Start Living, Stop Worrying

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Compared to decades ago, going to see a psychiatrist today would not be as daunting or embarrassing but to the most part, there is still some hesitation and a litany of excuses to delay seeking consultation. I had often wondered why that was so. If one would have physical symptoms of pain or fever, no one would hesitate to consult for these symptoms, but if one had psychological symptoms often this is kept secret. The person may ask his friends indirectly that a “friend” has symptoms and would ask for advice. Presently in the age of Google, one could ask for opinions on any psychological symptoms and would have literally thousands of possible opinions.

The fear of stigma of being a patient seeing a psychiatrist prevents one from getting proper care. And in the absence of proper care it impacts on the wellness of the person and more importantly on the career development of the person. One of the major compelling psychological symptoms which may impact on one’s career track is anxiety and panic attacks. But is it not normal to have anxiety and panic symptoms? Is she not just “nerbyosa”? And how many “nerbyosa” people are there in the family? At work or in the social circle? SO WHAT EXACTLY IS ANXIETY? Anxiety is part of the range of normal human emotions.



One may feel anxiety during stressful situations like waiting for the results of the exams or going to do a task that one may feel inadequate or unsure. Anxiety (“balisa” o “hindi mapakali”) is often accompanied with physical symptoms like: Chest palpitations (“malakas ang kabog ng dibdib”), rapid breathing (“hinahabol and hininga”), sweating (“malakas ang pawis”), headache, nausea, numbness even “pins and needles”. WHAT IS PANIC ATTACK? Panic is an extreme state of anxiety characterized which occurs spontaneously with no identified trigger and would could come and go several times a day. This extreme state of anxiety is often mistaken as a “heart attack” and it is not unusual for the patient to insist to go to the Emergency Room (ER)-only to return to the ER when the next panic attack occurs.

Given the calamities and disasters that frequent our country, it is expected that people will experience fear, anxiety, and panic attacks after the occurrence of the disaster. However, it is expected that the frequency and intensity of the symptoms would decline after several months. Hence, experiencing anxiety and panic attacks within a given situation may be considered normal and expected. However, when it is observed that the anxiety level may be exaggerated and the symptoms continue to be experienced many months or years after the event. One should consider a consultation.


If the symptoms already impacts negatively on the work performance and the usual social activities are declining this suggests that the symptoms are affecting the overall functionality of the person. It acts as a road block towards achieving more in one’s career and certainly narrows the social life of the individual. Therefore, one should consider consulting a medical professional at the very least. Let us be clear that anxiety symptoms and panic attacks can also be symptoms of medical disorders.

Therefore the medical professional should request for laboratory examinations that would assess the cardiac and thyroid functions of a patient with anxiety symptoms. Other causes of anxiety symptoms may be due to caffeine from coffee and soda drinks. It is when medical conditions are cleared when a psychiatric diagnosis of the anxiety symptoms and panic attacks may be considered. The psychiatrist will have to assess the totality of the symptoms of the patient. Therefore the presence of other symptoms would need to determined and assessed.

CASE VIGNETTE: Rachel is a 25-year-old female, single, college graduate who is presently working as a call center agent. She describes the work at the call center agency as “stressful” and had to cope with the shifting work duties.

Further at home, she has to look after her younger siblings and also make time for her boyfriend whom her family does not approve of. She started to have feelings of anxiety before the regular evaluations and would even have several episodes of panic attacks. One time she was feeling very overwhelmed and went to the ER for consultation. She was given sedating antihistamine which helped her to sleep and improved her condition. She had consulted a psychiatrist for evaluation so as to determine if she could go on sick leave. She was given a two-week sick leave and the series of laboratory tests were done.

After the two-week period there are two possible scenarios:


SCENARIO 1 Rachel feels rested and reported no recurrence of her anxiety symptoms or panic attack symptoms. She reports normal sleep and good appetite. She feels fine and is back to her “normal” self. Further, the laboratory tests were all normal. It is not likely that Rachel has any medical condition that may cause the anxiety and panic attack symptoms since the laboratory exams were normal and would most likely not have any anxiety disorder since the anxiety and panic attack symptoms completely vanished during the two-week observation with no medication provided However, the patient was advised to return for consultation once any of the symptoms recurred.


SCENARIO 2 The laboratory tests are normal, however, the symptoms of anxiety and panic attacks continued and she feels very limited by her symptoms. She is hesitant to meet up with friends and most of her thoughts center of the anxiety symptoms. Then the doctor will discuss symptoms and the diagnosis. Once this is done then treatment options will be discussed. The cornerstone of management is medications which can certainly improve the symptoms. Together with drugs would also be lifestyle adjustments like stress management, limitation of caffeine intake, relaxation techniques, breathing exercises, and psychotherapy. Each patient is different so the approach is very individualized and tailor fit to the patient. The end goal is the complete resolution of the anxiety and symptoms. But more importantly is the resumption to pursue the professional goals and enjoyment of personal relationships. The bottom line is that we are all faced with choices in life – choose to not only care of your physical wellness, but also your psychological wellness. You deserve it!


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