Differential Diagnosis
- Single most likely diagnosis
- SSRI withdrawal syndrome: The patient was weaned off Lexapro (escitalopram) 5 months ago, and now presents with increasing anxiety and nervousness. SSRI withdrawal can occur even months after discontinuation, and the symptoms presented are consistent with this diagnosis.
- Other Likely diagnoses
- Anxiety disorder (e.g., generalized anxiety disorder, panic disorder): The patient's symptoms of increasing anxiety and nervousness could be indicative of an underlying anxiety disorder, which may have been unmasked or exacerbated by the discontinuation of Lexapro.
- Hypertension: Although the patient does not have a diagnosis of hypertension, the elevated blood pressure reading (161/84) in the clinic today suggests that hypertension could be a contributing factor to the patient's symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pheochromocytoma: This rare tumor of the adrenal gland can cause episodic hypertension, anxiety, and nervousness. Although unlikely, it is a potentially life-threatening condition that should be considered in the differential diagnosis.
- Thyrotoxicosis: Hyperthyroidism can cause anxiety, nervousness, and hypertension. Although not directly related to the patient's history of Lexapro use, it is an important condition to rule out due to its potential severity.
- Rare diagnoses
- Akathisia: A rare condition characterized by subjective feelings of restlessness and anxiety, often associated with the use of antipsychotic medications. Although the patient was taking an SSRI, akathisia could be considered in the differential diagnosis, especially if other causes are ruled out.
- Cushing's syndrome: A rare endocrine disorder caused by excess cortisol production, which can lead to hypertension, anxiety, and nervousness. Although unlikely, it is a rare diagnosis that should be considered in the differential diagnosis due to its potential severity.