Posted by jay on August 26, 2003, at 0:10:47
In reply to anxiety attack- advice needed, posted by zeugma on August 25, 2003, at 18:19:26
> Hi everyone- I am having a real problem. I have been extremely anxious over a situation which has developed at which I KNOW should not be anxiety-provoking, in fact most people would take it as positive- but I am suffering extreme anxiety over it and a return of phobic symptoms. I ahve been diagnosed with social anxiety and I believe I also have avoidant personality disorder. I have found that in order to retain what little calm I can, I try to keep people at arm's-length as much as possible. I do not call friends unless they call first, I try to keep work relationships as distant as possible so as not to potentially become embarrassed by my colleagues' close observations of me, and I restrict my social life as much as possible, which is difficult for me, since I am a naturally gregarious person. But my fear of others and of being embarrassed is so great that I have found that my emotional stability is greater when these restictions are in place. This in itself has caused a lot of loneliness and depression, but that is better than panic (what I am feeling now).
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> The strange thing is I don't feel depressed. But I am experiencing a return of the symptoms of my depression. Agitation, phobia about spoiled food (I haven't been able to eat a real meal today), and extreme anxiety around others. I typically am anxious around others anyway, but my responses have gotten more severe. I can't even enjoy taking a walk anymore.
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> I called my pdoc about half an hour ago. He seemed pretty unfazed by all this. He told me that these were issues I should work out in CBT. I suppose what I am afraid of is that I will break down before I can see any of my therapists (I have two) or my pdoc- who told me that if I am still anxious by the time I see him again, he'll give me something on a prn basis. The problem is though that I feel I need something NOW. If this anxiety makes me lose weight, for example, the weight loss itself will add to the anxiety (I am already noticeably underweight). And it just reminds me of all the times in the past when severe social anxiety precipated a meltdown. I don't know what to do. My CBT therapist has a number for emergencies- I just saw her today though. Should I go to a hospital and tell them I am having a panic attack. I feel completely lucid, but also panicking- a strange feeling.
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> I take 75mg nortriptyline, 80 mg Strattera, 30 mg Buspar. Any advice would be appreciated.
>
>Hi...I know you already made your decision. But your two meds, the Nortrip and Strat combined could be inducing some intense norepinephrine activity, which you likely don't need. I am not saying dump them and try an ssri, which I imagine you have, but maybe the addition of a serotogenic med, and a med for GABA-related anxiety (like a daily benzo and/or Neurontin). I was on a high dose of Effexor (strong norepinephrine activity at high doses) for years, and suffered anxiety I thought I wouldn't live through, and a clinician doing an evaluation of my meds pointed to some research showing that over-doing norepinephrine based medication in very anxious people sometimes leads to problems. I've moved onto a balance of high dose serotegenic and low dose norepinephrine based meds, and higher benzo dose (and may be starting Neurontin again..).
I recall a similar feeling between nortrip and effexor (at the high dose I was taking.) For years on the med I had almost daily panic attacks, and had to resort to constant benzo use.
Now this is just *me*...but some may apply in your situation too. I kinda don't see why we have to wait to get a panic attack to take a benzo. If we can head it all off, or lower occurance, that sounds like a good choice. To me..IMHO....
But, best wishes and luck with whatever road you try.
Sincerely,
Jay
poster:jay
thread:254014
URL: http://www.dr-bob.org/babble/20030823/msgs/254162.html