Wednesday, April 4, 2012

Panic Attacks

Panic attack
(Photo credit: Wikipedia)
It's all right letting yourself go as long as you can let yourself back.
  - Mick Jagger

We have two parts to our brains – the conscious and the subconscious. I really, really like my conscious self. Through it, I’m able navigate this crazy world in a thoughtful manner (most of the time).

Although I’m not nearly as intimate with my subconscious self, until recently I never had much of a problem with it. For the most part it has made solid decisions on my behalf, and has rarely misfired. One exception has been my claustrophobia. Even when I'm in a tight space that I know is completely safe, my subconscious might insist that I get out, and NOW.

Recently, my subconscious has been acting up in a new way. It's as if, deprived of drama by my ever-sensible conscious self, my subconscious has decided to invent problems that don’t actually exist.

About a year ago I started suffering brief anxiety attacks. I felt the same panicky sensation that I had when I experienced claustrophobia, except I started feeling this way for unrelated reasons. These incidents were not as intense as my claustrophobia ones, yet they were still quite concerning. I categorized them as mini panic attacks. Over time they became more common.

Seemingly innocuous events would initiate these attacks. The triggers all had one common thread- they were situations where I seemed to be losing control of some of my most basic physical functions. Mind you, there were no actual emergencies worthy of the spike of adrenaline, increased heart rate, and the urge to flee that I experienced. For example, maybe my feet would get tangled up in the blankets in the middle of the night, and I would have to ask Kim to help me get them unstuck. In reality, this was a harmless situation. In my subconscious mind, however, it suddenly rose to the status of an emergency, and an attack ensued.

Imagine my frustration with these absurd reactions. But, as a person who is, in fact, slowly losing control of many basic functions, I suppose I should excuse my subconscious for its overzealousness.

Given that these trigger situations were only going to become more and more common as my MS continued to progress, I thought it wise to take action sooner rather than later. So I began to see a therapist for the first time in my life.

The therapist let me know that panic attacks are common and usually treatable. She taught me a set of techniques based on Cognitive Behavioral Therapy (CBT), which helps to interrupt and mitigate the irrational spiral that is typical of panic attacks. You can read about CBT here.

After about six weeks of therapy, I noticed that the intensity of my panic attacks was lessened, but they still existed at an unacceptable level. I talked this over with my therapist, and she encouraged me to visit my physician to discuss pharmaceutical options as a supplement the CBT program.

There is a class of antidepressant drugs called SSIR’s which have been found to be effective not only for clinical depression (which I don’t have), but also for taking the edge off panic attacks (which I do). From the day I started taking SSIR’s, at a relatively low dose, I have had zero panic attacks. The first two drugs that I tried had some undesirable side effects. But now I am on 10 mg per day of Lexapro, and it's really making a difference.

The combination of therapy and pharmaceuticals has been the answer for me. Although I've not had panic attacks, I still feel anxiety bubbling beneath the surface once in a while, so I know that this may not be a permanent fix. I need to continue practicing my CBT procedures, and I have to remain open to pharmaceutical adjustments in the future. But I'm thrilled that, at least for now, this issue is no longer haunting me.

People with MS are particularly susceptible to depression and anxiety issues. It can be a direct result of nerve damage in our brains, or it can be a secondary consequence of the stress that we are under in dealing with a chronic disease. In the end, it doesn't really matter to me what the root cause is. The treatment is the same either way.

I must admit, this whole episode has been a bit of a blow to my ego.

Let's examine that statement more closely. I always took pride in my mental toughness and emotional stability. There’s that, and the fact that I’m a, well, manly man and not a wimpy baby. But in retrospect, my pride was misguided and my machismo was self-defeating. I should no more be given credit for 47 years of panic-free existence that I should be blamed for the last year of panic attacks. The notions of pride and shame are of no value in this discussion, and in fact, only muddy the waters.

I open up about a lot of personal issues in this blog, but I don't write about everything that I'm going through. So why have I decided to share this sensitive issue? There are a couple of reasons. First, I want to raise awareness that people with multiple sclerosis not only suffer physical problems, but also must deal with mental and emotional challenges too. Second, I want to shed light on the issue that, no matter what the source of your depression or anxiety, it's okay to seek help. Don't let pride or shame prevent you from attending to health issues like these, especially since they are highly treatable.

I'm not looking for a commendation. I'm hardly the first MS patient to open up about these issues. And please don't treat me with kid gloves going forward. These panic attacks have not significantly affected my overall well-being. I just felt it prudent to address the issue before it became a bigger problem.

I must end this post now, as I’m overdue to pop my daily happy pill. It's not as if taking another drug is cramping my style though. All it means is that, due to a variety of MS blessings, I get to swallow 13 pills a day instead of only 12.
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  1. Thank you for sharing this, Mitch. It helps to know that others have the same problems. My anxiety attacks are few and far between -- and trust me, I AM A WIMP! I get panicky whenever there's a chance I might trip or fall. Once the danger has passed, I'm calm again. I'm not sure that meds would help in this situation, though.
    Again, thanks for your honesty.

  2. I appreciate your forthrightness. The thing is, the fear, though consciously it may seem distant, is lurking and having an impact. Sometimes, it will be unmistakable, as in anxiety attacks. Sometimes, it is more low key, like a quiet sadness, and more easy to ignore. But it is there and is a force. I would rather have the cognitive skills that allow me to recognize it in its more subtle forms and to deal with it then than to stuff it and then have it explode into something like an anxiety attack. But that is a skill I too have learned through therapy, for which I am profoundly grateful.

  3. 13 pills a day? Wow, that's some bad juju! ;>p Maybe you should pop another one of the others to be safe. j/k

  4. What a valuable post--and something I had never thought about. So glad the right combo was found for you!

  5. Very insightful. It took me over 10 years to figure out that my "fear of being weak" was actually the root of my panic disorder.

    Of course you can't fix 10 years of fearing panic attacks in only a few weeks. My treatment is very similar to yours... small dose of Paxil combined with CBT. It has taken me about 2 years to rewire my brain and feel normal.

    You saved yourself a lot of trouble by seeking treatment early.

  6. Hey Mitch, as someone who suffered anxiety attacks way before getting MS, I applaud your proactive approach at finding an getting help. No reason to suffer with anxiety when the combination of therapy and pharmaceuticals can have such a tremendous impact.

    Given the disease we are dealing with, it sometimes seems to me a wonder that there isn't a widespread panic amidst those of our ilk. I'm always impressed with the strength displayed by practically every MS patient I know, and I'd hold you up as a shining example, with or without anxiety attacks.

    I think you'll find the therapy process itself to be interesting as well. It's incredible how much of ourselves we tuok away in a subconscious cupboard labeled denial, when facing these issues straight up can lead to tremendous self awareness and empowerment. Of course, this does entail a bit of hard work and sometimes a little pain, but as a long-term veteran of the therapy wars, I'd say the effort is well worth it.

    But then, what the hell do I know?

  7. MITCH,
    cut youself some slack. I suffered from panic before and now during ms. I do all the self help shit and the ssr, but the panic still sets in. Youre a tough mf'er. Fight it. One little tool I have found that helps is to ground myself during the anxiety. Put my hands on the chair im sitting, or rub the counter or do something that brings me to the present. Fighting this ms shit can give even the toughest anxiety and panic. Watching my body deteriorate is the scaries theing I have ever experienced...