Mental Health Anxiety and panic attacks. How do you deal?

[shady4091]

Hey everyone, I've been away from TDS for quite some time now as my attempts at quitting opiates has failed and I've put any further attempts on hiatus for the time being. However, I'm not here for myself, I'm here for my girlfriend/soon-to-be fiance.

Approximately two months ago now, we took acid together. This was only her third time ever doing it and the guy who sold it to me told me it was pretty potent stuff so we played it safe and only took one each. Now I've never; in all of my dozens and dozens of trips, come across acid in which one hit was enough to get me off but much to my surprise, this acid was STRONG. Everything went well for the first few hours but I knew in the back of my mind that everything could change in a second, with one bad thought. I knew she wasn't experienced enough to keep it together on this high of a dose and eventually, it turned on her. I'm not going to go into great detail here but she spent the rest of the night (even after it had worn off for me) in a terrible state. The next day however, it seemed like all was well. She was actually in a very good mood. She said she had learned a lot about herself and the drug in that time and although wouldn't be trying it again for a while, looked forward to her next trip.

Fast forward about a month, were lying in bed together and she rolls over to me and says she's having a panic attack. She became VERY irritable and seemed like she was really fighting some bad feelings. I thought (hoped) that maybe it was just a flashback to her terrible trip. I rubbed her back and consoled her and eventually she calmed down and fell asleep. But this was just the beginning.

Now, a month later, I'm at a loss of what to do. She gets these anxiety attacks probably 4 or 5 times a weeks now and they're BAD. She completely breaks down and has been to the emergency room a few times. She feels like she can't breathe and her jaw locks up. She's told me how shes had suicidal thoughts during these attacks and it's killing me. She's been prescribed 2mg Ativans and the only time she feels at peace at all is when shes on them. She was a daily pot smoker and can't smoke at all anymore as it obviously brings on the anxiety. She says the thing that frustrates her the most is how she has no idea WHY it's happening. Her day to day life is totally fine, she says she has no reason to panic about anything, yet she still does. Neither of us know for sure if it actually was the acid that triggered it, but I'm fairly sure it is. She hasn't told the doctor about it in fear of being labeled, but she's thinking about seeing a therapist who she will tell about it.

I just don't know what else to do. The last thing I want is to watch her slowly fall into a benzo addiction, but I can't stand seeing her struggle with this anxiety. I've never suffered from anxiety myself so I don't even know how to relate. She says I'm the only thing keeping her together at all but I fear the worst. I guess I'm just wondering if anyone here has struggled with bad anxiety and what they did to help.

 

[Get2Think]

What is the root fear? Is it some sort of death, not able to breath, mortality thing? I use to (still am) a hypochondriac. I can still remember my first panick attack from smoking weed. I wouldn't wish it on my worst enemy. Since the source of my panick attacks was about fear of death: heart attack, cancer, liver problems, etc. I recently went in to the school doctor and got an EKG, liver test, etc. and found out everything is okay. since then i have not had a single panick attack, and if i feel one coming on, i immeditarly think about how everything is working properly and there is no reason to fear. I went through some weird shit as a teenager, i was convinced i had testicular cancer and lived with near constant fear for weeks/months. It was horrdendous and I've suffered from panick attacks like you wouldn't believe.

 

[shady4091]

I have asked her this and as far as I can tell there doesn't seem to be any real "root" cause for the onset of the anxiety. She says once it starts her fears are lockjaw and basically cardiac arrest or her mind just snapping or harming herself and that just sends her off the deep end. Sort of an anxiety spiral I guess. I've told her deep controlled breaths, focus on steady breathing and using a paper bag. The paper bag sometimes helps but now that she has Ativan (only a very limited supply mind you) she goes straight to that and says since she knows it can help, nothing else does now.

 

[Tryptamine*Dreamer]

I started having panic attacks when I was a little kid. It used to involve fear of being murdered. My dad would make all kinds of threats to kill my mom, burn the house down while we were sleeping, and shit like that. In the beginning, my panic attacks were mostly due to that. I eventually realized that he would not actually do anything, he was just making the same threats over and over again. After that, the panic attacks switched to fear of being murdered by someone else. They primarily occurred at night, and usually it was a fear that someone would come through the window and murder me while I was sleeping - they were a rational response to my dad's threats in the beginning and then sort of transferred to irrational thoughts of being murdered by strangers.

A few years go by, and I start to believe that I am dying of a deadly disease and that I am going blind (blindness has always been one of my greatest fears). These were not really like panic attacks, just thinking I was going to die. I was suicidal at the time as well. This just got worse until I had the symptoms of psychotic depression. I was not diagnosed as I got no treatment for it, but I have read about the condition and that seems to be a good description of what I was experiencing at that time. This was before I ever tripped. These symptoms cleared up abruptly with my first trip.

I did still have severe social phobia and could not really talk to anyone I did not know, but the panic attacks became much less frequent and less severe. I had more depressive episodes after that, and the panic attacks and hypochondria would return during these episodes. Some of the panic attacks throughout the whole time involved fear of imminent death from something within myself, like an unknown disease or heart defect but this type of panic attack was rare.

One day, I took a large overdose of DOI and had a panic attack that lasted about 60 hours. The whole time I was terrified that I was dying or that my brain was being severely damaged. After that incident, my panic attacks and anxiety became mostly focused on a fear of dying due to cardiovascular problems, strokes, and other brain diseases. I never got any kind of treatment for the panic attacks before this. I had been using opiates for quite a while by then and they worked well for panic attacks. I started using benzos after the DOI incident and they worked well enough to keep me functional.

Any type of unusual feeling in the body could trigger one of these panic attacks.

Lately, I have started talking to others online and to a counselor and psychiatrist about these problems and what I figure to be the root of a lot of my problems. Just talking seems to have helped, the panic attacks started improving some once I began talking to others.

I went through some pretty fucked up shit when I was a kid and teenager (there is a post here on The Dark Side describing part of it. It can be found here: http://www.bluelight.ru/vb/threads/666237-Confessions-of-an-evil-mind-a-glimpse-into-the-heart-of-darkness

I am not going to go back over that shit here. I do not know if any of that information would be at all helpful with what your girlfriend is going through.
I think in my case, I may have a mild case of PTSD or something like that in addition to my depression and panic attacks. If I do have some mild form of PTSD, it is in large part self-inflicted by the negative way in which I tried to deal with bad things that were going on around me.

It sounds like your girlfriend might have something similar from the bad trip she had. The source of her problems is much different from mine, but maybe if she could try to talk about what she is feeling it might help her with it.

I have a relative who was violently raped. She was one of the nicest, most caring people you could meet before that happened. After that, she started having severe panic attacks where she thinks she is dying. She also sometimes gets very mean and occasionally physically violent just out of the blue. She is still a very nice person most of the time. She thinks all kinds of things are wrong with her body during the panic attacks and that she is about to die - very similar to the panic attacks I have now (mine seem to be improving, I am not sure about hers. She is getting no treatment at all for her problems).

Not everyone is able to cope as well as others. Some people have a lot more emotional strength than others and are able to deal with these things in a more positive way.
Then there are emotionally weak/incompetent people like me who just let the bad things happening around them or to them affect them more severely than people with more emotional strength and maturity.

The only thing I can recommend that might help her is talking it through with someone else and just trying to figure out exactly what the major source of her fears is. For me, it is the negative way in which I tried to deal with emotional trauma and my inability to block things out as effectively as the people around me and the emotional abuse and threats I was subjected to as a kid (mostly by my dad). Maybe she has some kind of trauma from her past that you just do not know about. Some people just hold those things inside and do not share them with anyone, even the people they are closest to. There are a lot of things now that I would not dare let anyone know about anywhere but online, like I have done in The Dark Side forum here.

I also have some kind of personality disorder. They said it was a cluster b personality disorder. I don't really think any of those describe me very well. I definitely meet the criteria for a personality disorder under the DSM IV or whatever that mental health diagnostic manual is called but it does not seem to me like I meet the criteria for any particular personality disorder in any of the clusters. I am just completely weird and have been a real oddball my whole life. I have always lived in a family of nuts, and I am the nuttiest one of them all.

If your girlfriend is like me, then bodily feelings likely bring one on. I have recently been able to just tell myself that what I am feeling is nothing to be overly concerned with. Just as an example - mild physical exertion will increase my heart rate and I will start to breathe faster. This can quickly turn into a severe panic attack. Just knowing that this feeling is just a normal physiologic reaction to physical exertion can help alleviate the fear if I can just focus on that fact. Maybe she has panic attacks from similar harmless bodily sensations. If that is the case, it would help her to just think about what is causing her body to feel different when she first notices it.

From what I have read, it is very common for bodily sensations to trigger panic attacks in people with panic disorder. There are a lot of physical effects that you get when you have a panic attack. If you are feeling fine and then start noticing a bodily feeling that you get when you have a panic attack, it makes you feel like a panic attack is coming on. This results in fear and anxiety, which causes further physiological reactions - this can very quickly spiral into a full blown panic attack - it is just a vicious cycle.

 

[grafittibob]

Benzos like xanax or ativan help quite a bit, but as you probably know, are a double-edged sword.
However, there are herbal remedies such as l-theanine and Bacopa Monneri,
which are both completely natural and without much side effect (I would definitely look into those).
Medication combined with cognitive therapy is the best option.
Also exercise and healthy diet are fairly essential.

 

[Captain.Heroin]

Meditation. Focus strictly on breathing slowly to slow your heart rate, then meditate about happier things, the future, etc.

 

[shady4091]

Hey thanks for the replies everyone. Tryptamine, I know she is going through problems with her wisdom teeth right now and they have been bothering her. Apparently whoever pulled two of them when she was younger, left the roots in and they've gotten infected. Also, her other two are coming in pretty much sideways now. She gets jaw tension which is one of the major effects she feels while shes having a panic attack and she is getting that taken care of in the next couple weeks. We have been holding hope that this is the reason for her panic attacks but even though I want to be optimistic, I really don't think its the cause.

And Mr. Heroin, we have actually talked about meditation. Its been something I've wanted to try for a while now but always felt like I should clean up first. Do you know any good resources for someone completely new to it, or is it best to just wing it?

I feel like I'm being overly critical about the Ativan though. She called from work asking if I could bring it to her and I refused because she sounded perfectly fine and I told her (albeit kind of rudely) that she should try get through a night without it and it led to a huge fight. I feel like stuff like exercise and proper diet really WOULD go a long way in helping but neither of us exercise or eat remotely healthy, it's something we would both have to do and I don't even know where to start :s

 

[herbavore]

I think you are absolutely right to be worried about the ativan. She needs to know that she can do lots of things to get through panic attacks without them. I have panic attacks and have had for the last year and a half. I had them earlier in my life although I would have to say that they were not as severe, or at least thses seem worse. Just yesterday I was telling a friend of mine about them and what I do. I basically go through a checklist with myself in my head. I ask:

Is it happening now? (the traumatic event) The answer is obviously no.

Can you breathe more slowly and deeper? The answer is always yes.

Will worry make you feel better? the answer again is obviously no.

My friend suggested something completely different. She suggested simply naming every sensation I was having in my body. (i.e. My heart is racing. I can hear my blood pounding in my ears. I feel like can't breathe. I feel like my vision is blurred. ) She suggested that instead of trying to stop anything, I just literally paid close attention to it. The fact is, they do end.

I wonder if she is wanting a "valid" reason to take ativan? It does sound like she is already very dependent on them. The best thing she could do is to believe that there are numerous ways to deal with panic attacks without risking a benzo addiction.

BTW, welcome back, buddy! I've missed you!

 

[Tryptamine*Dreamer]

If you are thinking about possibly getting her to try a different medication, I have had some success with clonidine before - this is an alpha blocker, not a benzo. There is little or no risk of psychological addiction. Quitting it all at once after a period of use can be dangerous - it can cause severe hypertension. A lot of the physical effects of a panic attack are caused by release of epinephrine and norepinephrine, and clonidine blocks those effects at least partially. (I am almost certain that what I said is correct, but you might want to check to be sure).

If she has a problem with benzos, clonidine may also help with that. I can't say from personal experience with that, but I know it has been used for that purpose. It also seems to reduce benzo withdrawal symptoms from what I have read and this would make sense if my understanding of how clonidine use and benzo withdrawal affect the body is correct - I am not an expert on the subject though.

 

[Sepher]

A lot of the physical effects of a panic attack are caused by release of epinephrine and norepinephrine, and clonidine blocks those effects at least partially. (I am almost certain that what I said is correct, but you might want to check to be sure).

You are correct Tryptamine. Clonidine suppresses noradrenaline ( or norepinephrine. I'm UK, it's noradrenaline to us, I can hardly even spell norepinephrine ) production, and is used to treat anxiety and panic disorders for precisely that reason, yes. Noradrenaline plays a key role in the 'fight or flight' response to stress: anxiety ramps up the noradrenaline, that feeds into the fight or flight response increasing which then further ramps up that anxiety. Self-sustaining almost. It's used to try and prevent that cycle kicking in so much in the first place.

Having said all that I'm not an advocate of medications with quite serious side effects / associated risks unless absolutely needed. Abrupt cessation of Clonidine can cause a hypertensive crisis if you've been on it a while as noradrenaline production rebounds with the sudden absence of the drug. As already excellently stated above breathing exercises, bodily awareness, mindfulness should and probably do work better in the vast majority of cases I think. I think treatment with drugs would generally be a last resort for those whose condition is so severe that exercises of that kind don't work, for whatever reason, but hey, I'm not a doctor. That's just opinion.

Shady, not got anything to add that hasn't already been said better already except to say hey, I'm really pleased to see you about the place. Not seen you around for ages. Take care fella, hope things with your GF work out.

 

[FnX]

To me it really, really sounds like the "root-fear" causing the anxiety of your girl is the fear of losing control, fear of the unknown and fear of just losing it. They all kinda go really well together. The fact that you two got into a huge fight when she asked for her meds and you denied her that just makes me more sure that it's a control thing, but I could ofcourse be wrong. It also sounds like she had a really traumatic trip where, if she didn't actually "lose it" she was pretty close to losing control and that might have really freaked her out, leaving a mental trauma in her mind. Now whenever she feels she isn't 100% in control, these same feelings that emerged during the bad trip are experienced, although in a milder form and the end result is anxiety and panic attacks.

I also think herbavore is right on the spot with the whole naming every sensation your having, it's almost exactly the same I was going to suggest, she just described the method in a slightly different way. I use it myself and I can tell you it works wonders. Although I would say that in a way, even this is a form of meditation, I would recommend staying away from traditional meditation for now because in my experience, vast majority of people who try it seem to do it somehow terribly wrong and only get extremely frustrated.

I honestly don't know if I should go into greater detail about this 'method' or not, but the whole thing can be pretty much summed to "you are not your emotions or thoughts". It very efficiently prevents you from being sucked into thought/emotion feedback loops such as panic attacks because you just observe them and experience them in a different way instead of living them or actually "becoming" them (angry thoughts/emotions leading to an angry person that acts on anger and so on).

 

[Tryptamine*Dreamer]

^^
Sepher:

I completely agree with you on the clonidine thing - people have died from clonidine withdrawal.
After reading what I posted earlier, it is clear that it looked like I was recommending clonidine - I really did not intend for it to come across like it did. I was thinking that could be used as a last resort, I did not intend for it to sound so much like an endorsement for clonidine use.

I was mostly thinking that clonidine might be a somewhat better alternative to benzos if that was the only way to get her to stop relying too heavily on benzos.

There is something else that I have found useful that seems less risky than clonidine and not nearly as addictive or bad as long term benzo use.
That is phenibut. It has worked well for me in the past and it seems to have a significantly lower potential for abuse or causing serious harm. It does have some risks and downsides to it as well. Large doses are intoxicating and it could be misused/overused by someone who likes that sort of thing. I am definitely not recommending this as a first choice.

It would be far better if her problems could be resolved without drugs. However, if drugs are the only thing she will accept, phenibut is probably significantly safer than benzos or clonidine. You can develop a tolerance to phenibut as well - there are no drug therapies without some risks or possible negative effects. From my reading and experience, it is harder to become physically dependent on phenibut. It is certainly not something that should be used too much. I found that using it for too long tends to bring on headaches.

I could certainly be wrong about phenibut too. I think I know what I am talking about, but I could still be wrong. I am sure everyone has felt sure of something and then found out they were wrong, and I don't even feel certain about phenibut.
Anyone who is considering any drug, including non-recreational and non-psychiatric drugs (antibiotics, blood pressure medications, NSAIDS, or anything else you can think of) should learn all they can about the drug before they put it into their bodies.

Use of drugs will not solve her problems, it will only cover them up temporarily. There may be value in using some anxiolytics in combination with psychotherapy, especially in the beginning where it might make it easier to be more open about fears and problems. That is just my opinion though.

Any drug therapy should be used as a last resort. If the only thing she will accept is pharmacological treatment, there are alternatives to benzos that are less likely to make things worse or create new problems. That is really the main reason I mentioned clonidine as an option and am now mentioning phenibut. It is not a recommendation that she use either of those - I just think it would be a less harmful alternative to benzo use and it sounded like she might have a benzo problem or addiction. Perhaps the clonidine is too risky to really consider.

Non-drug therapy would be the safest and least harmful route, but some people will not accept anything but drugs - if she will not do anything else, there are better/less likely to be destructive alternatives to benzos. Clonidine and phenibut are just two examples of that (perhaps clonidine would be just as bad as benzos or maybe worse when it comes to danger of withdrawal - I was not using it daily when I was using it but it sounds like she might use it daily, which could lead to big trouble).

 

[shady4091]

Thanks again for all your well thought out responses guys (and gal), really means a lot to me. I think I somewhat overplayed her use of benzos. I mean, she really WAS relying on them too much but it was only for about a week. They're gone now and the doctors definitely won't give her more until all other options have been exhausted. I just felt like she should have; while she still had some, tried not to fall back on them so hard. I felt like doing so would render any other, more beneficial options pretty much useless as she'd have the mindset of "nothing is going to work but Ativan". With techniques like breathing and mental checklists and stuff you really can't go in thinking it's not going to work, its all in the mind. She is having a good day today though, so I will recommend all your suggestions.

It's good to see some familiar faces here It's too bad it couldn't be under better circumstances, but hey, it is TDS after all