Age: 49.0
Sex: F
Vaccine: COVID19
Symptoms: Anxiety, Blood testosterone normal, Blood thyroid stimulating hormone normal, Chest pain, Generalised anxiety disorder
Clinical narrative: On 2/18/21 less than 24 hours after receiving the second vaccine, experienced physical anxiety symptoms in the morning upon getting out of bed approximately 7 am - chest pain, increased heart rate, sweating, feeling of panic, restlessness. Symptoms resolved within a couple hours. However, these same symptoms continued daily for several weeks until finally seeking medical attention on 3/30/21, diagnosed with GAD. Talk therapy recommended. L-theanine recommended. No change in medication at the time. Returned to doctor on 4/21/21 when symptoms had not resolved.  Returned to doctor on 5/13/21 to review blood test results. Told to stop taking armor thyroid. Symptoms resolved and then returned two weeks later. Alprazolam .25mg prescribed on 5/13/21 to help reduce anxiety. Take one tablet by mouth twice a day as needed for anxiety 6/11/21 - Annual physical showed thyroid panel normal without supplemental armor thyroid. 6/14/21 - changed Effexor to immediate release which worsened anxiety. 7/22/21 - Another visit to the doctor for same symptoms. 7/28/21 - Began talk therapy. 8/4/21 - Prescribed Lexapro 10mg to be taken once daily, doctor visit on the same day. 9/2/21 - Changed from Lexapro to Cymbalta 30mg. Alprazolam refilled. 9/21/21 - New doctor visit to review results from DNA testing for psychiatric medication.  9/23/21 - Doctor visit, prescribed Buspirone 15mg once daily and Lunesta 1mg. 9/28/21 - Alprazolam refilled .5mg once daily as needed. 10/14/21 - First visit with psychiatrist. Increased Buspirone 15mg to twice daily. Continue with Cymbalta 30mg. 10/28/21 - Doctor visit, Lorazepam 1mg (stop alprazolam) twice a day as needed for anxiety. 11/3/21 - Hydroxyzine 25mg prescribed one tablet up to four times daily for anxiety. 11/6/21 - ER visit; mild serotonin syndrome. Stop buspirone. Continue lorazepam and Cymbalta. Prescribed Ondansetron for nausea. 11/9/21 - Second appt with psychiatrist. Reflled Lorazepam 1mg once daily as needed, increased Cymbalta to 40mg. 12/16/21 - Psychiatrist increased Cymbalta to 50mg daily to be taken before bed. 1/18/22 - Lorazepam 1mg refilled. 2/9/22 - Psychiatrist increased Cymbalta to 60mg. 3/3/22 - Psychiatrist increased Cymbalta to 70mg. 4/27/22 - Psychiatrist prescribed Abilify 5mg once daily. 5/12/22 - Psychiatrist increased Cymbalta to 80mg. 5/31/22 - discontinue Abilify as it caused insomnia. 6/15/22 - Annual physical. Doctor prescribed Mirtazapine 7.5mg at bedtime to help with sleep. 6/21/22 - Psychiatrist refilled Lorazepam 1mg take one tablet every 6 hours as needed for anxiety. 6/30/22 - Psychiatrist increased Cymbalta to 90mg once daily.7/19/22 - Cymbalta no longer effective and began taper off. Having more anxiety symptoms daily and panic attacks have become more frequent. Psychiatrist diagnosed GAD and PD (panic disorder). Experienced Cymbalta withdrawal from 7/26 - 8/7/22. Psychiatrist prescribed Mirtazapine 7.5mg to be increased to 15mg after 14 days on 8/23/22. Asked psychiatrist for direction on taper from Lorazepam. No help but began this on 8/15/22 at a decrease of 50% to .5mg. Found information on the internet to assist. Changed psychiatrists in September 2022. Began seeing PMHNP-BC 9/20/22. Continued with Mirtazapine until it too was no longer effective. In the meantime the lorazepam taper was becoming very difficult as was experiencing interdose withdrawal symptoms. No direction from first or second psychiatrist. Panic Disorder was getting much  worse. Began having suicidal ideation. Quite concerned with mental health. On 9/27/22 PMHNP-BC prescribed Pristiq 25mg. Continued with the taper of Lorazepam. Discontinued Lorazepam on 10/28/22 and have completed the withdrawal process. On 10/18/22 increased Pristiq to 50mg which I took until 11/21/22 at which time it was decreased to 25 mg as it caused OCD and a medical emergency. PMHNP-BC prescribed 25mg Seroquel on 11/22/22 taken at bedtime to help with sleep and decrease OCD.     Patient has not returned to state of health prior to the vaccination.