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khagihara, Doctor
Category: Mental Health
Satisfied Customers: 6590
Experience:  Trained in multiple medical fields for many years
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I think this question is more for a gastro doctor, but I

Customer Question

I think this question is more for a gastro doctor, but I need some direction and advice.
22 year old male college student.
A year ago started with stomach problems. After going through several tests, including a scope which found nothing, anti-nausea medicine was prescribed. This has helped some. 2 tablets at night of 25 mg of nortriptyline HCL. Side effects are not so good.
Other symptoms and perhaps related issues:
* High heart rate - 90 to 120 at rest. A cardiologist has been seen and tests show good heart health
* Tests also show moderate anxiety levels. Seeing counselors recently so some help in evaluating.
* Lost weight. From 190 to 165 in a year's time. Gets hungry, eats and then full rather quickly or just doesn't feel well.
* Need help deciding how to attach all of this. Perhaps starting with stomach so he can eat. However, school is difficult for now with a "fight or flight" mode he is in and difficulty in thinking and remembering.
Please help in some direction to take or how this can be resolved.
Submitted: 1 year ago.
Category: Mental Health
Expert:  khagihara replied 1 year ago.

How tall is he? What are his symptoms? Does anything make them better or worse? Are they consistent? Are they getting worse? Is he aware of anything which might have triggered them? Is his stress increased at home or school since 1 year ago? Any medical problems? Any surgeries? Any other medications including over-the-counter pills and herbs? Any family medical history?

Customer: replied 1 year ago.
Seriously? How tall is he?
No foods make any difference.
No other medications.
Family history on his mother's side of anxiety.
Expert:  khagihara replied 1 year ago.

Can you answer my each questions so that I can understand his condition?

Customer: replied 1 year ago.
6 foot tall
nausea, inability to sit still for a length of time, concentration has been reduced, memory has been affect - as I said earlier he is in a "fight or flight" mode - Do you know what that is in reference too?
He can be nauseous without any food in his stomach, so I am certain this is all related to anxiety and heightened adrenaline which can make him queasy. He is not aware of anything that has triggered it, but it became more unmanageable over time last spring. No surgeries. No physical medical problems.
I forgot to say that he does take Adderall on an as needed basis to help when he needs to study at college. Currently has not had any for ten days and makes no difference in his heart ate or nausea. His stress level goes down a little when he is not at school but not enough o where the symptoms are reduced enough to make any real difference.
Need help making decision on how to attack this.
Expert:  khagihara replied 1 year ago.

His symptoms seems to be depression in addition to anxiety. Nortriptyline is a medication called TCA. It could cause a lot of side effect. He should take different kind of anti-depressant such as SSRI, SNRI, Remeron, Wellbutrin which have less side effects. It is not usual that a psychiatrist prescribes nortriptyline at first. If his doctor is not a psychiatrist, he should see a psychiatrist who will prescribe appropriate medication and provide psychotherapy.

Customer: replied 1 year ago.
That is why for his stomach and all encompassing conditions I thought a GI person might have some thoughts on better short and long term therapy. Long term goal is to get off all of the meds.
Are you a psychiatrist?
So you are recommending different meds for now and a therapist?
Expert:  khagihara replied 1 year ago.

No. But most doctor know it. Yes. He should see a psychiatrist. It is not a GI problem.