Not sure what's going on...

I'll try to keep this brief.  I've always been somewhat prone to depression/anxiety.  In the past 5 years my brother was killed in a car accident, I was almost killed in a seperate accident, I moved 500 miles away from my family (to whom I am very close), and got married (the bright spot).   Throughout all of this, I've been functioning pretty well.  I've suffered from tension headaches for the last 3 1/2 years, for which I take Esgic Plus on an as needed basis.  I've had tingling in arms and legs, etc--went to a neurologist who said I had some nerve/muscle damage from accident--went to physical therapy.  In the last 3 weeks, I've quit smoking (pack a day for 13 years)--since then, I've felt like I'm losing my mind.  I've been either in the throes of an anxiety attack or anticipating one--insomnia (which i've never experienced before), foggy feeling in my head, can't concentrate, crying at the drop of a hat, chest pain, shortness of breath, palpitations, etc.  My doc put me on xanaz 0.25mg at bedtime--it sort of works if I take two of them.  I feel crazy.  My head feels like it's swimming. My doctor ordered blood work and my one of my thyroid levels is slightly elevated. I'm going to a specialist next week to check on hypothyroidism--does that sound possible?  I've read about other symptoms of it and I only seem to have a very few of them.  Sorry for being so long-winded, I'm just frustrated and scared that I'm losing my mind.

Thank you.

[HFHS MD-JM]

Ellen,

     It is difficult to sort out exactly what is happening as multiple issues are involved including: recent nicotine cessation/withdrawal, possible hypothyroidism, history of peripheral neurologic deficit/problem(ie numbness and tingling in extremeties0 and a predisposition to anxiety/depression.  I can not diagnose you and it is necessary that you have further evaluation to clarify all factors involved but, it appears that you are experiencing anxiety and possibly depression.  These things can be triggered by prior problems or may occur on their own.  Nicotine withdrawal, temporally related to the onset of your symptoms may be a major factor.  If your symptoms do not improve with time then a trial of buproprion(Wellbutrin, Zyban) might be helpful.
     I recommend that you proceed with further medical work up
,continue Xanax if you find it helpful and be evaluated by a psychiatrist to determine if a mood and/or anxiety disorder is present.  The good news is that effective treatment exists--its just a matter of clarifying your condition.  Keep in mind that this information is intended for general educational purposes only.

Sincerely,

HFHS MD-JM

Keywords: Anxiety, depression

[NRO-Sx]

It could be a combo of hyperthyroidism (too much) and nicotine withdrawal.  Propranolol (a beta blocker drug) produces a significant reduction in the serum concentration ratio of tri-iodothyronine to thyroxine.  When taken in small doses, Xanax (alprazolam) has anxiolytic properties, however ... your doc probably prescribed them as temporary sleeping aids, and you shouldn't take them throughout the day to control anxiety as this will mess up your circadian rhythm even more!  Wellbutrin is a good antidepressant that also reduces anxiety and aids in quitting smoking by attenuating the nicotine withdrawal syndrome. Ask your doc about it, and good luck!

[Ellen]

Thanks for responding.  If you wouldn't mind an additional question or two.  How long typically does it take to withdraw from nicotine?  I've also eliminated caffeine from my diet in the last week--maybe I'm cutting out too much at once?   Also, from what I've read, my symptoms seem more indicative of hyperthyroidism as opposed to "hypo"--however, my grandmother has hypothyroidism--I know these conditions are often hereditary--could a family member have one type of thyroid problem and pass on a different type of thyroid problem?  Again, thanks so much for this forum and your help.

[John]

All of the changes you've described could certainly be triggering some symptoms of depression. I've gotten relief from similar symptoms of depression and anxiety relieved somewhat through treatment of hypothyroid. Consider yourself lucky if that resolves your worries. Whenever I hit a "rough spot" and start to notice my old patterns of behavior (symptoms) I wonder if I should take what seems to be the next step and talk to my M.D. about trying an antidepressant. Best of luck to you.

[NRO-Sx]

First, nicotine withdrawal has two parts to it ... a physical withdrawal that lasts 3-4 days, and a psychological withdrawal (which also causes cravings etc.) that takes much longer (at least 2-3 weeks, but often much more).  The "patch" can alleviate the physical withdrawal syndrome, but not the psychological.  Family support, willpower and antidepressant drugs are helpful in battling the psychological withdrawal.  Second, cutting out caffeine is an excellent choice, since caffeine can initiate anxiety attacks ... headaches fatigue, and irritability are common side effects of caffeine withdrawal, whereas anxiety is not.  As for thyroid dysfunction, both hypo- and hyperthyroidism are relatively common entities.  Hypothyroidism is associated with depression, fatigue, and weight gain etc. whereas hyperthyroidism is associated with anxiety, weight loss, and tachycardia.  Elderly, post-menopausal women are at high risk for hypothyroidism (think of it as "wear and tear") and this is not necessarily a heritable trait .  Hyperthyroidism, on the other hand, is a heritable trait (for example, the CTLA-4 gene may be a susceptibility locus for Graves' disease which results in hyperthyroidism).
Hope I've answered your questions to your satisfaction, but don't hesitate to write back.

[Hope this helps]

I can see where you would be frustrated and scared that you may be losing your mind. But from an outsider's perception, looking at everything you've written...wow you've been through  a lot. I'm not a doctor, but I can tell you that last year I was in a similar situation (minus the almost dying in a car accident I was assaulted several times instead)...I had all of the same symptoms you described (including the beginning part about nasty tension headaches and the ending 'frustrated I think I'm going crazy' perception). My take on it is that it's the body's way of letting out the stress you've held in and had to deal with. Stress can do some pretty major things to your body and if you've been through enough traumatic events you can develop PTSD which over time mimics a panic disorder and becomes almost indistinguishable from it. The fact that xanax helps is a clue that most of it is anxiety/panic based. you may want to check out info at http://www.algy.com/pdi/BBS/index.html
there is also a link to there FAQs that have some REALLY helpful info. Like how CO Q10 can help heart palpitations and pain. Plus an MD writes and monitors the board daily. He's got a good reputation too and gives great advice. If I were you, I'd post all of this there and see what he says. I bet he steers you in a good direction. Also, I found cutting caffeine out entirely really helps. I was only drinking one cup of coffee a day, but cutting that out has helped. Is there anyone that you can talk to? An understanding therapist? Therapy alone didn't help my panic attacks, but it helped me to cope better and gave me reassurance that I wasn't turning into a bona fide nutball. Hang in there...and try to check out the pdi board. I think you'll be glad you did (if you post check again, the MD will r

[CAROL ANNE]

Hi there:

I am 48 and wept a bit as I read your question.
I was never anxiety/depression prone befoe either.  However, somewhat like you, I have experienced tremendous interpersonal stress.  Moved from one province to another in Canada last year, got engaged after 9 yrs divorced in Oct/98, moved to the US in July, got married July 10th, left my older teenagers in Canada (their choice), etc etc... The chest tightness, nubness/tingling in my left arm and sometimes left leg, and sometimes all limbs, the crying, tension, anxiety, foggy thinking....all symptoms of either thyroid dysfunction or perimenapause.  At least that what I think.  It is so hard not to think I have something serious wrong.  I started a low dose birth control pill in May and leveled off nicely.  I stopped for one cycle to have blood work and nearly lost it and my marriage.  Started up again 5 days ago and "normal" is returning.  Dr. gave me 20mg. paxil to which I experienced just about every side effect, and stopped after 2 days.  He also gave me post menapause PremPro, that was awful and I stopped after 4 days.  That was last week.  
Guess I didn't have to say all this to suggest, if not already done, to look at your possible hormone levels as they relate to estrogen/progesterone.  I think slowing down and having my muscles full of adrenalin from living at such a fast paste, means it will take time to work out the tension and function as productively, but without so much natural speed in me!  This may not make sense, but wanted you to let you know you'll make it!  Choose to!

[Ellen]

Hi Carol Anne,
Thanks for responding.  I do feel better knowing there are other people out there who experience these feelings--I'm not happy anyone has to feel this way, but it's good to know you're not alone!   I was diagnosed this last week with hypothyroidism and put on synthroid.  However, I still have concerns and that is this "head fogginess"--I just don't feel quite all together THERE.  I think that is the worst feeling.  The doc says it takes about a month to feel better, so hopefully I will.  I hope you feel better soon as well.  Thanks again.   Take care.