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Forum Name: Psychiatric Topics

Question: I am scared of going on holiday


 Shafiq - Sat Jul 28, 2007 12:11 pm

age 24
sex male
diagnoses depressive disorder and borderline personality disorder
medication 45mg Mithazapine

I am planning to go to pakistan to meet my mum and visit my dad's grave and i will b staying there for 2 weeks...but i m in constant fight with my mind that i wont b able to make it ..i might feel ill then who is gonna take care of me and i have never travelled outside UK for the past 8 years...generally i am always fearful of going to a party or to an event and i m getting the same feeling that i might faint or become unwell and i wont have the option of using the emergency services like i have in england ...somtimes before a party wen i have these feelings i ignore them and just go there and i make it to the end without any significant problems....but i m panicky because traveling outside the country wont b the same as going to a party so i dunno who to get advice from and should i take the risk or not?...if someone gives me some advice on this i will be very grateful
 Dr. K. Eisele - Sun Jul 29, 2007 3:56 pm

User avatar Dear Shafiq:

It sounds as though you may have a classic case of Panic Disorder, which can happen in depressed patients. People who have this problem often are afraid to go out because of a bad experience they had with becoming ill while they were out. Often the original event is a panic attack. A panic attack is a feeling of impending doom, such as the feeling that you are going to have an emotional "meltdown," or that something really traumatic is going to happen around you, or that you ARE going to die.

Panic Disorder is what happens after a person has a few of these attacks and then begins to fear that he will have another attack, which makes it even more likely that another will occur. That you have forced yourself to go out even though you feared another attack, only to get through the event without trouble, is a common report from patients with Panic Disorder.

Often, the person will then isolate themselves to their home, then their own bedroom, etc. That person's world becomes smaller and smaller, and soon he is consumed with anxiety, because there is no place he can go to feel safe. The suicide rate for people in this situation is very high.

On the bright side, though, there are effective treatments for Panic Disorder. You should see a psychiatrist as soon as possible, who will likely recommend some medicine and psychotherapy. Whatever you do, do not give up. This illness is very treatable--the success rate is very high, if done right.

Medicines usually prescribed are SSRI antidepressants, such as paroxetine, sertraline, citalopram, escitalopram, and fluoxetine (Paxil, Zoloft, Celexa, Lexapro, and Prozac, respectively). For people with severe anxiety, a benzodiazepine is also given while the SSRI is given a chance to work, which could take up to 6 weeks. Benzodiazepines commonly used are alprazolam and clonazepam (Xanax and Klonopin, respectively).

Some doctors will not prescribe benzodiazepines to anyone, no matter how bad the anxiety because these medicines can be addictive. If you've never had a problem with addiction, the risk is much smaller.

Mirtazapine is an effective antidepressant, but is not known to treat Panic Disorder, or other types of anxiety. SSRIs sometimes are combined with mirtazapine, but it is likely that you simply need a change in medication.

Good luck, and please come back and let us know how things work out for you!
 Shafiq - Sun Jul 29, 2007 6:41 pm

Thanks alot for ur kind explanation Dr.K.Eisele
i think u r right i might have panic disorder but i have always explained my situation to my psychiatrist or may b i havnt gone in depth...she wrote me a medication last time i saw her its called Chlorpromazine bcos i told her that i have become very sceptic and suspecious with stuff going on around me..can u pleez name one good medicine that wont b harmful and so addictive that i could take at night bfore i go to sleep which will help me...bcos i also have eating disorder and i cant eat in the mornings... i can only take medication at night time wen i have eaten finally otherwise i will feel sick ...i wanna make sure i feel better bfore i take this trip.
 Dr. K. Eisele - Sun Jul 29, 2007 10:59 pm

User avatar Shafiq:

Chlorpromazine is a medicine that can be taken at night. Most people find it very sedating. While chlorpromazine is not commonly used for panic disorder here in the US, I can't really think of why it wouldn't work.

If you cannot take medicine in the morning, you could take it after your lunch (you do eat lunch don't you?). It would be best to take a very small dose during the day, at first, until you find out how you react to it.

Good luck to you! Please come back and tell us how things work out.

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