Panic Attacks

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    Community Voices

    5 Things To Do Before Seeing a Psychiatrist

    Part 1 of 2 Walking into a psychiatrist’s office can be nerve-racking, whether it’s your first visit or a standard follow-up. Psychiatry – often seen as more of an art than a science –relies heavily on patient-reported data and experiences to guide treatment. As a patient and behavioral health physician assistant, I’ve seen firsthand how personal history plays a vital role in therapeutic management.

    Having insight into your physical and mental health can give you the confidence to be your greatest advocate, particularly when follow-up visits are limited to a brief fifteen-minute appointment. While there may be personal information you think is irrelevant to your case, you’d be surprised how often small details can significantly impact treatment. The following tips can help you navigate an appointment with your psychiatric provider with some forethought and preparation.

    Know your medical and behavioral health history. Suppose you’re seeing a new provider for the first time. In that case, the initial visit will be a dedicated psychiatric evaluation that typically lasts one hour. During your appointment, the provider will have many questions for you. To get the most out of this interview, it’s best to list all physical and behavioral diagnoses you’ve had in the past.

    Sure, the new pimple on your nose or last winter’s pesky cold need not be mentioned. Still, hyperthyroidism, liver disease, or an abnormal heartbeat are significant pieces of history that you should always share. Likewise, childhood behavioral issues and prior mental health services are crucial to a proper diagnosis.

    As a psychiatric provider asking patients about their history, I like to do so in a head-to-toe approach. I start with the brain and work my way down. For example, is there a history of migraine, seizures, stroke, or traumatic brain injury? Moving to the heart, has the patient ever had an abnormal EKG, a heart attack, or high/low blood pressure? Are there any abnormal or involuntary muscle movements or trouble sitting still? To be sure nothing is forgotten, you might find it helpful to go through your history in a similar fashion before your visit.

    If possible, know your family history. Much like physical illness, people can have a familial predisposition to certain psychiatric disorders such as generalized anxiety, major depression, schizophrenia, or bipolar disorder, to name a few. It’s best to know the health history of your parents, siblings, children, and even grandparents. This information is indispensable when deciding on appropriate treatment, as many psychiatric medications vary in effectiveness from one individual to another.

    When a particular medication has worked well for a close relative, research has shown that the same drug has a good chance of being effective for the patient. For example, if someone has never been prescribed medication for depression, but the psychiatrist learns the patient’s mother had great success with sertraline (Zoloft), this medication would be an excellent starting point for the patient.

    If you are unaware of your family history or feel uncomfortable asking about it, don’t worry. Any information is better than none, and your personal health remains the most critical factor.

    Bring a list of all medications. Seriously, all of them. That multivitamin you’ve been taking every day for ten years? The nightly melatonin to help you sleep? What about the tablet you’re prescribed when you have a migraine? Yes, yes, and yes – Tell your provider about all of them! Drug interactions can be uncomfortable or downright dangerous. Even supplements can interact with psychiatric medications, so let your provider know the frequency and dose of any OTC products you use.

    P.S. Tell us about the not-so-legal drug use, too. A good provider will always prioritize patient safety over judgment, and the combined use of undisclosed narcotics and prescription medications raises the risk of life-threatening interactions.

    Know what treatments have (and haven’t) worked for you. This point is essential if you have previously received mental health treatment. Perhaps you found a medication that alleviated your panic attacks years ago but stopped taking it due to cost or availability. Maybe the antidepressant prescribed gave you nightmares and eliminated your sex drive.

    Whether a positive or negative experience, be prepared to tell your provider what medications you’ve tried in the past and their associated side effects. This information is essential for two reasons – (1) your psychiatrist will not waste time with treatments that you already know don’t work for you; (2) if you are prescribed a medication that is not available in generic form, the insurance company may require your provider to document that you have tried other classes of

    Community Voices

    Advice needed on therapy

    Hi everyone. I'm struggling a lot today. My therapist will be having an appointment with me at 2 today and I'm really starting to question the point. I have been having therapy with her for 8 years and although I have made some progress it hasn't been enough to keep me stable. I'm unable to afford other therapy and am considering using better help because it's more affordable. Has anyone had any experience with it? #BipolarDisorder #ObsessiveCompulsiveDisorder #Depression #Anxiety #PanicAttacks #BetterHelp

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    Community Voices

    Relationship triggers

    I’ve had depression and general anxiety for 7 yrs now. It started as postpartum depression. I’ve been on meds and many different kinds of therapy.
    My marriage broke right when my depression started. My ex n I still have bad relationship. He triggers my depression and anxiety. I get panic attacks when you I’m around him. My last suicide attempt was because of him. I avoid him. I’d like to get rid of him from my life but we co parent my son.
    I had to sacrifice so my son can grown up with both parents. It’s been hard.

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    Community Voices

    How I knew I had anxiety… and what I did next

    Part 1 of 3 Anxiety: A nervous disorder characterised by a state of excessive uneasiness and apprehension, typically with compulsive behaviour or panic attacks – myteam.org

    I remember the feelings of chronic anxiety – vividly. Tension. Unease. Apprehension, creeping into more and more areas of my life. Slowly, normal things became different to what they ought to be… used to be. They were bigger, more overwhelming… the world just seemed a scarier place. I knew there were natural things that it was normal to be anxious about – public speaking, finances or a big event to name a few. But everything out of my control had disproportionately escalated. My capacity for living life was maxed out.

    It wasn’t a week, a day, or a moment that I realised I had a problem on my hands with anxiety, because I knew that it was normal for anyone to get anxious from time to time. So what distinguishes a ‘normal’ level of anxiety apart from that which becomes debilitating? As a starting point, I would recommend going to your GP, they may give you something like a DAS21, a questionnaire that gives you a good indication of where your anxiety, stress, and depression levels are sitting against, dare I say it, the norm.

    There wasn’t a moment when I deemed myself anxious. Anxiety had slowly evolved, filtering into my life like a sandglass.

    But what I also learned over time, was that stepping back and taking a passenger seat, and reflecting on how I’m being and doing in life helped me discover many deeply engrained patterns of thinking, feelings, and behaviour. Over time, I discovered anxiety had a grip on my life in two distinct ways, firstly, obsessive control, and secondly escalating avoidance, both becoming an impediment to happy living.

    This reared its ugly head in many facets of life. Socialising, sport, work, phone calls… anything with a variable really, that which I couldn’t control. And it scared the crap out of me.

    Avoidance & obsessive control increased my anxiety & maxed me out

    PROBLEM 1: CONTROL

    More time, more resources, more energy. I thought harder, tried harder, and threw more hours at things to make sure it was my version of perfect. And when I didn‘t meet those lofty standards, it reinforced that I needed to give it even more attention to control the situation or outcome. I became my own micro-manager, controlling and fussing over minor details that resulted in an imbalanced lifestyle. I had done this for as long as I can remember, but it became more pronounced over time.

    PROBLEM 2: AVOIDANCE

    As time went by, and I realised the above approach didn’t work I removed myself from being exposed to someone or someplace which might confirm my shortcomings. This method was reinforced because in the short term, it worked – I could escape my anxiety by hiding from that which brought it about. Eventually, this created an imbalance in my life and lead to further avoidance, perpetuating the problem.

    Over time, I learned that both of these two strategies are unhealthy ways of trying to control that which is ultimately out of my control. As Corrie Ten Boom puts it, ‘worry does not empty tomorrow of its sorrow, its empties today of its strength’ – this perfectly describes the crippling effect anxiety had on me. Moreover, the fretting over what I couldn’t control amplified the very thing I was fearful of. Obsessive control meant I spent more time thinking about it; avoiding it made it scarier, bigger than what it actually was.

    The compounding effect it had on the quality of my life started becoming apparent. Life wasn’t fun like it used to be, I played everything safe, and I missed out on living. As time went by, I could see a trend, and I knew I couldn’t continue on this same trajectory. So, with the help of psychologists, various podcasts, loads of reading, and taking a good hard look at how I landed where I was – here’s what I did next…

    STEP 1: AWARENESS

    I stepped back and became aware of that which occurred subconsciously. I did this through curiosity and being reflective… almost a kind of inquisitiveness around who I’d become and how I engaged with the world. I had to take a good hard look at what caused me anxiety. It initially freaked me out because I had to get close to it, but I kept re-positioning myself back into the passenger seat of life, removing myself from judgment and replacing this with curiosity. I realised over time, I’d created a narrative, a rhetoric that helped me understand the root cause behind my anxiety. For me, it centered around achievement. I focused so intently on the ‘what’ of achievement that I had no wiggle room for mistakes. When I hit the mark, it reinforced my expectations, when I missed it, well, I saw the big ugly gap… that gap w

    Erica Camp

    How PTSD Can Affect Attachment Styles in the Workplace

    Attachment to people can be really strange with people who have mental illness. This shows up at work especially to me because I have been with the company for nine years. I have built up a lot of relationships and have had a lot of feelings leaving the company. It seems impossible for me not to keep in touch with people. I am in a constant struggle not to press too hard for a response, and the anxiety that if they do not respond, our relationship is cut off. This is particularly weird for me because in my personal life, it is astoundingly easy to cut people out of my life. But work is a beast. I have enjoyed validation throughout my career, especially when it comes to accomplishing goals and providing an environment conducive to productivity. From a psychological standpoint, validation and needs remind me of John Bowlby’s extensive research on the concept of attachment. He talks about not only the different kinds of attachment styles, but the psychological need for connectedness. Most attachment styles show up in childhood, in a child’s relationship to their caregiver. Since I come from an abusive background, I am ill equipped to maintain relationships without either being anxious about the future of my relationships or avoidant as to protect the vulnerability. This mainly presents with fearful-avoidant attachment characteristics because I am attached, but I do my best to make sure this person does not realize how far that attachment goes. This creates a work environment where I could suddenly become cold or suddenly very needy for validation. Part of the fearful-avoidant attachment style that really spoke to me was how as adults, we can become very distraught when relationships end. I find this especially hard at work because many of these people in the last three years have seen me have flashbacks, severe panic attacks, psychosis, and healing. As someone who lives with post-traumatic stress disorder (PTSD), along with other mental illnesses, this reminds me strongly of my childhood because of the breaking of my relationships with certain family members. As I have grown as an adult, the anxiety of a broken relationship has just intensified to anyone I become just slightly attached to. But I saw this especially with those who I have opened up to and now have me on read. To me, I gave a part of myself to you that I expect you to keep safe. Which translates to, if you ignore me, you aren’t keeping me safe. The goal in my journey is to become securely attached, which is obviously the ultimate attachment style, hence the “securely.” I trust my husband absolutely, but when he leaves for work or to do anything without me, there is a considerable amount of distress for me because of my attachment style. I’d love to work on having a secure attachment where I take comfort when he returns but am secure enough that he leaves. These people tend to seek out social support, which I tend to be good at because I constantly reach out to friends. But when I am rejected, it is a harder blow to handle. Avoidant attachment style sounds like it is. They tend to avoid situations, relationships, and invest little emotion in their partners, coworkers, or anything social. This idea of having difficulty with intimacy sounds like it would suit me well, however, the fact I have a strong need to connect and get validation from other people doesn’t quite match up. When I first become acquainted with someone, it is extremely hard for myself to showcase my best qualities. I tend to be more reserved with people, I talk less, and I am not open to conversations that might trigger a response from me. One of the worst things a person can do in this situation is press me, even if you know me, to open up to other people. Trust me in this, I do try. The thing about these attachment styles is that I can see myself a little bit in each one. Therefore, I chose the two mixed together: anxious/avoidant attachment style, which translates to fearful-avoidant attachment style. Anxious attachment style is probably a close second and one that is easy for me to slip into. There is a deep fear of abandonment and I can see this every day. I expect a response from people, not right away, but I assume that they need the same time of emotion that I am pouring into them. I do not worry about my husband leaving me, but I do fear that my coworkers will leave me or I suddenly don’t have the support of a friend. I need a lot of support and I feel almost selfish that I require a lot from those around me. The hardest part is feeling very secure in my relationship with my husband and his family, yet fearful-avoidant with everyone else who isn’t in my inner circle, like friends, coworkers, certain family members, and myself. Sometimes I am the problem, which is where mental illness comes in. PTSD can trick you into believing that you were at fault for the damage inflicted. I am the “bad” person for breaking my relationship to someone who was toxic and causing me serious harm. The need for approval from other sources like job performance, “fitting” in, and my likability. The good news is through therapy I have grown more securely attached to my husband, but like everything, it is a work in progress. I hope for the next months after leaving my job that I will find it easier to have a secure attachment style instead of having those toxic traits of which I already had formed a habit.

    Community Voices

    Today for the first time ever, I started having panic attacks. I got in touch with my doctor right away and he prescribed me something for them. We're being basically forced out of the house we just moved into 4 months ago. We both have horrible credit scores, so finding another place is going to be very difficult. I don't know what to do in this situation.

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    Community Voices

    What has been your experience with panic attacks?

    <p>What has been your experience with panic attacks?</p>
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    Community Voices

    Routine and mental health

    Through my time of working with different therapists they have pretty much all said having a routine each day helps with anxiety and depression. I'm unable to work so obviously would probably be very beneficial to me and when I am more occupied through the day I do feel better. The only problem is I can't stick to it. I was wondering if anyone else struggles with this and if anyone has any tips? #routine #MentalHealth #Anxiety #Depression #BipolarDisorder #ObsessiveCompulsiveDisorder #PanicAttacks

    4 people are talking about this
    Community Voices

    Dark Times with Panic Attacks

    “The darkest hour is just before dawn,” a line in a song by the Mamas and The Papas, is one that stands out to me as someone that suffers from #PanicAttacks . Although the song is called “Dedicated to the One I Love,” the lyric speaks to me about the difficulty of the loneliness of nighttime, and of #Anxiety .

    For as long as I can remember, I have lived with some form of anxiety or panic disorder. During our time together, anxiety and panic have taken many forms within me; physical ailments including nausea, vomiting, diarrhea, racing thoughts, tachycardia, test taking issues, and #Depression . My physical health includes other chronic health and pain issues, which I will not get into here, but those issues have been blamed on my panic disorder, although I have always felt that I knew the difference between panic and anxiety and my actual health issues, and the combination of both. Mental and physical health are definitely intertwined, yet sometimes, they are separate issues. I have been in therapy, had intensive psychotherapy, and have taken medications. I have tried meditation and deep breathing, imagery, hypnotherapy, and many other forms of treatment. I am all for getting help.

    One of the scariest parts of my disorder is the hopelessness that it brings. Imagine feeling your heart racing, thoughts going a million miles an hour, your body so uncomfortable that you can’t even lay down, all of the stomach issues that commercials for Pepto Bismol advertise, sweating, chills, etc., and not knowing when the symptoms will stop. For me, I know that I am not dying, and luckily, I don’t want to, but I don’t know when I will get any little relief, and that feels just as bad. Seconds go by extremely slowly due to my discomfort, minutes feel like hours, and often times it feels like there is nothing that will help.

    Now, imagine all of this in the middle of the night. Everyone you know is sleeping, as you should be, as you wish you could be, but you aren’t. Your body is revolting against itself, and the time doesn’t feel like it is moving. This is the dark time. These times have been some of my worst moments of my life, alone and not knowing when reprieve will come, when this episode will end. If it’s 3am, you think, “People normally wake up around 7, so if I call them at 6, I’m not disrupting them all that much,” because sometimes you just need someone to talk to, or to be there for you, but even waiting 3 hours to call them feels way too long. If it’s 3 am, your doctor usually doesn’t get into the office for another 5-6 hours, and most don’t take calls in the middle of the night. Acute mental health care is for people with suicidal or homicidal ideations, people that are having psychotic breaks, and not for people having panic attacks; we fall through the cracks of acute and emergent care.

    Every minute of a panic attack is difficult, but it’s those dark hours before dawn that are the loneliest. It’s the hours that should be filled with peaceful sleep, when the rest of the world is quiet, but, quiet is too much to for you to handle. It’s the time when reaching out to loved ones and interrupting their routines, their sleep, makes you feel like even more of a burden, something that having both mental and physical illnesses already does, and thinking of that adds another 10 pound weight to your chest.

    I don’t have an answer for the darkness. I am fortunate that I have been able to get help in my dark days, my dark nights, and my dark years, but for many people mental health and panic attacks leave us feeling all alone and scared, and sometimes, just like the Mamas and The Papas said “The darkest hour is just before dawn.”, but what we must try and remember is that the dawn comes, and that we have gotten through our hardest days and hardest nights before. Please reach out to someone when you feel lonely or scared, when panic feels too much, they’ll be glad you did.

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    Community Voices