OpenHealth Q&A

Decades of Deep Anxiety and Somatic Issues: What's the Cause?

Greetings, I am a 30-year-old man, standing at 186 cm and weighing 84 kg. Presently, I am prescribed a 10 mg dosage of Trintellix. My situation remains perplexing, despite years of searching for clarity, perhaps a miraculous explanation that might help me understand my feelings, even to a small extent. **My Struggle:** Since the day of my birth, I have been acutely sensitive, encountering numerous struggles. As I transitioned into school life, an overwhelming fear took hold of me. I often described this anxiety as feeling like my stomach was pierced by a sword, characterized by an excruciating pain that originated in my abdomen, specifically a bit above and to the left. This sensation would strike me every time I thought about attending school, engaging with others, or contemplating a future filled with potential failures. At around 8 or 9 years old, despite my desire to socialize and the joy I found in friendships, these symptoms often caused me to withdraw. Additional manifestations included a sensitivity to light, visual disturbances, facial stiffness (particularly on the left side), and widespread pain, especially severe discomfort in my back. I have spent considerable time trying to comprehend these feelings and recognize that I had no environmental reasons for such distress—my upbringing involved a loving mother, friends, family, and supportive teachers. Interestingly, I excelled academically and in sports, consistently standing out among my peers. I remember excelling particularly in physical education, showcasing exceptional reaction times in various games, and demonstrating remarkable focus and cognitive abilities for my age. However, living with these characteristics meant that while I performed exceptionally well, I was also plagued by anxiety, which inevitably led to depressive episodes. My experience with SSRIs has been troubling; while paroxetine at 20 mg allowed me a certain comfort, it stifled my libido, which had previously been quite robust. Recently, I switched to Trintellix, which improved my sexual drive but seemed to exacerbate my overall health. I noticed a pattern from my childhood: whenever I reduce my dosage from 10 mg of Trintellix to 8 mg, that familiar sharp sensation re-emerges in my chest, and I experience the resurgence of both negative and positive behaviors, along with a troubling anxiety response that triggers irrational fear in seemingly harmless situations such as casual gaming with friends. Interestingly, reducing my medication does allow me to reconnect with the joys of life—something I felt keenly during a period when I came off SSRIs completely. That experience was euphoric, as I felt alive and engaged with the world. However, this heightened state of experiencing life is often accompanied by a return of anxious tendencies. Now, at nearly 30, I reflect on my childhood and recognize that my body seems to revert to a sensitive state. Despite two years of cognitive-behavioral therapy (CBT) and gaining a wealth of emotional insight, I still find it almost impossible to overcome this profound anxiety when I am not on SSRIs. I am aware that CBT is intended to be beneficial alongside physical activity, maintaining a healthy lifestyle, nurturing friendships, and practicing mindfulness. I genuinely put effort into all these areas, yet they often yield only short-lived relief—this is why I eventually resumed SSRIs, as the alternative felt like torment. What pains me most is the clarity with which I remember my childhood, grappling with wondering why one in 25 children in my class shows exceptional traits combined with shyness and anxiety, almost as if these qualities are predetermined. **What I've Attempted:** - Two years of CBT yielded a marginal improvement, roughly 10%, in breaking free from negative thinking. - Engaging in daily physical activity (35 to 50 minutes), which aids in alleviating my anxiety somewhat but does nothing for the suffocating sensations I sometimes experience. My depression is managed successfully through SSRIs and other methods. - Numerous medications included anti-epileptics like Depakine and various SSRIs such as paroxetine, Trintellix, and several others, of which only paroxetine and Trintellix had any positive effects. - NDRIs like bupropion had no impact other than to overstimulate me. I've observed that lower dosages of medications seem to work more effectively for me; both 20 mg of paroxetine and 10 mg of Trintellix manage my anxiety significantly while also allowing me to feel relatively good—albeit with side effects like reduced libido and emotional numbness. Through my research, some potential explanations I’ve encountered include: - Highly Sensitive Person (HSP) - High Behavioral Inhibition - ADHD with somatic manifestations - Generalized Anxiety Disorder (GAD) with significant somatic elements - Autism Spectrum Disorder with high masking I am in the process of self-assessing for ADHD. Could this be linked to my experiences? If not, what else might I investigate for a possible diagnosis?

Answers (1)

2/15/2026, 1:00:58 AM

OpenHealth AI

It sounds like you've been on a challenging journey with your mental health, marked by deep, persistent anxiety and somatic symptoms that have affected you throughout your life. Your efforts to understand your experiences and seek solutions demonstrate great resilience.

Summary of Key Points:

1. You're experiencing a complex interplay of anxiety, depression, and physical symptoms.
2. Various psychiatric conditions, including Generalized Anxiety Disorder (GAD) and potential ADHD, could contribute to your experiences.
3. You've tried different treatments, including CBT and SSRIs, with mixed results.

Explanation:

Your history of acute anxiety since childhood, coupled with somatic symptoms—like abdominal pain and visual disturbances—suggests that your body reacts intensely to stress. Many people with anxiety disorders report physical symptoms, and yours may reflect a heightened sensitivity to stressors from a young age. The improvement you've felt with certain medications and the challenges with others also indicate that your mental health is particularly responsive to chemical changes in your brain.

Given the patterns you've described, the possibility of ADHD or related conditions is worth exploring, as they can often manifest with symptoms similar to anxiety. Additionally, traits associated with being a Highly Sensitive Person could also play a role in how intensely you experience both emotional and physical sensations.

Next Steps:

1. Self-Assessment for ADHD:

   • Continue with your self-assessment for ADHD, as understanding this could provide clarity and help tailor your treatment. Look for standardized assessments or questionnaires online that focus on adult ADHD symptoms.

2. Discuss Medication Adjustments:

   • Consider discussing your responses to SSRIs, noting that lower doses seem to help your anxiety without as many side effects. Your mental health provider can help you balance efficacy with side effects and might suggest a different medication strategy.

3. Integrate Mindfulness and Relaxation Techniques:

   • While CBT has given you some tools, exploring mindfulness practices or relaxation techniques (like yoga or meditation) may help you manage anxiety more effectively. These can complement your existing therapies and offer immediate coping strategies.

4. Monitor Symptoms:

   • Keep a detailed symptom diary for several weeks. Note when symptoms occur, their intensity, and possible triggers. This can help identify patterns that may support any formal assessment for ADHD or other conditions.

5. Support Connections:

   • Engage in supportive communities or groups related to anxiety and ADHD. Connecting with others who share similar experiences can provide additional insight and support.

6. Review Somatic Symptoms:

   • Consult with a healthcare professional knowledgeable about the mind-body connection. Addressing your somatic symptoms through complementary practices (like physical therapy or specialized therapies) may help alleviate some distress.

Closing Thoughts:

Your journey is complex, but each step you take towards understanding and managing your mental health is valuable. Remember, it’s important to work closely with your healthcare provider as you navigate these challenges. You're not alone in this, and there are pathways to improve your quality of life. If you have more questions or concerns, feel free to reach out!