Monday, September 3, 2012

"Now is the age of anxiety.” *

Three years before I was diagnosed with bipolar disorder, I was diagnosed with a panic and anxiety disorder. I was working at the newspaper in Berne, had started having these weird attacks where I would get super hot starting in my stomach, have an electric taste in my mouth, then get cold and shaky. My blood pressure would rocket up; I'd get very dizzy and disoriented; and I was convinced I was dying. I'd never felt anything like that before. It took several trips to the ER and a trip to the doctor mid-attack ("Come in when you have one of these so we can see what's going on") before I was finally diagnosed with the panic attacks. The anxiety disorder was diagnosed at the same time.

That I'd had an issue with anxiety should have been no surprise to me. I'd had horrible fears about people dying, getting sick, being hurt, disappearing, etc. since I was a very small child. All with no reason. A weird pain in my head would trigger a sense of impending doom and I'd think something was horribly wrong with me.

When I was 8-years-old, everyone was taking a nap one day while Dad was at work. I was supposed to be napping, too, but I couldn't sleep (not an unusual thing for me). Instead, I was in the living room watching "Island of the Blue Dolphins" on TV. When that was over, I was bored and trying to think of something to do. A few months before, I'd made a craft in Girl Scouts - a blue block with my picture on it, coated in varnish to seal it. It was a Mother's Day gift, I believe. I picked it up and kissed it for some reason, being only 8-years-old and somewhat goofy. And then I had what I think was my first panic attack.

When we'd made the picture blocks, the Girl Scout leader had told us, "Don't get any of this in your mouth, it's poisonous." I was very careful and of course, did not get any in my mouth. But she didn't tell us that it was going to be safe once it dried. And when I kissed myself in the picture, I freaked out because I knew I'd poisoned myself and I was going to die. I didn't know what to do, and I didn't know how long it would take, but I was under the impression that death was imminent.

Instead of waking up my mom and telling her what I'd done, I went to the room where she and my middle brother were napping. I quietly said goodbye to them and asked God to take care of them. Then I went to my infant brother's room, said goodbye to him, and prayed for him to grow up big and strong. Finally, I went into my bedroom, laid down on the bed, and waited to die.

I heard a voice that told me I wasn't going to die, that I was going to be okay, but I should take a nap. I did...and was more than surprised to wake up. I'm not sure when I told my mother about what happened, but it was years later.

During junior high and high school, I had severe issues with anxiety and depression (and the bipolar mania), but I didn't know things weren't "normal". It's just how it was. My paternal grandmother was a "worrier" and I supposed a lot of us were. (And a lot of us ARE...but not all of us get to a point where our mind goes to worst case scenario at the drop of a hat.) I can't tell you how many times I planned my parents' funerals in case they died suddenly, leaving us children as orphans. Or the times I tried to figure out how the three of us kids were going to go to school and grow up alone.

As an adult, I have called Emergency Rooms when people have been 30 minutes late home from work. I have called Sheriff's departments asking about accidents involving my loved ones' vehicles. Never has anyone I've been looking for been in the hospital or involved in a wreck. Probably 99% of the things I worried about and fretted over never happened. Which, oddly enough, was kind of a relief and at the same time, fuel for my anxiety-treadmill. I had it in my head that if I worried about it, it wouldn't happen. And yet, if I worried about it, it was also possible. Which made me worry more.

It is no wonder, with the series of life changes I was going through (a divorce, raising a teenager alone, working at a high-stress job many hours a week, and being on a bipolar mania that I was unaware of) that I got to the point that I was having panic attacks several times a week, sometimes several times a day. Not all were bad enough to send me to the hospital, but some were. Blood pressure levels over 240/160 were not uncommon and I had a whole cadre of doctors trying to get that down and keep it down. Once I was diagnosed and started getting counseling and pharmaceutical treatment, things starting calming down for me.

In the 10 years since my diagnosis with the anxiety/panic disorder, I have learned a lot about it. I've learned how to recognize when it is ramping up, when to breathe deeply and center myself, when to take a pill to short-circuit a full blown attack (which isn't nearly as often as it used to be), and when (and how) to reach out to fellow sufferers on different support websites I've been a member of. I am by no means a doctor, nurse, or other medical professional. I am, as some would say, a "mental health consumer" - meaning I participate actively in the mental health world as a patient and client. However, I have learned a few things over the past decade that might be beneficial to others. If the following is helpful to you, I am glad. But always, always, always check with your doctor before pursuing a course of treatment if you are having panic and anxiety attacks. Don't be afraid to get the help you need - often and early.

I think that if I had remained untreated, I would likely be a hermit now - afraid to go out and interact anymore. For a while, I didn't leave home unless I had to, wouldn't go anywhere without my safe person, etc. There is nothing wrong with that - a person does what they have to do to protect themselves. But when I got treatment and support, I was able to get out of that coccoon and learn to function in spite of my attacks or underlying anxiety issues. It is now to the point that sometimes, a panic attack will happen - for no reason - and no one around me will know it. Which is a vast improvement over my former freak outs.

Anyway, below, I've provided some of the information about medications that I've learned about in the past decade that help treat anxiety and panic disorders. I hope you will find it helpful.

For anxiety, doctors will sometimes prescribe an anti-depressant. I found this list that outlines which ones those would be and what they are prescribed for other than depression:

Citalopram (Celexa) –off label for panic disorder, social phobia and trichotillomania

Duloxetine (Cymbalta) – approved for generalized anxiety disorder (GAD)

Escitalopram (Lexapro) – approved for GAD

Fluoxetine (Prozac) – approved for OCD and panic disorder

Fluvoxamine (Luvox) - approved for OCD in children (8-17 y) and adults

Paroxetine (Paxil) – approved for obsessive-compulsive disorder (OCD), panic disorder, social phobia, GAD and post-traumatic stress disorder (PTSD)

Sertraline (Zoloft) – approved for panic disorder, PTSD, social phobia and OCD

Trazodone (Desyrel) – off label for panic disorders

Venlafaxine (Effexor XR) - approved for GAD, panic disorder and social anxiety disorder in adults

There are also some hypertension medications that work against anxiety. If you have high blood pressure, you can talk to your doctor about which ones might be more helpful to you. This link has some information about those:

Finally, doctors can also prescribe anxiolytics (fancy word for “anxiety breaking”) like clonazepam (Klonopin) or alprazolam (Xanax). They can be very addictive, though, and they aren’t always a first line of defense for many doctors. It depends on your symptoms, how frequent and how intense your anxiety or panic attacks are, and how inclined your doctor may be to prescribe them overall. At one point, I was taking three Klonopin a day (every 8 hours), but that was before I was diagnosed with bipolar and got on meds more suited for a bipolar rather than just for someone with depression. (Antidepressants alone can trigger mania in bipolar.) Now, I’m on 0.5 mg, either half a tablet or a whole one, that I only take when I feel an anxiety/panic attack coming on.

For the underlying pervasive anxiety, I do have the hypertension med that works, the Klono back-up, and then the things I learned in the hospital and in therapy (as well as what I learned through an online support group called tAPir – The ANXIETY/PANIC Internet Resource; it’s at ). I have a book (I think it’s called Anxiety Disorder for Dummies) that was helpful, too. But there are also other print resources (online, at the bookstore, or at the library) that are available, as well.

There are many other resources available online, and very often, there are face-to-face support groups available through your local community health programs or churches. Take part in as many as you feel comfortable participating in, because I don't know that there is ever such a thing as too much support. If you don't know where to look, you can contact your doctor and ask him or her about resources in your area.

* W.H. Auden

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