On Understanding Panic Disorder

I almost don’t know how to start this. “Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year” (1)

I am one of those 18.1% who suffer. When I’m in panic it’s almost as if a doppelgängertook over my body. So many people do not understand what happens and that the person has no control over how they feel. Stress and cortisol flood the body.

Last night I had a panic attack. I actually had several in the past week, and 4 or 5 just yesterday alone. What made my last two particularly long and painful is that other people were home and weren’t reacting compassionately. They live with me and don’t quite understand what I go through, how painful it is, and how little to no control I have over how I feel or can possibly react. I can empathize and understand that it can be scary to someone else – really I can. I don’t want to be in full-blown panic either, believe me – way MOREso than the people around me don’t want to see it.

A key driver is understanding. Panic disorder with panic attacks is not something that can be helped at the moment or have a lid put on it. What makes it all so much worse is when those around you and in society judge you and falsely believe mental health issues are something that can be helped (2). I’m writing this because if my own household doesn’t quite understand what this is about, how can any one else? I need to do my part in spreading awareness.

I didn’t know much about true anxiety either. Why should I? We throw the word around a lot. Many of us live with low -evel anxiety constantly. As a society we are mostly all anxious. Anxiety and Panic Disorder is a little different. “This is not to be confused with nervousness — what most people experience in normal situations. Nervousness and anxiety can both cause similar symptoms, but normal nervousness such as how one feels before making a big presentation or applying for a job differs from anxiety in that it’s rational.” (3) Some things can be helped or talked away from. Normal nervousness is one.

I’ve read a lot about anxiety in the past two years since I’ve been diagnosed. Stress is prevalent in our culture. A large part is due to technology and the bombardment of information. Also, the ability for others to reach into our lives at any moment day or night through social media, texting, email, etc. When I was younger and we had a house phone attached to a wall, either going to someone’s house or calling on that phone was the only way to let the outside in. When you left work everyone was shutdown for the day. No one was on texts and emails creating new things to sort through when you got to work – what you left it as the day before is how it was when you arrived the next morning. These things cause constant low-level stress. A text at 9pm makes our hearts beat faster and creates a false sense of urgency to pick up the phone to read it. Whether the message is from a loved one or your boss, the body reacts as if it’s in danger (heart rate, quickened breath, maybe stomach in knots). While we all might experience that quick burst of anxiety when the cell phone dings at 9pm, after a few minutes it goes away. For those of us with an anxiety disorder it not only doesn’t go away, it escalates.

This article describes it better than I can-

Picture this: you’re asleep at night when suddenly you wake up to the sound of someone breaking into your house. What do you do? You panic, like every sane human being would. You start to sweat, you breathe heavily or struggle to breathe, you feel nauseous, your heart races, there’s a heavy pressure in your chest, so on and so forth.

Now picture something else: all of those symptoms happening when you aren’t actually in any danger. No one is breaking into your house. Nothing is about to harm you or is currently harming you. Your body suddenly just starts to panic anyway. That is a panic attack.”

With panic disorder, the body for no real and current reason goes into full fight or flight mode. It differs for everyone, but for me in particular I’m often triggered by something externally that was threatening in the past. Many times I cannot initially identify the trigger. It is almost impossible too when the brain is flooded and the executive functioning goes offline.

Panic attacks arouse the body to a peak level of excitement which makes the individual feel not in control of him or herself. The mind is preparing for a false fight or flight mode, forcing the body to take over to help the victim face or run from the perceived danger, real or not.” (4) The reptilian brain that all land creatures have to flee or fight is what takes over. Rational thinking is completely shut down. It’s not the time to start figuring out the cause or rationalizing with the individual.

I want to feel normal and not panic more than anything. Riding it out, medicine and therapy are helpful, but it took years for the body to become dysfunctional to this point; it likely will not go away overnight.

I can tell you what makes it worse for me –

  1. Being with someone during a panic attack that doesn’t understand and gets annoyed or mad if they can’t help me. I can’t be helped at that point. Someone in my face rationalizing it for me feels condescending. Shunning me at that point feels humiliating and akin to abandonment. I’m humiliated enough. Standing in judgment only makes it worse.
  2. Another horror is trying to hide it to not scare other people. I feel further trapped. I’ve had panic attacks on an airplane, in restaurants, at work, while driving, while getting ready for bed, when waking up… Of course no one wants to see or hear it, but other people hiding or pretending nothing is going on just makes me feel like a freak creature that needs to be avoided.
  3. Last but not least on is the shame of having to hide a huge piece of yourself to others. Our society doesn’t look kindly to Mental Health issues. Before suffering myself, I too thought it was the sign of a weak mind and something you can control. Last summer I spent a full month in an IOP (Intensive Outpatient Program). But forbid I let people know. My own step kids and extended family were kept in the dark. I was afraid to tell people at work why I was on FMLA. It may sound silly or it may not, but if I felt that way I would be willing to bet I’m not the only one.

May is Mental Health Awareness month (5). If you don’t suffer from any mental health issues (Yay You!), it’s very likely you know someone who does; you just don’t know they do. Let’s all do our part to bring awareness and be compassionate to one another to avoid shame, humiliation and judgment. We are all human. Let’s treat one another as such.

Peace.

  1. Anxiety and Depression Association of America https://adaa.org/about-adaa/press-room/facts-statistics#
  2. We Need to Talk. Our Society Has an Issue With Anxiety and Mental Health. https://futurism.com/we-need-to-talk-our-society-has-an-issue-with-anxiety-and-mental-health/amp/
  3. https://medium.com/@gtinari/how-to-handle-someone-elses-anxiety-or-panic-attacks-51ee63f5c23bHow to Handle Someone Else’s Anxiety or Panic Attacks
  4. How to Help Someone Having a Panic Attack https://m-wikihow-com.cdn.ampproject.org/v/s/m.wikihow.com/Help-Someone-Having-a-Panic-Attack?amp=1&amp_js_v=0.1&usqp=mq331AQECAEoAQ%3D%3D#origin=https%3A%2F%2Fwww.google.com&prerenderSize=1&visibilityState=prerender&paddingTop=54&p2r=0&horizontalScrolling=0&csi=1&aoh=15272981860562&viewerUrl=https%3A%2F%2Fwww.google.com%2Famp%2Fs%2Fm.wikihow.com%2FHelp-Someone-Having-a-Panic-Attack%253famp%3D1&history=1&storage=1&cid=1&cap=swipe%2CnavigateTo%2Ccid%2Cfragment%2CreplaceUrl
  5. Mental Health America http://www.mentalhealthamerica.net/may

<a href=”https://dailypost.wordpress.com/prompts/doppelganger/”>Doppelgänger</a&gt;

 https://dailypost.wordpress.com/prompts/doppelganger/

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Lexapro Journal (Continued)

I’m writing this blog as an update to the Lexapro 100 day Journal one that I wrote back in 2016.

I don’t blog that often, but when I do check the statistics for the number of readers, I see that between 3 and 15 people each day read this article. It is the only article that picks up any traction after the first few days post publishing. I has received more hits recently, so I’m not sure if it show up higher on search engines; but in any case it’s amounted to a few thousand people who have at least opened it. Doesn’t mean they read it through though!

When I tried to go off Lexapro just a little over a year ago, I wrote another blog entitled Lexapro Rollercoaster. I haven’t written anything about it since. I’ve been approached by so many people (some I know well & others hardly at all) who have read my blogs. Folks have asked for advice, inquired how I’m doing, or wanted to share that they or someone they love has experienced the same thing. Because I see that a few thousand strangers have read some of this as well, I wanted to follow-up as Lexapro wasn’t my answer.

I didn’t particularly have a love affair with Lexapro. I started it in March 2016. It seemed at first to be to a miracle drug. After several months the side effects kicked in. Particularly they were the two I was most afraid of – decreased interest in sexual activities and weight gain. Initially I thought it was a fluke and both would pass. But as pounds kept adding on and I felt less and less inclined to indulge in carnal activities, I knew it was the medication.

In January 2017 I didn’t feel like I needed Lexapro any longer. I felt stable emotionally. My primary care provider talked me through tapering off. It was a little difficult because I felt physically sick, but that passed after a few days. A few days later I felt off kilter emotionally again. I went back on Lexapro the same way I went off, but this time I held the dose steady at 5mg to test out how that made me feel. I immediately felt better, as I had the first time I went on. At 5mg I didn’t have the unwanted side effects. Fortunately my BMI had always been on the low side, and even with all the weight gain I was still in a normal range. I didn’t lose any weight, but I didn’t gain more either. The other department I feared was also in check. But my moods weren’t steady. I could get hyped up at anxious about almost nothing, and angry at the drop of a hat. I felt off balance. Nowhere near as badly as I originally did, but not as great as I did at 15mg either.

I believed with some meditation and a deeper yoga practice I could keep taking 5mg, feel better and go off completely. I set a soft goal to go off Lexapro before the start of summer in June. But I didn’t deepen my yoga or meditation practices. I didn’t have time to, I was as busy as ever. Although I cut down my professional hours at work; I taught as much yoga as I could without being picky and I wasn’t even doing my own practice. My husband and I started renting out our second home in Branford and I was managing all the rentals and turnovers. Even though I changed the stressors in my life, I unknowingly added different ones back in.

In May that year I took a 50-hour training in domestic violence and sexual assault in order to teach yoga at safe houses in Connecticut. One evening during a presentation about PTSD, I realized with unbelievable clarity that the slide I was looking at described me perfectly. Until then I have prided myself for rising above being a childhood victim of domestic violence and putting it behind me. It wasn’t until that evening I realized I was indeed affected by my past. The ground slightly shifted beneath me, but I wasn’t sure what to do about it.

My emotions became more tumultuous after that. If I was more aware of myself I may have noticed Lexapro really wasn’t helping anymore. One evening in July I had the worst emotional breakdown I ever had. I knew I needed help in a different way. After a little research I filled out some FMLA paperwork and cleared my calendar so I could spend a month in intensive outpatient mental health treatment.

Under the care of the facility, I started to decrease my 5mg of Lexapro daily to once every other day until I went off completely. I felt great. I had no responsibilities during this month other than to care for myself. I journaled daily after my sessions. For the first time ever, I had the time and was willing to really think about how I feel, where my assumptions and habits formed, and how I got to be where I was mentally, physically and emotionally. I was able to sit and question whether or not I wanted to do those things or if they were just maladaptive habits I had from childhood. I made conscious, well-thought out decisions about what I wanted to do, what I wanted to keep in my life and what I wanted to let go.

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I needed follow-up after the program with some type of regular treatment. I’ve gone to weekly couch talk therapy for years on an off and never found it helpful. With the advice from the program I just completed, I researched local therapists that specialized in the exercises we used that I found most helpful. I messaged a few by reaching out and providing a short background about myself. It was easy to discern who I might have a connection with through upfront written communication. I settled on someone local that I thought might work.

When I finally met my new therapist, before she asked me anything about myself; she explained some practices and tools she uses and why. She described the energy and meridian lines that run through our bodies and explained that most people start to question their lives after they meet their goals toward success (or the second half of life). She didn’t need to go on any further, I was sold. Energy, questioning life and it’s purpose, Pema Chodron quotes on the wall, a jiggle jar on the table, a semi-organized non-dusty dank/dark room… This is the therapist I was looking for and never knew it. Additionally, since I had just finished a month long intensive therapy treatment, I knew exactly what things I needed to work on and where they came from. For the first time I felt like I had clear therapy goals and found someone who spoke my language and could help me.

Around the same time I started therapy, I started a 9 month advanced yoga teacher training. This training wasn’t all that different from the standard 200 hour teacher training, but it was far more in depth. This time, having a new-found goal of self-care and making time for myself, I was actually deepening my own yoga practices. I also started a daily sadhana (spiritual practice).

I was only in the training a few weeks and saw my new therapist a handful of times before taking several weeks off for a trip I had previously planned with my husband. I was off medication and only using some new techniques and my sadhana practice to keep everything in check. It was going very well.

Once we returned from vacation I had to cancel my next therapy appointment. I got busy and fell back into the older routine of not making time for myself. After just a few days of skipping sadhana and not doing the therapy exercises, I was completely off balance. It took a full week of being back on the wagon before I felt like myself again. Two more weeks passed and I again made the decision to skip my practices for a few days because I became busy with the holidays. Again, not shortly after I felt incredibly unstable.

For a myriad of reasons I didn’t have a therapy appointment scheduled for several weeks. One day during work when I felt like I was completely unraveling, I called my PCP for an appointment to discuss anti-anxiety meds again. I received an appointment for me the next morning. I spent the evening online looking up various medications that I might ask about. I didn’t want to use Lexapro again and was fearful about gaining even more weight or losing that loving feeling again.

When my provider asked why I went off Lexapro, she asked me to consider Effexor (Venlafaxine). It’s not for everybody, but most patients don’t report weight gain or sexual side effects. I had nothing to lose.

The first evening I took Effexor I felt incredibly sick and disoriented. My husband said I looked and sounded drugged. The next morning I woke up feeling like I had a really terrible hangover. I was groggy, dizzy and nauseous. Sometime around dinner the next evening I didn’t feel dizzy if I wasn’t moving. I was able to eat. I was almost feeling normal by the time I was ready to take the next pill. The next pill brought the same side effects, but they were about half as bad as the evening before. The following day by lunchtime I felt as good as I did at dinner the previous evening. On the third morning I had some vertigo for just a few short hours. I have since experienced zero effects.

Exactly one week after beginning Effexor, I made a nice dinner for my husband and I. We enjoyed it with some wine. As we were cleaning up and getting ready to watch a movie, I was dancing around doing silly kicks and laughing. My husband said I looked and sounded really happy. To which I replied “You know what? I am!” He said it must be the wine. I laughed it off but thought about how we have wine often but I often don’t feel that way. I considered that it might be the meds. I hadn’t felt that good in a long, long time. Before I started “waking up”, having anxiety, questioning the second half of life, giving myself time to contemplate the trauma that I made myself too busy to think about…. I felt like my old self, minus all the stress.

The next day I realized I felt just as good. I felt good the day after that as well, and so forth for the next several weeks. Sometime in January I became busy again and starting skipping self-care. Like the previous experiences, I wasn’t myself. However, this time it took just two days of practice to feel good again. Then again two weeks later I skipped my self-care and practices three days in a row. Not surprisingly I fell right back into the hands of anxiety and stress. It was then I realized that I need to continue to make self-care a priority.

It’s been approximately 2 straight months since I have felt balanced without excessive anxiety. I continue to take Effexor, go to therapy and do the “work” and self-examination it takes to improve mental stability.

Thanks to the program I spent a month in last summer, yoga, and therapy – I’ve received the reinforced message that it is not only ok, but necessary to take care of yourself. I know some people take that too far, but for me taking it too far was never even close to an option. It was almost a necessary survival tactic to stay so busy that I would never have time to relive some of the trauma I was trying to avoid until my body was ready to process it. Instead of running from it, I’ve learned it’s not going to hurt me and sitting with it is the only way to get through it. Sitting with [dis]-ease has only become easier and helped me in all types of other areas of my life.

I still don’t have a magic answer for anyone looking for help. Lexapro was my start. I have my own personal combined strategy that is feasible and working for the time being. For anyone struggling with anxiety or depression – there is no magic pill. It has taken me two years to find something I can keep up with and works. I had to look to where it was coming from. For me that was a strain of PTSD. I had to figure out what works for my body. And I had to find a therapist that I really feels can understand the issues that I struggle with. I hope to sustain some level of sanity while I heal and deal with old issues that have plagued me. I truly am happy and feel more better and better each day. I trust there is something for everyone and it won’t look anything like what helps me. Like I said, unfortunately there really are no magic pills.

Anxiety vs Anxiety Disorders Infographic.png

 

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