This is a case of a pregnant woman in her late 30’s. She calls and takes an appointment for the same day. She sounds desperate and anxious on the phone, pleading for help.
She talks continuously with anguish. She says money is not an issue and that she needs to get treated and what is the point of saving the money if not for our health and the health of our kids.
She’s been having sudden panic attack for the last week. She calls again at the appointment time unable to find the office and expects me to guide her despite using her GPS.
She arrives a half hour late and says she was searching for the office for the last 35 minutes and was unable to find it. I had to guide her by phone until she reached the parking area.
The Case
I have heavy anxiety issues, depression since the last week. I don’t know what triggered this, started all of a sudden. Earlier was taking a depression med, very low dose, Citalopram, 10mg, was fine on it, got to know I was pregnant and stopped it.
Currently on work with visa in the United States and must apply for extension soon. Was reading about it, a lady online was asking about what should she did as her visa got denied. I thought OMG, my due date is just a month after my visa would expire if I do not get an extension!
My husband is looking for a job. I went to the temple to pray. I had thoughts like my baby is not growing well. I have a 5-year-old. I had pre-eclampsia back then and my son was premature, delivered at 29 weeks, he had a lot of health issues. Also, have an older child.
Six months ago, I wanted to get family planning procedure done but then got to know I was pregnant. It was unplanned. Didn’t want an abortion, it’s not good. I have had an abortion before. I feel my son might have been prematurely born because I did that abortion; back then I was feeling very guilty. I am almost 20 weeks pregnant; USG is normal.
I am now anxious, is this baby growing? Who is there to take care of me? We did not tell anyone about this pregnancy; mom got to know. People say, look they are 35, both of them are educated and are still having a baby so late; I will feel very sensitive and hurt.
I told my mom because she will go to the temple and pray for me every day. I am religious. If people say something negative about me, I will feel very hurt. I feel people cast an ‘evil eye’ if you tell them things. I know it is superstition.
Every morning I look at my abdomen to see if its growing or not. Last pregnancy also I was wondering if the baby was growing. I will concentrate on small things and get tense. If this baby is born early what health problems will happen? How to tell everybody that we had our baby this way?
My husband does not work here, comes home only on weekends. I have to do everything alone here, no support. (Crying) 2 months back, had a lot of morning sickness, I was alone, even the smell of food was horrible. I suffered so much, would vomit, and lie down, husband is only able to come on weekends. He could not come down, still it was fine, was managing it.
I am not getting much sleep in the last week. I am not interested in doing any work at home, doing it mechanically. I was just lying in bed last night, no thoughts. My sisters have panic attacks and depression. In childhood, I did not get love and affection from father. He used to abuse my mother. We bought a home for him and I am happy to take care of him; that generation’s curse will come onto my kids if we don’t take care of him. I believe that, so I take care of him. I feel obliged to do it.
The nausea was only for the first 2 months but it was huge. I was alone but my mind was strong. Last pregnancy also, the same thing happened, after 22 weeks the BP was a little high. I googled, it was in my mind, it turned to anxiety and I delivered early.
I saw that there can be preeclampsia, premature birth etc. Now too there are variations in the blood pressure. If this anxiety continues, I am 100% sure it will be a premature birth. I don’t fear death, but I am worried about the baby, that is too much.
I would crave salty foods. Sweet not a craving but I like it. I have hypothyroidism, taking levothyroxine tablets.
Before pregnancy, depression. I used to cry easily, anxiety if kids do not study well what will happen? Fear of driving couldn’t even get into the car seat. Was possessive about my husband. I have come a long way from that, this anti-depressant was helping me a lot, took it for one year.
I got a lot of depression and anxiety when my son was born prematurely.
Anxiety and depression is a chronic issue, maybe since college days. If somebody is telling me something, I can’t respond back, I can’t argue back, will be nervous and escape from there.
My sister used to call me and complain about her in laws. If I say please don’t call me, she could cast a bad spell on me because of her thoughts, like a curse, so I wouldn’t say that to her. I once supported my in-laws and my sister-in-law didn’t like it; she asked me why did I do so?
A week later I had high BP and delivered my child prematurely. This kid is a blessing. I am not thinking in a negative way, want this baby healthy. I am happy to have this baby.
Whatever I plan for in life, the opposite will only come to me all my life. People say I should plan my life, but it never works out. Every week I go to counselling and they ask why are you thinking what will happen 5 months from now, think for now, but I am unable to do so.
They tell me to live in the present, but I am thinking what will happen in the next USG? I want to change, that is why I am going for counselling. I am going for hypnotherapy today; I am unable to be in the present. I messaged my physician too and am supposed to meet her tomorrow.
During anxiety, will have palpitations, no energy, feel lethargic all the time, do not feel like doing anything. Just simply sitting and thinking those thoughts. I am impulsive. I took an appointment with you today right away, within 2 hours. I have an appointment today for acupuncture too. I do these things very suddenly, don’t want to waste even one day since I am pregnant.
Fear of heights, cannot go on rollercoasters. I used to be nervous before exams, even in the driving test I was extremely nervous. Lack of confidence in myself. I want to be positive, but my mind is not letting me to think in that way. A day before exams will have palpitations. Even when I go for my medical tests, palpitations; what will happen? As you are giving me the instructions now, I am getting anxiety in my chest and feel it in my stomach too.
Analysis:
Desperation, almost clinging for help.
Open and friendly despite the anxiety
Superstitious
Suggestibility, easily affected by what others say or think of her.
Impulsiveness
Some of the ‘anxious’ remedies that need to be differentiated here are:
1. Phosphorus – People needing this remedy tend to be very ‘suggestible’. They are easily affected by situations in their environment, ‘sensitive to external impressions’. She is so sensitive that she delivers her baby prematurely after her sister-in-law confronted her. She also developed great fears after she googled about her high blood pressure, which further contributed to the premature labor. Phosphorus types also have a highly active imagination and exaggerated fears. They imagine that the worst is expected and that something terrible is going to happen. A prominent aspect of the Phosphorus fears is that they can be assuaged easily when you convince them that they are okay. But the relief from the consolation is temporary; after a few hours the anxiety tends to return, and they begin to panic again.
2. Arsenicum album– The personality profile of Arsenic is different in many aspects from our case here. Arsenicum tend to be very ‘suspicious’ in their interaction with the doctor. They don’t easily trust your advice and will throw many questions at you, just to reassure themselves that they are in good hands. In our case I could see a certain openness and receptiveness. Arsenicums are closed and ‘cautious’ in their interaction during the consultation. They can be religious and superstitious, fear that their God will punish them if they do not do the right things. It is similar to what our lady talks about; that she will be cursed if she does not fulfill her duties towards her father by taking care of him.
3. Aconite– Tend to have anxiety, panic attacks, that ‘come on very suddenly and leave suddenly’ like a storm. Fear of death, fear of accidents, fears that come on during pregnancy. Palpitations accompanying the anxiety spells, anxious restlessness. Cannot sit still, tossing about constantly in their panic state.
4. Nitric acid– Great physical prostration. Hypochondriacal, worry about their disease and trivial matters, fear of death. The anxiety of Nitric acid is accompanied by a ‘sense of hopelessness’, that nothing can be done. They tend to be irritable and quarrelsome. There is a prominent tendency to ‘dwell on the past and to hold grudges’. Seek revenge for the wrongs done to them- an ‘embittered’ personality of sorts.
5. Argentum nitricum– Tend to be open and extroverted. A sense of hurriedness along with their anxieties. ‘Anticipatory anxiety’ with fears- like the outcome of a doctor’s appointment, examination or stage performance. Fear of heights, claustrophobia. The anxiety can be accompanied by diarrhea. Can be superstitious and suggestible. A characteristic of this remedy is their ‘impulsive nature’. This is very clear in our case- She makes a call impulsively to take an appointment for the same day, pleading that she be seen immediately. She has also booked appointments with a hypnotherapist, acupuncturist and counselling session for the same day! Jumping from one specialist to another, which shows her flitting anxious nature.
The Synthesis repertory shows 692 remedies under the rubric ‘anxiety’. As we can observe from the few remedies that we have compared, all of them have similar anxieties and can throw us off track. In any given case, it is necessary to delve further into the intricacies of the condition to prescribe more accurately.
If anxiety is the presenting complaint- what is the anxiety about and why do they have it? How does the patient handle the anxiety? What is the body language they exhibit and how are they expressing themselves? Such factors must always be considered during the case taking to help our patients successfully.
I prescribed Argentum nitricum LM1 for this lady and asked her take it for three weeks and follow up after a month. I never heard back from her and thought that I had lost the case. She called me 2 years later and reported that her anxieties went away completely after the remedy and she went on to have a full-term normal delivery. She called this time to schedule appointments for her children.
