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[mencia]

I know there have been other posts on this topic -- I think I've searched out nearly all of them! -- but I wanted to start my own topic, with my specific situation.  I've been suffering from anxiety (GAD) for a long time, and until February 2010 was treated very successfully with Paxil.  Then... stresses came, the Paxil pooped out, and I've been trying to get back on my feet for months.  I'm taking Lexapro, seemed to be feeling better, then the new semester hit... and I'm so anxious again, especially in the mornings.  I'm trying to take care of myself, eating well, exercising, etc but it's just so damn hard!  I'm not sure what I'm looking for here.  Just support, I suppose, from people who know something both about anxiety and the stress of starting school again.

Thanks.

[merinoblue]

Mencia, do you find exercise is helpful, and have you been getting enough?  I start feeling the tension rise when I'm not active enough, but as soon as I get outside for a walk, it displaces worry & adrenaline.

[mencia]

Yes, I do find exercise helpful.   I probably could try to get more.  As it is, I do some vigorous exercise about four times a week, but maybe a walk on the other days would be good.

[merinoblue]

Maybe you could try for a relaxed, easy walk on the other 3 days.   Walking is such a nice distraction from everything. There's so many things to occupy one's view and imagination, and there is usually an opportunity to have a conversation with someone, whether it's an acquaintance or a stranger walking their dog. I've chatted up more dog walkers in my neighbourhood over the last 12 years than I can count.

[prytania3]

Exercise, prayer, and benzos.

[mencia]

It's been such lovely weather here lately that I going to try to work walks into my schedule.  I usually exercise indoors, and I know that being outdoors can have a calming effect.

As for benzos, well, yes, I'm taking them to get through this "rough patch" as my doctor put it.  I have very mixed feelings about taking them, because I'm afraid that I'm already physically dependent on them and will at some point need a very slow tapering schedule to get off them.

Thanks to both of you for your comments.

[prytania3]

It's been such lovely weather here lately that I going to try to work walks into my schedule.  I usually exercise indoors, and I know that being outdoors can have a calming effect.

As for benzos, well, yes, I'm taking them to get through this "rough patch" as my doctor put it.  I have very mixed feelings about taking them, because I'm afraid that I'm already physically dependent on them and will at some point need a very slow tapering schedule to get off them.

Thanks to both of you for your comments.

If you take benzos for a while, you do have to taper off or you risk having a seizure. I can't understand why anyone would want to go off them, though. They work for years and years and years without increased dosages.

[mencia]

Prytania3, I always thought that, ideally at least, benzos were supposed to be used for a relatively short period of time, like as a stop-gap measure before a medication like a SSRI took effect.  I haven't heard much about what the effects of long-term use of a benzo could be (although one psychiatrist mentioned to me that "cognitive problems" could be one such effect -- obviously this is scary!). 

For myself, I'm not sure how long I'll be on them.  It's supposed to be until Lexapro reaches its full effect.  I've been on that medication for a full 6 weeks now and things have improved somewhat but my doctor says it can take even longer before I'm completely back to normal.

In any case, I may want to have another baby in a couple years, and that would be a good reason to want to get off the benzos eventually.

[irhack]

Can I ask how much coffee/tea/soda you drink? I have a friend who has taken Paxil for anxiety. She's also one of those people who keep a put of coffee brewing all day long. I can't help but think contact infusions of caffeine might affect her anxiety. I personally seem to be getting less tolerant of caffeine as I age -- nowadays more than one small cup sets my heart racing.

[tinyzombie]

I hope this isn't a derail, but I'm getting really curious about panic attacks, and what the symptoms are. I have friends who have them, but the details are foggy.

Anyone here have any experience with them?

[merinoblue]

It's not a derail.  Panic attacks are closely associated with anxiety.  Some people seem to be prone to them. My lay interpretation of what I've read about the neurobiology of them would be along the lines of, "the brain incorrectly responds to an ordinary stimlus by perceiving immediate, life-threatening danger where none exists. It then triggers the flight or fight response, which dumps a huge amount of adrenaline into the bloodstream, to enable the organism to survive the perceived threat."  Of course, there usually is no threat to life, and no need to have a strong fight or flight response in the situation, so it's a maladaptive response. There also seems to be a strong learned component to them  (e.g. the smell of a food, or a particular thought, can trigger one).

I've had a lot of experience with them (caffeine is a trigger, as are some medications). I've learned, over time, how to shut them down immediately, but it's taken a lot of practice.  Symptoms vary for each person. I experience a flood of adrenaline without warning. This feels like a rush to my head, a tightening of my throat, rapid heartbeat, numb lips, sweaty palms and feet, hyper-alertness to my surroundings, chattering or shivering, and fear.  Fun times!  One woman I was sailing with experienced her first panic attack during a storm, and her symptoms were mainly laughing.  They're usually over within 20 minutes, but can last longer. Or they can come in waves. 

They're sneaky.  You think you might be dying (a common interpretation of the symptoms is that you're having a heart attack or an anaphylactic reaction). It takes experience, or a perceptive doctor who educates you, to realize that what you're experiencing is panic.  It's such a frightening sensation that it sends people to the ER.  They're completely harmless (just too much adrenaline flooding your system), but absolutely terrifying.  And embarrassing.

Good techniques when you think or know you're having one are deep, slow breathing to generate the relaxation response, talking with someone about what you're experiencing, and exercise. All that adrenaline has to be displaced.   I've found it helpful to label it a panic attack as soon as I think that's what's happening, and just tell myself that it will resolve shortly.

[atlchemist]

Prytania3, I always thought that, ideally at least, benzos were supposed to be used for a relatively short period of time, like as a stop-gap measure before a medication like a SSRI took effect.  I haven't heard much about what the effects of long-term use of a benzo could be (although one psychiatrist mentioned to me that "cognitive problems" could be one such effect -- obviously this is scary!). 

For myself, I'm not sure how long I'll be on them.  It's supposed to be until Lexapro reaches its full effect.  I've been on that medication for a full 6 weeks now and things have improved somewhat but my doctor says it can take even longer before I'm completely back to normal.

In any case, I may want to have another baby in a couple years, and that would be a good reason to want to get off the benzos eventually.

Mencia, I am in a similar situation. I have had crippling anxiety for the past few years. I tried a couple of SSRIs and SNRIs in 2010 with no success. I gave up on meds and stuck with my cognitive behavior therapy, which seems to be working but very slowly. (Sometimes I feel I am impervious to psychological intervention...WTF?)

Anyway, things had gotten so bad early in January that I made an appointment with my psychiatrist for the first time in over a year. I ended up on Lexapro, with clonazepam as a "bridge" as you have described. I was very, VERY reluctant to start on benzos due to the sedation issue but especially the dependence issue. My psychiatrist assured me that she wouldn't let me take clonazepam long enough to get addicted to it. After asking her very many questions, I finally agreed to try it. I started out at 0.25 mg, which did nothing. (Again, impervious.) After ramping up slowly, I am at 1 mg at night and 0.5 mg in the morning. It seems to be helping some. I am sleeping through the night for the first time in weeks, so that is great. I still feel anxiety during the day, but it is less crippling. I am reluctant to increase my morning dose because I need sharp motor skills for my lab work.

Anyway, best of luck to everyone struggling with anxiety. It is an insidious little beast that has affected all aspects of my life. Luckily, some things are starting to happen professionally that are giving me a little more confidence and relieving some of the anxiety, but I know how it feels to spend all your days with a knot in your stomach.

[alto_stratus]

I've experienced some anxiety, but haven't found a medication that works for me (they knock me out too much).  I was struggling to find time to get through a few books on the topic, to try to understand what was going on, and ended up online for audiobooks.  I found a hypnosis track for social anxiety that has been helpful (http://www.audible.com/pd/ref=sr_1_2?asin=B004FONIOC&qid=1327943132&sr=1-2).  I can't say I was hypnotized, but the speaker takes you through a deep relaxation exercise, and gives you an easy non-visible exercise to do while she says some affirmative things (some of which I noticed my mind rebelling against).  Whenever I feel the stress start to kick in, I practice some of the relaxation techniques and try to connect back to that feeling of relaxation, and it seems to help take the edge off.  It also helps you fall asleep if you listen to it at night.

I am doing other things, too--dealing with anxiety seems to require a multi-pronged strategy of getting enough rest, trying to reduce stress, reducing/eliminating caffeine, finding sources of positive reinforcement, therapy, etc.  The audiobook gave me one easy and relaxing way of feeling like I was making some progress on a regular basis, because I do think one of the elements of getting through anxiety is learning to recognize, halt, and replace that adrenaline feeling with a more relaxed and in control feeling.

[mencia]

It is amazing to read these replies and not feel quite so alone during my (somewhat) anxiety-ridden Monday.  Another reason I'm not so in love with benzos: they take off the edge, but that's it.  I can't imagine how much I'd need to take to be absolutely calm.

About caffeine: I limit myself to a half a cup of coffee in the morning.  I realized months ago that more than that really aggravates the anxiety.  However (and this feels like a confession), I started smoking again when I began to have a lot of anxiety, months ago.  I realize that nicotine also worsens the anxiety, but I find it really hard to cut down.  Some part of me does actually believe that smoking calms my nerves, even when I am faced with evidence to the contrary.

Atichemist, I relate to much of what you wrote, like the feeling of being impervious to interventions, whether therapeutic or medicinal.  I hope that the Lexapro and therapy helps.  If I may ask, what have you found helpful in therapy?  I am also doing CBT, and haven´t been at it long enough to know if it's helping things, but some of the relaxation techniques I've learned are definitely worth it.

Indeed, as alto_stratus writes, anxiety requires a multi pronged approach... I'm trying to exercise, practice deep relaxation, doing this cognitive behavioral therapy (which part of me resists -- like, what do you mean my thoughts are faulty in some way?!?), trying the medication, and just trying to eat well. 

I'm thinking of trying out a mindfulness stress-reduction course that's offered in my city.  Anyone have any experience with mindfulness meditation?

[prytania3]

Maybe you're bipolar and are having mixed episodes. Just a thought.