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How do you know when it's time to start anti-anxiety meds?


ILiveInFlipFlops
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I don't have big, debilitating anxieties, but I'm finding myself having a harder and harder time pushing off smaller anxieties, often over things that don't even affect me. I was just reading the thread about finding childcare for sick kids when you have to go to work, and now I'm so tense that I feel queasy. DH and I watch scary shows on TV, and I've never in my life had a problem with scary or suspenseful TV shows (except for Criminal Minds!), but now I find myself with actual pain in my chest from the tension.

 

The big one is that I was driving over a huge, frightening suspension  bridge while coming home from a family visit yesterday, and I nearly blacked out from fear :( I've been nervous in bridges and tunnels since 9/11 (we live outside NYC, and both DH and I were in the city on 9/11), but nothing like that has ever happened before, and I don't ever want it to happen again. I mean, that bridge was pretty scary (I've since read some references about it and apparently it scares a lot of people), but to nearly black out in fear? With my children in the car? In moving traffic? That's really bad, and I'm still shaken up over it. I don't know if it counts as my first panic attack or not, but it was truly terrifying. 

 

I deal with some near-daily anxiety and mental gymnastics over a physical issue that I won't go into at the moment (because it's kind of embarrassing), but I wonder if dealing with that for the last few years has decreased my ability to cope overall. 

 

So at what point do you accept that you need to do something about it? How do I know what kind of meds to look for? Do I need to go to a psychiatrist, or can I talk to my GP about this? There's a part of me that says this is all in my head and I just need to calm down and be rational--and then there's that part that is reminding me that being rational hasn't helped so far! Blech.

 

Thanks in advance.

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I would say try some therapy first to try to learn ways to self calm during stressful situations.  You can also learn to find ways to anticipate stress inducing situations and to work to gain mental control over your emotions before your body kicks in the physical response.   

 

 

I believe medications are an amazing tool to deal with ongoing anxiety, but that should never be used to change the bodies natural response to stimuli, without actively trying to change it mentally/biologically first. 
 

If you have already done that, then I would work with that person to find an appropriate person to help you decide what kind of medication will help you most and what kind of doctor you need.  

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It's affecting your quality of life. Actually beyond that--endangering your life and the lives of others. You might consider not driving until you get it under control. BIL had his first huge panic attack after almost being hit on the freeway, and it caused him to hit another car when he tried to pull over. Thankfully no one was seriously injured, but it was expensive and time consuming. He had been having smaller ones and ignored them.

 

Your GP may prescribe meds, but your anxiety sounds intense. I would go to a specialist. I hope you get it under control quickly. :grouphug:

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That is not anxiety, that is PTSD and you need a specialist.

 

Having daily anxiety is one thing but full blown panic on the road with kids in the car is an emergency. I think you should call your GP, tell them what happened and get a referral asap.

 

I think normal SSRIs or anti anxiety meds are used for treatment but I think you should see a psychiatrist.

 

It is not in you head, ignoring it will not making it go away, there is no "snapping out of it."

 

:grouphug:

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Well, at least I know I'm not crazy for being afraid on that bridge!

 

http://baltimore.cbslocal.com/2013/07/08/gephyrophobia-is-common-in-maryland-thanks-to-the-bay-bridge/

 

I went over two bridges before that one and three after, and I was fine (although I was nervous at the next bridge just because I was afraid I might get panicky again--I didn't, thank goodness). That bridge was just...too much. A low blood sugar and too much coffee didn't help me at all, I'm sure. 

 

I don't think it's really full-blown PTSD, because we've been going through the NY bridges and tunnels since 9/11 with my having no more than mild nervousness. It did take me years to get past being unsettled over airplane noise overhead and crisp September days with bright blue skies :( But none of that really bothers me now. I don't think the bridge thing is really related--it's more of an example of a fear that overwhelmed me that I could barely control. I'm actually more worried about managing my small day-to-day anxieties, because I suspect they're wearing down my ability to cope with unexpected large fears like yesterday's. Now I know to never cross that bridge again, but what will the next surprise be? And when will it happen? 

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Well, at least I know I'm not crazy for being afraid on that bridge!

 

http://baltimore.cbslocal.com/2013/07/08/gephyrophobia-is-common-in-maryland-thanks-to-the-bay-bridge/

 

I went over two bridges before that one and three after, and I was fine (although I was nervous at the next bridge just because I was afraid I might get panicky again--I didn't, thank goodness). That bridge was just...too much. A low blood sugar and too much coffee didn't help me at all, I'm sure.

 

I don't think it's really full-blown PTSD, because we've been going through the NY bridges and tunnels since 9/11 with my having no more than mild nervousness. It did take me years to get past being unsettled over airplane noise overhead and crisp September days with bright blue skies :( But none of that really bothers me now. I don't think the bridge thing is really related--it's more of an example of a fear that overwhelmed me that I could barely control. I'm actually more worried about managing my small day-to-day anxieties, because I suspect they're wearing down my ability to cope with unexpected large fears like yesterday's. Now I know to never cross that bridge again, but what will the next surprise be? And when will it happen?

You don't know what will set off PTSD, it can be a certain noise or the light flashing a certain way.

 

You cannot just avoid a bridge, you need to talk to someone.

 

I am not a psychiatrist but I do have anxiety and I take medication. Eating well, exercise, taking vitamins are all helpful as well.

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I would say try some therapy first to try to learn ways to self calm during stressful situations.  You can also learn to find ways to anticipate stress inducing situations and to work to gain mental control over your emotions before your body kicks in the physical response.   

 

 

I believe medications are an amazing tool to deal with ongoing anxiety, but that should never be used to change the bodies natural response to stimuli, without actively trying to change it mentally/biologically first. 

 

If you have already done that, then I would work with that person to find an appropriate person to help you decide what kind of medication will help you most and what kind of doctor you need.  

 

This would be my usual approach to things like this, but after yesterday, I'm afraid that no matter how much I practice coping mechanisms in advance, I won't be able to stave off another panic attack. I managed this one by deep breathing, eating a little bit of food to distract myself, reminding myself that people drive that bridge all day every day, that my very nervous aunt has traveled that bridge many times, talking to my kids calmly when I had to shut off the radio, etc. But what if the next one is even less manageable? And how will I know what would trigger it? I never expected a bridge to scare me so much. I've been back and forth over lots of bridges, including during yesterday's 8-hour drive.

 

I feel like I just want to stop the whole thing dead in its tracks, KWIM? 

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Ok reading that article that bridge sounds crazy. I can't believe there is a service for people to drive your car across a bridge while you cower in the back under a blanket.

 

I KNOW!!! It was seriously crazy. And I was in the left-most (EZ-Pass) lane, so there was no place for me to pull off and compose myself before I crossed. It was so narrow--only two narrow lanes--and it arched from ground level to way up high in the center, and it was super long, and people were doing 50 miles an hour (the speed limit was 40!). I watched the lines in between the lanes the whole time so I could avoid seeing the water in my peripheral vision. I was taking a different route home so I could avoid the 95 slowdown around DC, but now I know I can just get back on 95 before I get that far north (which is what I did last year). 

 

I crossed the next bunch of bridges with no problems, but they were wider and had higher sides. I don't know, it was just really scary. 

 

Oh, and part of my self talk was about how people drive that bridge the whole time, and they would have addressed it if it was unsafe, and cars don't just fall off bridges etc. Then when I went to look for a picture to send my mom this morning, some of the first references I came across were articles about cars and 18-wheelers getting knocked over the dang side. 

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It's time to get help. Anxiety is debilitating, but very treatable.

 

Usually the best medications to try first are antidepressants, most of which also have an anti-anxiety effect without being "tranquilizers" or sedating you. (Disclaimer: I am not a medical doctor.) Cognitive-behavioral therapy for anxiety is about as effective as medications for most people. Are you in Maryland? Feel free to PM me. I'm a psychologist in the Baltimore suburbs.

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This would be my usual approach to things like this, but after yesterday, I'm afraid that no matter how much I practice coping mechanisms in advance, I won't be able to stave off another panic attack. I managed this one by deep breathing, eating a little bit of food to distract myself, reminding myself that people drive that bridge all day every day, that my very nervous aunt has traveled that bridge many times, talking to my kids calmly when I had to shut off the radio, etc. But what if the next one is even less manageable? And how will I know what would trigger it? I never expected a bridge to scare me so much. I've been back and forth over lots of bridges, including during yesterday's 8-hour drive.

 

I feel like I just want to stop the whole thing dead in its tracks, KWIM? 

It sounds like you already have some strategies you are using that aren't getting you over the hump right now. In that case, I would seek some medical help to help you get over the worst of it with medication, but simultaneously seek out therapy with a mental health provider.

 

If know my stress level is much higher when my vitamin levels are out of whack.  I had my doctor test me for a whole list of things (vitmin/minerals, thyroid, hormones etc) and found out I was low in Vitamin D, B and ferritin.  Supplementing those, made a big difference in my physical response to stress.  Yes, I am still stressed, but I am just left working through the mental part, not the overwhelming physical response at the same time.  

 

That is why I would suggest a full check up with a doctor before going to a P-doc for meds. I am diagnosed with PTSD, have a permanent back injury, have a stressed marriage, and am raising my special needs niece.  My issues aren't small ones, but if I had just started on Antidepressants or anxiety meds to lower my bodies response to the situation, I wouldn't have got to the point of dealing with it....and starting towards recovery in the areas where I can recover.

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I would vigorously disagree about seeing a Dr regarding vitamin work ups before seeing a psychiatrist.

 

Vitamins will take weeks before one would see any noticeable effects. If the OP could have another episode while driving that could be a very serious situation.

 

Vitamin deficiencies don't all take weeks to see progress after they've been diagnosed. When I was diagnosed with a B12 deficiency I saw improvements within 5 days of taking my supplements. 

 

Also, don't forget that most anit-depressants need a good 2-3 weeks to show improvements also. 

 

I'd talk to your GP, get a full blood workup, start with talk therapy, and move to meds if you feel they are necessary. 

 

I'm in the process of dealing with anxiety that has become nearly debilitating recently, even though I've had it for 30 yrs+. My coping techniques stopped being helpful, and so my Nurse Pracitioner and I have been working quite hard to figure out a solution (as well as a cause). I refuse to take anti-depressants for a few reasons, so I'm seeing a therapist through my nurse practitioner's office as well as going for an MRI to rule anything physiological out. I do need to stay on top of my B12 or else that can make me much more susceptible to anxiety blowouts that are almost unmanageable. 

 

Something you COULD ask for is a prescrip for a benzo (ie Ativan), which DOES work immediately after taking it. I keep mine with me for panic attacks that are completely unmanageable with my usual techniques. Also for attacks that come on lightning fast with no pre-symptoms. Dissolves under the tongue, hits within 10-20 mins, and takes all the edge off of the attack and stops it in its tracks. You don't take them regularly (and definitely don't want to take them more than just occasionally), just as needed. Mine make me sleepy a bit, so I keep them mostly for my nighttime attacks which tend to be my most intense. 

 

Good luck, anxiety is brutal but it's definitely manageable :)

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Not a physician here, either, but my experience (not personal) with SSRI's for anxiety is that they take several months to reach full efficacy for anxiety.  They act on depression relatively quickly, but they are not a "quick fix" for anxiety.  However, they can be pretty effective once they have reached full efficacy.

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If you have to ask, then it is time.  If possible, and insurance permits, go to a psychiatrist , who will probably be more knowledgeable about treatment options - and take you seriously - than the family doctor.

 

One of my adult kids is on meds for anxiety (and a host of other issues, alas, including panic attacks, depression, bi-polar, PTSD) and it can make a big difference in daily life when the correct med is found. Not everyone responds to every med, sometimes you have to try a couple to find which one works best for you.  It can take a while for a med to "kick in" so you have to be patient and give any one med time to work.  DS is also on one med (sorry, don't remember which one it is) that he takes to stop a panic attack when he feels one breaking through. Might be Ativan, although I think it is something else. Klonopin? Yes, I think it is Klonopin.  Sometimes he takes up to three a day (still working on finding a maintenance med to help him - like I said, it can take a while).  But he is a pretty severe case :-(  overall.

 

Good luck, hang in there, and keep us posted!

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A psychiatrist can and should order blood work to check potential medical contributors to anxiety. Mine checked my thyroid, vitamin D, etc. at my first visit. No need to wait for two completely separate doctors.

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Vitamin deficiencies don't all take weeks to see progress after they've been diagnosed. When I was diagnosed with a B12 deficiency I saw improvements within 5 days of taking my supplements. 

 

Also, don't forget that most anit-depressants need a good 2-3 weeks to show improvements also. 

 

I'd talk to your GP, get a full blood workup, start with talk therapy, and move to meds if you feel they are necessary. 

 

I'm in the process of dealing with anxiety that has become nearly debilitating recently, even though I've had it for 30 yrs+. My coping techniques stopped being helpful, and so my Nurse Pracitioner and I have been working quite hard to figure out a solution (as well as a cause). I refuse to take anti-depressants for a few reasons, so I'm seeing a therapist through my nurse practitioner's office as well as going for an MRI to rule anything physiological out. I do need to stay on top of my B12 or else that can make me much more susceptible to anxiety blowouts that are almost unmanageable. 

 

Something you COULD ask for is a prescrip for a benzo (ie Ativan), which DOES work immediately after taking it. I keep mine with me for panic attacks that are completely unmanageable with my usual techniques. Also for attacks that come on lightning fast with no pre-symptoms. Dissolves under the tongue, hits within 10-20 mins, and takes all the edge off of the attack and stops it in its tracks. You don't take them regularly (and definitely don't want to take them more than just occasionally), just as needed. Mine make me sleepy a bit, so I keep them mostly for my nighttime attacks which tend to be my most intense. 

 

Good luck, anxiety is brutal but it's definitely manageable :)

 

I agree about the B12. I had a deficiency. It's very common. It stilled my thoughts almost immediately. It couldn't hurt to try it in the short term, until therapy or a doctor's appointment is lined up.

 

I've also had friends who have had success with Bach's Rescue Remedy in the short term. It's also something to consider while you're waiting for appointments.

 

Sometimes just knowing something can take the edge off helps you regain a feeling of control which can be very helpful. I have xanax on hand. I take half the lowest dose to control my heart rate at medical appointments and for anxiety related to flying. I've flown twice in the last thirteen years and took it once last year for a doctor visit, so obviously it's not necessary for me to have. But it still helps me to know I have it, since I went through a bad PTSD episode twenty-five years ago. 

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Meds can make things worse.

 

I have severe PTSD and carry a diagnosis of not expected to recover. Severity of symptoms doesn't always indicate whether or not drugs are the best treatment for someone.

 

Benzos are the most effective anti-anxiety but they are addictive and have other side effects. They increase my memory loss, drop my blood pressure and heart rate, and make me depressed. And even worse, they make me more submissive and impulsive which in the past has led to becoming involved in situations that led to more PTSD.

http://en.wikipedia.org/wiki/Benzodiazepine

 

My PTSD is so bad it sometimes sets off seizures. If I can't stop seizing, I sometimes end out being injected with a benzo as the only way to stop the seizures. Drugs can do awesome things, but they are not one-sized-fits-all cure alls, and they are not symptom free.

 

The whole submissive and impulsive thing is NO joke. If you do things you might not otherwise do, people might NOT be forgiving or tolerant, or see things in context of the drugs you are on. Worse yet, they might use your vulnerability as an opportunity to hurt you.

 

And the drugs are depressants, and depending on what else is going on, that can be dangerous.

 

I have to skip a lot of TV and a lot of other things. PTSD is an injury and I have been injured. Some things just don't heal, especially in an environment that is not conducive to healing. For ME, living a bit more sheltered and limited life has proven to be better than being drugged. I had to stop pushing myself so hard or allowing others to try and intimidate me into pushing myself too hard. I'm injured. Period! I didn't ask for this injury. I didn't do it to myself. It's not my fault.

 

According to many people that I trust, it's unlikely I'll ever get better in the REALITY of the REAL world I'm living in. If I enter some type of idyllic situation, then maybe my body and brain could heal. But, if I remain in the world I currently inhabit–no.

 

So, I have a "new normal" just like amputees and the newly blind need to find a "new normal". I've had to accept that. And demand that people who want to remain a part of my life accept that, too, or part ways with me. I'm done denying, apologizing, or trying to use dangerous drugs to disguise my injury.

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(((hugs)))  Hunter

 

May I suggest that you research EMDR?  It is a research-backed therapeutic intervention for trauma.  I don't mean to suggest it is a cure-all, but it is something I would personally be researching in your situation.

 

I'm too unstable for EMDR. And all attempts to get me stable enough for EMDR made me even more unstable. Sigh!  :banghead:

 

It would be like trying to do physical therapy on a broken hip, before setting/replacing the hip.

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I've driven that bridge before -- it is pretty freaky.

 

What you've described sounds similar to they types of things my dh had with anxiety. He got meds through his GP & it helped a lot. As already mentioned, go ahead & follow up on it now as the meds can take weeks to start making a difference.

 

:grouphug:  You can do this.

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It's hard to answer a question like this because in a way it is so personal, but speaking generally, if it was beginning to affect me in everyday things, and it seemed to be getting worse, I would do something about it.

 

I would not look at meds first, i would look into other options for dealing with the problems  I am not against meds always, and have in the past taken them for depression, but I have over the years become a little more skeptical that they are the clear solution that doctors were promoting at one time - both from my reading and from my observations and experience.

 

At the very least, they can have side effects and they can be serious.  My dad has been on a med for anxiety for many years, and as long as he takes it he has serious problems controlling his weight.  he is diabetic so this is a significant problem.  When he comes off it, he loses, but becomes insominac to the point it is almost unbearable and affects his daily life, for example he cannot drive - this seems to be an effect of withdrawl, not something that is directly from the anxiety which can be controlled by other things. 

 

Meds are usually most effective with other strategies anyway, so I would try those first.

 

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Please don't be afraid to talk to your doctor. It will be the best thing you can do for you and your family. Good for you for recognizing that things are getting beyond your control.  Recognizing that you need some help is the first step in healing. I've been down a similar path as you are on right now.  A great councilor and the right meds helped tremendously. They say you come out the other end of these situations a stronger person and I am now a believer that this is true.

 

As others have mentioned it does take a while for the anti-depressants to kick in so my nurse practitioner also gave me a prescription for Ativan as needed until they did. I saw a psychiatric nurse practitioner for my medication and I think that made a big difference for me as she had a lot of experience treating people with anti-depressents./anti-anxiety meds. Make sure your doctor is well versed in using them.  I think a lot of people who have bad experiences with these types of medications do because their doctor doesn't understand all the ins and outs of them. This happened to me the first time I tried them.

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((Hugs)) to everyone struggling.

 

I could never, ever go across that bridge. Never.

 

I used to think I was afraid of heights but eventually figured out it was bridges.

 

Regarding anxiety, ime, I can see that my anxiety is worse when I "use up" my "strength" on other things. I can also see that big traumas left me "depleted". (Sorry for all the quotes. Hope it makes sense!)

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A bucket will overflow if you try and put too much water in it at once. I have learned that some really innocuous seeming things can fill up my bucket, and that if I can skip them, I have more ability to handle the important stuff.

 

I've had to learn not to judge and shame myself, so I can not be in such denial that I cannot notice WHICH things ARE stressing me. I need to pay attention to the signals and then give myself permission to let people down and not give them what they want. Often if I let people down in silly little areas, I can meet more their bigger needs. It can be hard to start doing this if people are shouting in your face and mocking you. If someone can't seen that avoiding the stupid little stuff is for THEIR benefit and just keeps pushing for it ALL, then they have to go.

 

Sometimes throwing a little money at something can severely reduce my stress level. I've had to learn to do that. Buying something just around the corner for $2.00 more instead of taking a long train/bus ride to a cheaper store. Paying for my new iPhone that syncs effortlessly with my Mac.

 

"Avoiding" can be a good thing. Avoiding can be logical and smart. Avoiding can sometimes benefit everyone in your circle.

 

Not being able to handle TV is really a good indicator of where your stress level is at. It's helpful information. Think of things like this as information, instead of something to be ashamed of, or to cause more stress. When I can't watch any TV, I start avoiding a bit more, and spending a bit more money, as a place to start, until I can catch my breath, and let that bucket drain a bit. Then I try to reevaluate things and take a more head-on approach to deal with the bigger issues, if I can.

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Meds can make things worse.

 

< snip>

 

So, I have a "new normal" just like amputees and the newly blind need to find a "new normal". I've had to accept that. And demand that people who want to remain a part of my life accept that, too, or part ways with me. I'm done denying, apologizing, or trying to use dangerous drugs to disguise my injury.

 

I simply cannot bring myself to "like" this post, so quoting it and thanking you for having the courage to express an unpopular opinion that (IMNSHO) needed to be said will simply have to suffice.

 

Lots of hugs to everyone here who is dealing with this issue and no judgement intended whatsoever.

 

OP, please don't take this the wrong way, but if you are in perimenopause (as young as late 30s or as old as mid 50s) this might be related to your estrogen levels and either part of the journey or a symptom of needing your HRT fine tuned, depending on your personal choice.

 

Edited because I misunderstood which Bay Bridge was being discussed. Oops, my bad.

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I agree that Meds can make some people worse,

 

I can't take SSRIs without having serious side effects and those are the most commonly prescribed.

 

A psychiatrist can help manage all those issues and help one find what will work best for them. Everyone's brain chemistry is different, I don't take the typical medication and the meds that work for me were found just by trying different ones. They are always going to start with SSRIs because they are typically fairly safe and work for most people. They don't work for me.

 

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I think I went over that bridge once, with someone else driving, 10 years ago, and I still remember the terror. 

 

I have always had a generally high anxiety level.  Nothing like yours, though.  Almost blacking out from anxiety would make me find help.

 

I second the recommendation to try to reduce things that contribute to anxiety, as much as possible.  Any inputs that have high levels (or even moderate levels) of tension - crime shows, scary books, aggressive/depressing music, etc.  Any of that stuff can raise my general level of anxiety, and then my brain is looking for a place to focus the anxiety and so all of a sudden I'm afraid of robbers an hour after I saw a movie about sharks, or something.  

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