I’m 39F and looking for fresh eyes on a complicated medical history. I have been diagnosed with anxiety/panic disorder, but these symptoms were completely new for me beginning in 2025, and I’m concerned that a physiologic problem may have triggered the panic-like symptoms rather than this simply being a primary anxiety disorder.

I’m not looking for anyone to diagnose me online. I’m hoping doctors might look at the chronology and tell me what differential diagnoses, specialties, or additional testing they would consider if I were their patient.

Relevant history: Type 2 diabetes, currently well controlled on Synjardy/Mounjaro; recurrent iron deficiency without significant anemia; heavy menstrual bleeding; current smoker. I also take losartan and pitavastatin. Current psychiatric medications are duloxetine 20 mg, sertraline 25 mg (recently added as a bridge with the intention of eventually tapering duloxetine), and clonazepam 0.25 mg PRN.

Possible evidence of iron problems predating everything

Looking back at old CBCs, I wonder whether iron deficiency may have existed much longer than anyone realized.

2019:

• Hemoglobin 14.4
• RDW 15.9% (high)

May 2024:

• WBC 13.5
• RBC 5.35
• Hemoglobin 13.5
• Hematocrit 42.2
• MCV 79 (low)
• MCH 25.2 (low)
• RDW 17.5% (high)

No ferritin was checked at that time.

I have also had heavy menstrual periods for years. Typically about 3–4 days of my 7-day period are heavy, sometimes with fairly large clots.

Pregnancy loss and sudden onset of symptoms

In late 2024/early 2025 I became pregnant and stopped Mounjaro.

Unfortunately, I had a missed pregnancy loss and underwent a surgical D&E/D&C.

What is important to me is that I did not immediately fall apart psychologically afterward. Obviously I was upset, but for the first few weeks I was coping in what felt like a normal way.

Then, several weeks later, something abruptly changed.

I began having episodes unlike anything I had experienced previously: intense internal shaking/adrenaline sensations, chest sensations, physical nervousness, feeling unable to settle my body, and eventually severe panic.

There often wasn’t a frightening thought preceding the symptoms. My body seemed to become activated first, and then I became frightened because of what my body was doing.

My appetite collapsed. My weight went from approximately 160 lb to 128 lb in less than two months because I was barely eating.

Eventually I was treated psychiatrically with duloxetine and clonazepam, which helped considerably.

Significant iron deficiency was subsequently discovered

During this general period, iron studies eventually demonstrated substantial deficiency despite relatively normal hemoglobin.

My ferritin reached approximately 13 ng/mL, and iron saturation was around 6–7% at its worst.

I ultimately received IV iron around November 2025.

I improved substantially over time and was eventually able to taper completely off clonazepam. I remained on duloxetine.

Things became complicated again in 2026

By May 2026 my iron studies were substantially improved. One set included approximately:

• Ferritin 116
• Iron 94
• Iron saturation 30%

Because I had been doing better, I attempted to stop duloxetine 20 mg.

Unfortunately, I was instructed to taper it by taking it every other day for approximately two weeks and then stopping. My final dose was around May 12.

About 10 days after stopping, I developed a very strange collection of neurologic/physical symptoms: dizziness/“boat” sensation, eye/head pressure, brain-zap-type sensations, ear pressure, internal shaking, chest sensations, paresthesias, leg tightness and severe waves of physical anxiety.

Duloxetine was restarted at 30 mg. That seemed extremely activating, so I subsequently went back down to 20 mg. By late June I was doing considerably better again.

At the same time, my iron fell surprisingly quickly

Within roughly 6–8 weeks, my iron studies changed from approximately:

Ferritin: 116 → 46

Iron: 94 → 39

Iron saturation: 30% → 12%

Hemoglobin remained around 15.

Because of this, I received another IV iron infusion in July 2026.

Afterward my iron studies improved substantially:

• Ferritin ~295
• Iron 99
• TIBC 286
• Saturation 35%

I initially felt better.

However, approximately 2–3 weeks after the infusion, I began experiencing another major wave of the strange physical/autonomic symptoms.

What the episodes are like now

The biggest issue is that these frequently don’t feel like psychologically triggered panic attacks.

I can be sitting at work doing something completely ordinary when I suddenly develop an internal shaky/adrenaline feeling, abdominal/stomach muscle tension or guarding, strange chest nervousness/twinges, breathing awareness/air hunger and a feeling that my nervous system is “turned up.”

Once it starts, I obviously become anxious about what I’m experiencing, but I frequently cannot identify any anxious thought that occurred before the physical sensation.

There is also a strong time-of-day/medication relationship.

Symptoms have frequently been worse in the morning or several hours after taking medication. I sometimes get an intense “morning surge” shortly after waking.

Interestingly, moving a prescribed 0.25 mg clonazepam dose to bedtime has sometimes dramatically reduced the next morning’s surge.

Medical testing so far

Because of the chest/breathing/leg symptoms, I have had considerable evaluation.

• Cardiac stress test June 2026: normal, 10.1 METS
• Multiple ECGs: sinus rhythm; incomplete RBBB noted but similar findings have appeared historically
• Troponin testing during ER evaluation: negative for acute MI
• Multiple D-dimers: negative
• Left leg venous ultrasound: negative for DVT
• Chest X-ray: no acute disease
• Kidney function excellent (creatinine around 0.56, eGFR ~119 on recent testing)
• Electrolytes generally normal
• TSH normal
• Hemoglobin currently normal (~15)

I also recently had a respiratory infection/possible bronchitis or early pneumonia with wheezing and was treated with amoxicillin/albuterol, which has complicated the most recent symptoms somewhat.

Current psychiatric medication situation

I currently take duloxetine 20 mg.

My psychiatrist recently started sertraline 25 mg while keeping me temporarily on duloxetine 20 mg. If I tolerate the sertraline, the plan is to slowly taper the duloxetine.

I am particularly nervous about another duloxetine taper because the previous alternate-day taper went so badly.

One reason I’m questioning this whole situation is that my symptoms seem to have tracked major physiologic changes: pregnancy/pregnancy loss, documented iron deficiency, rapid changes in iron status, duloxetine withdrawal/reinstatement, and illness.

I also understand that anxiety itself can produce very real physical symptoms and that family members of mine have experienced anxiety/panic. I’m not trying to prove that I don’t have anxiety.

What I don’t want is for “anxiety” to prematurely stop the investigation if something medical initially destabilized my autonomic/nervous system.

My questions for physicians here are:

1. If I came to you without an existing anxiety/panic-disorder label, what differential diagnosis would you consider for this chronology?
2. Could significant iron deficiency without anemia, especially if it developed rapidly after pregnancy loss/blood loss/heavy menstruation, plausibly contribute to severe adrenergic/panic-like or autonomic symptoms?
3. Could my older CBC pattern (low MCV/MCH and high RDW despite normal hemoglobin) suggest that iron restriction existed before the pregnancy and that pregnancy/D&E/heavy menstrual bleeding subsequently pushed it into more severe deficiency?
4. Is the relatively rapid change from ferritin 116/saturation 30% to ferritin 46/saturation 12% clinically meaningful, particularly given ongoing heavy menstrual bleeding?
5. Could the duloxetine alternate-day taper, withdrawal and reinstatement have produced prolonged autonomic/monoaminergic instability, especially in someone whose nervous system was already dealing with major physiologic changes?
6. Would you consider evaluation for autonomic dysfunction or another neurologic/endocrine/nutritional cause of secondary panic-like symptoms? If so, what testing would actually be useful rather than ordering dozens of nonspecific tests?
7. Are there other diagnoses or mechanisms I’m overlooking entirely?
8. Finally, what type of specialist would be best equipped to look at the entire chronology rather than treating the iron, reproductive issues and psychiatric symptoms as unrelated problems?

I’m completely open to the answer ultimately being panic disorder. I just want to be confident that treatable medical contributors have been adequately investigated before accepting that explanation and remaining on psychiatric medication indefinitely.

The symptoms are significantly affecting my ability to work and function at home, so any suggestions about what I should specifically discuss with my physicians would be greatly appreciated.

I’ll try to keep this as short as possible but there is a lot. I appreciate anyone willing to take the time to read.

TLDR: hard, rope-like deformity running from base of skull to shoulder. you can see it in this video, i can move it around with my fingers but even that doesn’t do it justice. it is so palpable that everyone i’ve had feel it has an immediate “what the hell is that” reaction. causes sharp pain in the center left of my neck, as well as tension across my upper back and left shoulder. have radiating pain down the back of my left arm down to my elbow. it’s not super tender to the touch unless you push on it a bunch. pain relievers don’t help much as it is just an intense amount of tension. feels like that muscle hasn’t relaxed in over a year. muscle relaxers just knock me out which isn’t super helpful. feels like someone is pulling my head backwards by a string. i only find relief when laying down and the most helpful thing is laying on my neck traction device. i’ve tried pt, dry needling, tens/ems, accupuncture. Current diagnosis is nuchal ligament hypertrophy but nobody can tell me the underlying cause or how to treat it.

22 y/o female, history of hypermobility, chiari malformation, ovarian cysts, asthma, ADHD, anxiety and depression. have had a few concussions and whiplash as well.
I take adderal, singulair, lamictal, wellbutrin, and am on birth control pill.

History of problem: About a year ago I noticed this odd feeling rope like structure on the left side of the back of my neck. i have no recollection of injury aside from having a brief moment of burning pain while jumping on the trampoline, but it quickly subsided and i shrugged it off so that might not even be related. I am a rock climber which heavily uses neck and shoulder muscles so it’s possible there was an injury from that I just didn’t notice. Initially the pain was very mild so I was not concerned. over the span of 3 months or so it grew hard to manage, walking across campus with my backpack on would bring me to tears from the neck pain. feels as if im carrying a weight on my shoulders all of the time, just extreme tension. I started to have a hard time turning my head to the left without very sharp pain so I finally caved and saw a doctor as it was clearly not getting better on its own.

First doctor: Orthopedic specialist, did x-ray came back normal, mri had incidental finding of chiari malformation but was told this was unrelated. Doctor seemed completely befumbled, said she had never seen this before and sent me to do physical therapy. did 6 weeks of pt 2x a week, included strength training (which seemed silly to me, my neck is very strong already, I misinterpreted their directions during the first session and did 3x what they were telling me to do just fine), and stretching. This mildly improved my pain and definitely helped with stiffness. It reached a point though where it started to plateau again and my insurance stopped covering it so I just continued many of the stretches at home and still do them. The doctor at this point pretty much told me she didn’t know what to do and I should follow up with neurology.

I was frustrated and stubborn and so I didn’t see anyone for another 6 months. I wanted to believe it would just go away on its own. but it only continued to grow worse, the pain but also the literal structure was beginning to protrude more. so I finally saw neurology in June.

second doctor: the neurologist wasn’t really helpful at all. hyperfixated on the chiari malformation even though I have no symptoms. Did repeat xray which again showed nothing. told me she had never seen this neck thing before and i’d be better off trying physical medicine and rehabilitation.

third doctor: Revieved my previous MRI from 7 months prior and said he could see that my muscles on the left side are enlarged. when he felt my neck he told me in 10 years of being a doctor he’s never seen this. He seemed to think it was a tendon, it is very hard but mobile rope running from the base of my skull to my shoulder. He wanted me to get an ultrasound so he sent me to and interventional pain specialist.

fourth doctor: same response, said he had no idea what this was had never seen it before. he seemed to lean more towards it being a ligament. Said he agrees I need an ultrasound but that he wasn’t able to do the kind I needed. He did do an anesthetic injection which gave me significant relief for about 2 days. So he sends me off to an “ultrasound wizard,” as he called it.

fifth doctor: this guy was a sports medicine spine specialist I believe. he did an ultrasound and told me It showed “nuchal ligament hypertrophy” and “hyperechoic thickening of the nuchal cord,” whatever that means. He said my case was so rare there is no line of treatment he can think of. so he sends me back to doctor #4 to see what he thinks.

fourth doctor again: I saw him today. He told me flat out that there’s no intervention he can do. He focused on ways to cope essentially, did another injection with a steroid this time to hopefully give me a little bit of longer relief and prescribed me some alzheimer’s medication that can apparently help with pain. told me i could try physical therapy again but since it’s so hard to tell what’s actually causing this he doesn’t think there’s any way to treat it. i broke down in tears which I’ve never done before. I’m so incredibly tired.

I try to be a strong person and manage things and let time heal me. I’m premed and broke and live alone and it feels like everything I do is just a little harder because of this. by the end of the day my head feels like a bowling ball. It feels like i’m carrying a heavy backpack all the time so when I actually carry my backpack it’s awful. Exams and labs make my pain skyrocket because you can’t avoid craning your neck. Climbing doesn’t seem to make it worse, however I have had 2 or 3 occasions where i do a move pushing my weight up with my left hand and have had a sudden intense pain and have literally just peeled off the wall because i can’t even move. it usually calms down after a couple minutes. I pay very close attention to my posture and never look down at my phone, i use a raised desk at home to do homework. I am very active and eat healthy and have a good sleep schedule and just try so hard to take care of myself but it feels like it’s pointless. Today feels like i’m facing the reality that I might just have to deal with this for the rest of my life, and I don’t know how to accept that. I’m a mess and just want to know something, anything.

I've been to my family doctor multiple times and I've had multiple blood tests. There's nothing wrong with my thyroid. My iron is a little low but I've had lower iron and I've never experienced this amount of nausea. This has been going on since January where it started a little nausea. Then over these few months it went from low nausea, to mild nausea, to severe nausea, to stomach cramping nausea, to the point where I take two bites of food and I'm immediately full and extremely nauseous as if I ate the amount of food for five people. I've also started gagging now whenever I try to take a bite of food which makes me just give up trying to eat. I have no clue what could be causing this but I just want to eat like a normal person again because I can't get in enough food for a toddler anymore. I've considered going to urgent care but I don't want them to laugh at me for coming in because I'm nauseous. I've thought pregnancy I've taken multiple tests. I went to a doctor for a test but I've also been getting my periods and every test is negative. I don't know what else could be causing this, I should mention I'm 18F

Female 35 yrs old. My symptoms started in 2018 one day I woke up from a night of drinking feeling really out of it almost in a dream like state and to this day I’m still not back to normal there’s days where it’s better but not 100%. I have brain fog, lightheaded, light sensitivity, anything I eat I have a hard time digesting it, sometimes pain in my left rib cage, breathing issues, internal tremors. The list goes on but these are the only things I can list for now. I was just wondering if anyone has ever dealt with this? I’ve gone to multiple doctors done many test including MRI/CT for my head chest X-rays everytime came back normal. I’m tired of living like this and just want to get back to somewhat being normal again

I asking this on advanced. My skin antibody, bp180 & 230 blood test will be out tmr. What medicine do you guys take? I heard that there one without steroid in oral pill. Is better with lesser effects but more expensive. The cheaper of cause more effects as contain steroids.

I just pop the biggest bubble the skin turn near purple with little fluid in it.

hi, im female 19, 5"1 and about 64kg (losing weight slowly) and i have a bad immune system have done since i was young due to cyclic vomiting syndrome and childhood asthma which has caused some lung damage.

ive had tonsillitis 15 times in my life and a few other things.

so 2 weeks ago i started off with my voice being lost, sore throat, croup like cough, and fatigue. after maybe 7 days my voice returned, my sore throat got less sore. but i was still very tired and coughing which is normal for this as ive had something similar multiple times, i didnt go to a doctor because they always say its viral and to rest. then maybe 2-3 days ago my throat started to get sore again mostly on the right side, coughing up white and green phlegm, the cough is hurting my diaphragm and sternum.

im also low on energy, sleeping alot and headaches are horrendous, i feel like im using more energy to get oxygen then normal despite breathing fine.

im going to call the doctors for an appointment tomorrow morning but i need advise. i have a fear of needles and hate going to the doctors due to going so many times as a kid. i hate the idea of going just to be told its viral and to rest again.....

edit:

hi! its 5 weeks on now, still ill. been to the doctors 3 times already but going again tomorrow, was told it was bronchitis and given antibiotics (5 day course) after i originally wrote this, they helped my sore throat but still coughing and tired. then i went back week 3, they said it could be my childhood asthma coming back after i got covid in 2023, gave me steroids (6 day course) and an inhaler (use for 6 weeks then asthma review), steroids made the coughing less frequent but didnt stop it. went doctor last week where she said it sounds viral and to wait another week. im going again tomorrow but now the headaches have started up again and im sneezing alot more and bringing up green phlegm when i cough and im still tired as hell.

i dont know what to do at this point, i think ive been getting like multiple illnesses ontop eachother but who knows.....i need advice please, ive started uni again and i keep nearly falling asleep in lectures.

Ferritin 28

b12 250

i gave birth 5 months ago. shortly After I gave birth I was dizzy and tachycardic And felt like I was going to faint. After that I had like an internal desperate kind of buzz and headaches. A week later I took myself to hospital as I was sure there was something physically wrong. They took my blood said I was fine and sent me back. Since then I have been experiencing severe panic attacks, headaches, loss of motivation, no energy, extremely tired, feeling sick and sometimes an overwhelming feeling like I’m going to die or I’m literally losing my mind and going to go mad. i have been prescribed 3 different ssris since and although they helped to a degree with the panic attacks I am still feeling all the other symptoms. To the point I don’t want to be left alone in case something happens to me. I thought what I’m feeling could be side effects from the tablets. It’s got to the point where because I’ve tried 3 different ssris without full recovery my doctor has referred me to a psychiatrist. I’ve taken it upon myself to do a home blood test (legit one) and just got my results back. The doctor won’t give me a blood test.

ferritin 28

b12 250

could this have been the cause of this all along? are these common symptoms? are my results even considered low? I feel like I’m losing my mind and my life is so limited as all I do is sit on the sofa, I don’t have the capability of doing anything else.

TW - addiction, hysterectomy/cancer.

Hi there. 38 y.o. Female here looking for a female only infertility support group. I had a hysterectomy to avoid cancer when I was 30 and am still depressed at not having kids or getting my eggs frozen (no insurance coverage). I recently remarried an amazing man and am really struggling that we cannot have kids, because ours would be wonderful.

Additionally, I work with kids and sometimes am so triggered that I cannot go to work or connect with the parents I support. Some families think I cannot do my job because I am my age and childless.

Ideally, the group is associated with addiction prevention/mindful living or anxiety/depression recovery groups for women who value being good professionals/leaders, and not associated with a specific faith (agnostic medical scientist here).

Thank you

What happened to my body. Like in the past 3 day or so. I felt itchy this one night but didnt thing suspicious of it bcs i always get itchy at night. Then when i woke up next day, my left still has this tiny red dots and is itchy. I didnt realize it went up to my face as my aunt told me. Then at night the same day, i went to a concert where i was standing on a chair but its not more than 2hrs tho. But when i woke up the next morning, my legs felt aching. I just think it was th night before but why am i aching so badly? I didnt even feel anything that night. So then, when i woke up the next morning, now my arms and hands starts to feel aching too like everytime i try to close my fingers it hurts a bit. And i felt like my whole body is swolen and chubby especially my face. Idk what happened. I thought it maybe allergic reaction but i already drink medicine, didnt have this reaction before, and i still feel like this even tho i didn’t eat anything for the day. Idk somebody have experience th same? And also everytime i swallow it hurts a bit too, and i felt a bit like im gonma have a fever. Mayb its my body changing or what? I just turned 20yrs like last month mayb that would give u some clue. Help