypotension and would not constitute POTS. Realize that in the case of POTS, pooling at the lower extemities is observed to various extents through diagnostic tests and the actual clinical presentation is rather dramatic. I've observed a great number of people on the forum here who state that they've been diagnosed with POTS and while this may be the case, it is commonly associated with misdiagnosis. It would be highly unlikely that your doctors would conclude that you have POTS in the presence of the medications being taken and to do so would be rather short-sighted. Based upon the broad spectrum of symptoms described by you, there are no associated algorithms of disease that would characteristically represent such patterns other than clinical depression with anxiety/panic disorder at this point. I would continue to follow your doctor's treatment plan and if you observe a change in symptoms, notify them. Understand that the dynamics of clinical depression and anxiety may require close monitoring and dosing considerations in order to produce the most positive therapeutic effects with the least side-effects. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • February 1, 2009
    • 01:12 PM
    • 0
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  • Even if it’s a long shot, have they ruled out pheochromocytoma? Please ask your doctor. Good luck with everything! :)
    Felsen 510 Replies
    • February 1, 2009
    • 04:08 PM
    • 0
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  • Well I've stopped taking the Wellbutrin now. The Lisinopril has lowered my blood pressure by about 20 points, and the Zoloft has helped to kind of even my moods a bit, but the other symptoms haven't changed at all. I'll look into a pheochromocytoma.
    crackerjackamf 7 Replies
    • February 1, 2009
    • 11:17 PM
    • 0
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  • I wanted to add that I've taken my pulse quite a few times in the last couple of days, and I don't have a high pulse by nature, only when standing. When I'm lying flat, my heart rate is about 65-70 bpm, but when I stand, it shoots to 115-140 bpm. I wouldn't expect anxiety to do that, would it?
    crackerjackamf 7 Replies
    • February 2, 2009
    • 11:47 AM
    • 0
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  • Dr Cottle,I believe she stated that the symptoms began before she took the meds??
    pamelasmc 82 Replies
    • February 2, 2009
    • 03:55 PM
    • 0
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  • I'm concerned with the symptoms she is experiencing now, not the dissociation between what she believes her symptoms to presently be versus what they were originally. What a person describes in the way of symptoms is entirely subjective and my subsequent medical comments are alternatively, objective. If you were a physician, you would recognize that distinction. I've noted time and again that people come rushing out of the woodwork to try and point out what they believe to be the obvious as though I'm blessed to be here among the more scholarly and in need of constant correction. I was a physician for more than 40 years and yet I seem to lack the insight so proliferently demonstrated by members to this site who apparently experience a thrill by the opportunity to play doctor. If you have comment regarding what the poster may be experiencing in the way if illness and disease, please direct your comments accordingly but I'm entirely disinterested in having you and other birds of a feather critique my responses as though I'm being qualified by your standards. J Cottle, MD
    JCottleMD 580 Replies
    • February 2, 2009
    • 06:03 PM
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  • Dr Cottle,OUCH !Apparently you have a very fragile ego. I was simply asking a question, possibly assuming that you had not read every post on that particular thread.I have run across more than one DR with said fragile ego. I'll hazard a guess that you have not always been correct in your long career...after all, you are not God...but I hope your bedside manner was better then than now.Has it occurred to you that when people post something that doesn't agree with you, that they are simply looking for more info from the "expert" ?Best RegardsPamela
    pamelasmc 82 Replies
    • February 2, 2009
    • 06:14 PM
    • 0
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  • There's nothing wrong with my ego at all and your comment was not couched as an inquiry to learn anything in my opinion. It was an attempt to try an illustrate a factor that was assumed to have been overlooked. I offer my personal time here in efforts to strictly respond to people seeking answers to medical dilemmas. At 84 years old, I certainly feel I've been around the medical profession long enough that I can read what a poster has written. I certainly take into account all of the information being provided to me and base my responses upon my experience as a physician, regardless of what the individual may feel or interpret as the "same" symptoms. And you close by inferring that I'm too narrow-minded to see the actual motive underlying comments made to my responses. I do not consider myself to be omniscent as you suggest as well, but merely a physician who has a professional medical opinion that regularly seems to be the focus of contempt or scrutiny rather than exercising an independent response to the original question. Lastly, what I encounter more often than not is people on this forum who regularly use the internet as a database for attempting to demonstrate medical knowledge and experience as though it somehow magically confers the requiste skills. If medicine were even remotely so simplistic, everyone would have a license. My personal time is being dragged into an arena where people without medical training, licensure or experience are trying to bring challenge to my comments based upon their own interpretations of what they can scour from the internet. I'll make no comment of what I think of such a comparison. If it weren't for the fact that these people need genuine help in some cases, I would not waste another moment of my time here. J Cottle, MD
    JCottleMD 580 Replies
    • February 2, 2009
    • 10:52 PM
    • 0
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  • Are you taking birth control by chance?DOM
    acuann 3,080 Replies
    • February 3, 2009
    • 02:09 AM
    • 0
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