Question
Hi, Ten years ago I was in a car accident, where I fractured C3,C4 & C5 neck bones. Immediately after accident I was paralyzed from neck down. Fortunately the spine was only bruised, and gradually Most of my mobility came back. I was left with a weaker left side, which also affected reflexes. Over last 5 years I have suffered intermittently from anxiety, which always exaggerate left side problems. My Dr prescribed me SSRI antipressant, this sent my problems on left side worse, sweating, soreness, slight spatisticity. Changed meds to mirtazapine (remeron) which immediately helped. Anxiety recently got worse again while taking mirtazapine, and Dr has prescribed Xanax (which Im not happy about). But these have also helped. My question is could the anxiety be driven physically, because of the damage to the spine and nerves. I cant help thinking that maybe I should be taking a different course of treatment. Before accident I never suffered from anxiety. I have noted all the medicines that have helped have been relaxant types. If you can help in any way it would be greatly appreciated, I live in a remote part of Ireland, and seeing specialists is very difficult.
Kind regards Dan.

Answer
Dear Dan,

Yes the anxiety can be related to the car crash...this is a frequent symptom in my patients, but I usually see it early on after the crash.  Most of them do not require pharmaceutical intervention to control it and improve, but some have. However, in your case the anxiety seems to have been delayed in onset (was it?), which is not something I have seen clinically in practice.  It may relate to facts that occurred after the crash, but were related to your care from the injuries sustained, or just your knowledge of the severity of injury.

When it comes to anxiety, the best way to deal with it (in my experience) is to seek help from a psychologist or psychiatrist and try to pinpoint the reasons why the anxiety presents itself and then work though the issue.  Biofeedback is great for this, because you learn to control your emotional reaction to the stressor causing the anxiety.  This takes a few sessions to master but it works.

As far as the medication is concerned, the SSRI class of drugs have their problems, but can be a very effective means to help control anxiety, there is not doubt about that.  However, they can be dangerous as well and you need to discuss all options with your doctor...better would be to discuss it with a psychiatrist because they will likely know the drug class much better.  Any further discussion on pharmaceuticals is really out of my scope of practice.

Hope this helps Dan.  Good luck with your recovery.

respectfully,
Dr. j. Shawn Leatherman
www.suncoasthealthcare.net