An adult patient presents with palpitations, trembling, and a sense of impending doom that started shortly after beginning a new medication for chronic pain. The patient has no prior history of anxiety disorders. Which condition is the most likely cause of the patient’s current symptoms?
- Post-traumatic stress disorder
- Generalized anxiety disorder
- Panic disorder
- Medication-induced anxiety disorder
The correct answer is:
Medication-induced anxiety disorder
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Explanation:
The patient’s symptoms—palpitations, trembling, and sense of impending doom—are classic for acute anxiety-like symptoms, and the temporal association with a new medication strongly suggests:
- Medication-induced anxiety disorder (substance/medication-induced anxiety in DSM-5).
Common Medications Causing Anxiety Symptoms:
- Stimulants (e.g., methylphenidate, pseudoephedrine).
- Bronchodilators (e.g., albuterol).
- Corticosteroids (e.g., prednisone).
- Opioids (e.g., tramadol—also has SNRI effects).
- SSRIs/SNRIs (initial activation syndrome).
Why Not the Others?
- Generalized anxiety disorder (GAD): Requires chronic, excessive worry (not acute onset).
- Panic disorder: Recurrent unexpected panic attacks, not linked to medication.
- PTSD: Requires a traumatic stressor, not medication use.
Key Clue:
The absence of prior anxiety + recent medication initiation points to a drug-induced etiology.
Thus, medication-induced anxiety disorder is the most likely diagnosis.
