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DrFee
DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience:  I help people overcome anxiety and enjoy life again.
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My 17 year old daughter has been on cymbalta almost 4 week

Resolved Question:

My 17 year old daughter has been on cymbalta almost 4 week for migranes which have caused depression which in turn have caused anxiety and panic attacks. Since being on the med the panic attacks are more frequent. we are in the process of getting counseling. She is also getting acupunture and massage therapy once a week. The panic attacks are very scary and so far hasn't been able to predict them. Everything has changed so fast she is missing tons of school her senior year. She is an honor student and works but this is affecting her life and we are trying to do the right thing. What are your thoughts.
Submitted: 1 year ago.
Category: Mental Health
Expert:  DrFee replied 1 year ago.

DrFee :

Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.


 

DrFee :

I'm wondering if you are looking for advice from a Psychiatrist about the medication issue or if you'd like some help with the panic attacks.


 

DrFee :

I can help you with the later --I have 20+ years experienc helping people with anxiety/panic.


 

DrFee :

*latter


 

DrFee :

I'm going to start telling you some things about panic attacks --and you can stop me if that's not what you are looking for.


 

DrFee :

Anxiety is our body's signal that it believes danger is present, and the body prepares itself to either fight, run away from, or flee from that danger. If we have to get out of the way of an oncoming bus, it is quite useful to be able to move quickly. The problem is that the body does not know the difference between "real" danger such as a bus, and "perceived" danger --which can be triggered by so many other things including ---thoughts, feelings, memories, images, bodily sensations (even relaxation triggers anxiety for some people, but also being too hunger, hot, or tired, or effects of medication). Your daughter's panic could have been triggered by the medication in and of itself.


"Overstimulation," which can occur when too much is happening and "Understimulation," (not enough is happening such as waiting, traffic, et) are also triggers. Anything external (sight/sound/smell/taste --as well as flourescent lights for some) can trigger an internal trigger and also cause anxiety.

DrFee :

One problem with panic is that even if it is triggered by a medication or a medical condition, the emotional reaction to it (fear, dread of another attack) can trigger further attacks.


 

DrFee :

Therefore, it's important that your daughter learn that the "panic attack is misearable, but it can't hurt me."


 

DrFee :

A first step that is helpful to take is to learn how to rate anxiety at a variety of places. A "0" is perfectly calm,relaxed, whereas a "10" is a panic attack.


 

DrFee :

She needs to know what a 2, 5, 7, etc...feels like for her.


 

DrFee :

This means becoming more keenly aware of herself and when her anxiety starts to get triggered.


 

DrFee :

She needs to intervene at a "5" or "6" in order to prevent a panic attack from occuring.


 

DrFee :

I'll give you some instructions for abdominal breathing, which when done properly, is excellent for preventing panic attacks.


 

DrFee :

This is called the 4 by 4 breathing exercise because you should practice it for 4 minutes 4 times a day to learn to do it well. If you are able, do this with your eyes closed, imagining a pleasant place. This is calming and designed to help you manage stress. There are two important things to learn about breathing:


 


1. Learn how to breathe from your diaphragm (from your tummy area) and make that pattern a part of your daily life.


 


2. Become skilled at shifting to diaphragmatic breathing whenever you begin to feel stressed.


 


Natural Breathing


 


1. Gently and slowly inhale a normal amount of air through your nose, filling only our lower lungs. Place your hands on your tummy so that you can feel it rising and falling with each breath. Count to 5 slowly as you do it.


 


2. Exhale slowly through your lips, counting to 5 as you do so.


 


3. Continue this slow, gentle breathing with a relaxed attitude, concentrating on filling only your lower lungs.


 


4. As you breathe, slowly repeat the word “relax” or “calm” or some other word which means the same to you.


 


If you have difficulty following the above instructions:


 


1. Lie down on a rug or your bed, with your legs relaxed and straight, a book on your tummy and your hands by your side.


 


2. Let yourself breath normal easy breaths. Notice what part of our upper body rises and fall with each breath. Rest a hand on that spot. If that place is your chest, you are not taking full advantage of your lungs. If the book is moving up and down, then, congratulations, you are doing it right!


 


Deep Breathing


 


Deep breathing is an extension of this normal process. With one hand on your chest and one on your abdomen, take a slow, deep breath, filling your lower lungs, then your upper lungs. When you exhale, let your upper lungs go first (causing your upper hand to drop), then your lower lungs (causing your lower hand to drop).


 


Reminder: Too many deep breaths, instead of natural breaths in a row, will produce a sense of lightheadedness. This is not harmful; just return to natural breathing.


 


Practice


 


Natural slow breathing and the deep slow breathing several times each day. Practice natural breathing for a period of at least 4 minutes, 4 times a day. The object is to train yourself to breathe from your diaphragm most of the time.


 

DrFee :

I see you are not stepping in --I need to step out, but if you would like to continue with me later, I would be happy to answer your specific questions.


 

DrFee :

Final thought for now --anxiety/panic is VERY treatable. Don't lose hope or give up. There's lots of effective therapy available. She can overcomie it and enjoy the rest of her senior year!!!!


 

Customer:

Thank you so much your comments are very informative. It makes a lot of sense, that is the type of info I hoped we would be getting from the counselor. Thanks again.

DrFee, Psychologist
Category: Mental Health
Satisfied Customers: 437
Experience: I help people overcome anxiety and enjoy life again.
DrFee and 2 other Mental Health Specialists are ready to help you
Expert:  DrFee replied 1 year ago.
Dear XXXXna,
Thank you for your "excellent" rating and bonus, I appreciate both!

I hope that the information that I provided will help you to get your daughter started down the path towards recovery. The most important thing will be to find a counselor who is knowledgeable about anxiety and how to help people overcome it.

Thanks again, and best wishes to you and your family.

Dr. Fee

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