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OKMH925100 Is it possible to treat panic disorder/anxiety

OKMH925100 Hi! Is it possible...

OKMH925100 Hi! Is it possible to treat panic disorder/anxiety disorder without medication?? I'm in my mid-thirties and just started having panic attacks after a very stressful past 4 years (I thought I was a calm person who handled stress well, but now realize I was just harboring those feelings). After two weeks of Zoloft I quit, due to the horrendous side effects that sent me to the emergency room. I've been encouraged to try a low dose of Ativan, Klonopin, and/or Xanax, but I'm terrified after my response to Zoloft. I have been trying breathing exercises in the moment, but it only helps for a short while and then I start to feel lightheaded, get a headache, and start to panic all over again. This has been going on for 4 months now. I've done some research and have started to eat better, and get more sleep. I'm just discouraged that this isn't helping so far.

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Customer reply replied 1 month ago
In addition, I have talked to a few counselors... one continues to push medicine even though I'm not comfortable with taking anything else at the moment, one was a hypnotherapist who I was not comfortable with at all and he cause my panic attacks to worsen, and the third counselor I've only spoken with twice so far, but I do think there's some hope there. It's just unfortunately expensive and not something my insurance will cover.
Answered in 13 hours by:
9/26/2017
LeahMSWuofm
LeahMSWuofm, Clinical Social Worker
Category: Mental Health
Satisfied Customers: 717
Experience: 10 years post-MSW experience
Verified

Hi, thank you for writing. My name is***** am sorry you aren't feeling your best. To answer your question, it is possible that anxiety can be managed through behavioral approaches which help you understand how your thoughts, feelings and behaviors intertwine (this is called Cognitive Behavioral Therapy). A lot of our anxiety can be fostered by the way we perceive things, the way we feel about them and ourselves, and the way we choose to respond. Panic disorder can be treated through exposure work as well as CBT where people face the things that cause them the most anxiety and retrain the brain that those things are not as severe or dangerous as the brain initially perceived. So this combination tackles our thoughts as well as our behaviors. Furthermore, people suffering with anxiety can be helped to learn better how to assess things more objectively as opposed to emotionally, and that living with some level of anxiety and uncertainty is normal and can be tolerated.

With that being said, the ideal gold standard treatment for panic-level anxiety involves combinations of SSRIs or benzos with behavioral therapy. While I hear that you had a bad experience on Zoloft, each person reacts slightly differently to psychotropic medications and with the right support, it is likely you could find a medication that does not have the significant side effects that you experienced with the Zoloft. So in this case, it is important you recognize the irony that the bad experience you had with that trial on zoloft set your anxiety alarm to full blast when it comes to assessing use of medications and that anxiety alarm can get reset and notched down by addressing the objective likelihood of a similar event happening, assessing the true weight pf the event (how scary it was at the time versus how significant it actually ended up being) and what your options are in terms of trying to assess pros and cons in regards ***** ***** something else.

As far as your experience with counseling, i would absolutely encourage you find a counselor who you feel confident is a good match for you. This does not mean perfect or the therapy will be "easy", but it means that the person will make you feel comfortable, willing to share, and willing to take direction. Ideally, this person should be trained in behavioral methods for approaching panic including things like breathing, meditation, mindfulness and progressive muscle relaxation, but aldo to the art of exposure work. I know htjat this is expensive but it may be a worthwhile use of money for a short-time until you can harvest the gains on your own without guidance.

If therapy proves too expesnive, there are some self-help ways to go about this...

https://www.amazon.co.uk/Anxiety-Panicking-powerful-self-help-suffering/dp/1500117927/ref=pd_lpo_sbs_14_t_0/260-9046510-7488222?_encoding=UTF8&psc=1&refRID=AZ1VYC2BSWDCNB7WME4C

http://medicine.umich.edu/sites/default/files/content/downloads/CBT-Basic-Group-for-Anxiety-Patient-Manual.pdf

http://www.amazon.co.uk/Anxiety-Panicking-powerful-self-help-suffering/dp/1500117927/ref=pd_lpo_sbs_14_t_0/260-9046510-7488222?_encoding=UTF8&psc=1&refRID=AZ1VYC2BSWDCNB7WME4C

https://www.anxietybc.com/self-help

Lastly, here is a link to a blog I wrote on some immediate strategies you can implement (breathing included!). http://healthblog.uofmhealth.org/wellness-prevention/3-easy-exercises-for-anxiety-relief-you-can-use-anywhere

I hope this helps and am here to chat more if you'd like!

-Leah

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Customer reply replied 1 month ago
Thank you for your response, Leah. I appreciate the response and links, and will take a look at them this evening. In the meantime, the other issue I'm struggling with is work. Financially I can not afford to quit my job, nor would I want to do that to my bosses and my colleagues... but this job is a major stressor. I am an introvert working in a majorly extroverted environment (open office with a lot of extroverted people).In situations where people are having frequent, daily panic attacks, is it possible to continue working while managing and recovering from panic/anxiety disorder? I'm in a situation where work stresses me out majorly, but having to miss work stresses me out as well... and the cycle continues. I know moving forward I need to find a different line of work that is much better suited for me, but I'm nervous to try to tackle a new job move while dealing with this. I also am concerned about the health consequences for staying in a job that is causing so much anxiety, despite knowing the financial consequences of leaving will cause stress as well on me and my husband (he has been very supportive by the way, so that is the one positive throughout all of this).What advice would you give clients in this situation and with these struggles? Thanks for your time.
Customer reply replied 1 month ago
In addition, I was raised in a family where work was everything... and my parents were always stressed, home life suffered, but being "perfect" and "doing it all," all while keeping a smile on your face in public was the ultimate goal/message received. So, I am having some depression/anxiety regarding quitting work, and feeling like a failure or like there is something wrong with me.

Hi, thank you for the reply. Your response speaks perfectly to some of the things I mentioned. While it is not easy, in general, pushing through work (or any anxiety provoking situation) including your panic and anxiety is the ideal direction to go in if leaving is not an easy, immediate choice. Anxiety is FUELED by behaviors and avoidance is one of anxiety's favorite foods because it reinforces your brain's perceptions that things are undoable, dangerous, risky, etc. So pushing through the anxiety and putting your best foot forward should continue to pay off in terms of deescalating your anxiety as it shows your anxiety that while you may feel uncomfortable, there isn't anything inherently dangerous about your job therefore the brain should not trip it's anxiety alarm and send you into panic. This can take time but this IS exposure work.

But, it does sound like your job is stressful and I do think the ideal thing is to push through but also make more concerted efforts at seeking other opportunities. Panic is not dangerous despite the fact that it feels like you are in a life and death battle when happening but long-time stress does tend to take a toll on our physical and mental well-being. So ideally, you can fight that day-to-day anxiety by facing it head-on and thereby lowering your anxiety alarm's sensitivity but also do some tactful problem-solving in the meantime about where you see yourself in your next chapter.

As far as your last point, this speaks highly to the cognitive behavioral therapy understanding of us as people. We have lots of thoughts that serve as driving factors for the way we feel and behave but the irony is. these thoughts may not always be accurate. Quitting a job that you dislike immensely or is not a good fit does NOT make you a failure. Busting your butt at work while sacrificing a quality home life is NOT an example of perfection. Helping to understand how you think about things and the fact that the way you think may not be accurate or productive is a huge step in combatting anxiety because it will help you challenge your misperceptions and formulate more achievable, comfortable goals for yourself overall.

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And, there is nothing wrong with you! Stress, anxiety, and panic are real problems to have. Keep facing forward addressing challenges rather than fleeing from them. And keep facing those unwanted, unproductive and defeating worried thoughts as they are stagnating. To do these things on the regular can lead to freedom but it does take time and patience to get to the ;point where you can do so with tact and ease.

-Leah

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Customer reply replied 1 month ago
Thank you for you thorough response, Leah. Last question, if I were to try a low dose benzo while continuing therapy and other self-help methods, do you have any thoughts on pros/cons of Xanax, Ativan, or Klonopin? Which one might be better for me with medicine anxiety? I'm hearing a few different opinions and want to weigh all options carefully before trying another medication. Thanks!
In general, I try to help steer patients away from benzo use for more "chronic" anxiety. This is because the benzo medications are very effective and effiicient and therefore well-liked by the brain. This lends itself to addiction even when not ibtended and also difficulty finding providers willing to continue to dispense which can lead to problems with tolerance and ultimately withdrawal should the stream run dry. More....
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Sorry, I am having some technical difficulties. Let me co plete my answer when I can get to a more stable area in a short time!
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Customer reply replied 1 month ago
Ok, I will look for your response when you have a better connection. Thank you!

Hi :) Sorry for the delay. So I know this is not ideal to hear given your past experience with Zoloft but I would advocate for trying another SSRI or SNRi and starting on a low initial dose and upping slowly if needed. This is because I generally describe that the SSRIs are more preventive of anxiety while the benzos tend to be used more reactively. You may not have the same reactions to another SSRi that you had to the Zoloft - people can react very differently to each of these meds and trial and error is often needed. I do believe short-term benzo use can be indicated when a person is first starting an SSRI to mitigate against "activation" side effects such as peaked anxiety, restlessness, jitteriness, etc.. In this case, benzo use may be frequent for a week or two but should taper down in need as the SSRI starts to show promise which is typically around the 3 week mark when it comes to anxiety lessening.

Now, to address your question about a preferred benzo, I personally like Xanax although it has a capacity for dependence because it is the fastest acting with the shortest half-life of the 3 you name. This is actually why it is such a good medication- it does the job quickly. But I would advocate for its use only as a last resort to anxiety that can't otherwise be tamed or accepted through behavioral interventions. I also think it can be helpful when used solely for PRN purposes to help cope with something unique (a particularly stressful meeting, a daunting work function, a intimidating medical appointment, an airplane trip, etc.). Avoid using Xanax for help at bedtime because the short half-life can cause rebound of anxiety in the early morning causing some people to suffer from early-morning wakening and problems falling back to sleep.

If you really want to try a benzo for more around the clock coverage, both Ativan and Klonopin, on a schedule, are sound choices. Still, I would always caution a patient about this class becoming the crutch for chronic anxiety as it can ultimately perpetuate problems due to addiction and potentially restricted availability.

-Leah

LeahMSWuofm
LeahMSWuofm, Clinical Social Worker
Category: Mental Health
Satisfied Customers: 717
Experience: 10 years post-MSW experience
Verified
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Customer reply replied 1 month ago
Thank you so much for your responses, Leah. I appreciate all of your advice and links; please know they have been very helpful with the anxiety and panic attacks I have been experiencing today. I know that patience and persistence, while implementing many of the things you mentioned will be key in my recovery. Thanks again! Have a great week!

Thank YOU for the rating! You are certainly welcome. May you feel your best very soon!

-Leah

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Customer reply replied 1 month ago
I spoke yesterday about the frequency of my panic attacks, whether I could recover without medication, and whether I should quit my job or stay. After giving the responses much thought, I felt it necessary to add a few pieces of information.Is it doing more harm than good regarding my recovery to stay in a job that was causing me an immense amount of stress before I even started having the panic attacks? I stress about getting enough sleep and being late to work, I wake up stressed thinking about work and how I don't want to go. My colleagues and bosses are wonderful, it's just not the job or environment for me, and I had been stressing over how to leave before I started having panic attacks. I've only been in this job for one year (same company (71/2 years), just a different department and different building). Besides not being a good fit or what I want to do, my father was the president of this organization for 17 years... it is a reminder everyday that I'm still living life for my parents and not myself.There are other factors that have contributed to the stress - two dogs I've had to put down within two years of each other - I had one for 14 years and the other one for 15, stressful relationship with my family and in-laws - we have completely different religious beliefs (my boyfriend and I ended up getting married only because our families made us feel so bad and guilty for living together before marriage - yes we are adults in our mid-30's), new marriage and the social changes that come with it (we did elope, and I still hate the attention we're getting and pressure to have a big party), financial difficulties from the past that I'm trying to recover from, and the list goes on. Overall, after doing some therapy, I have discovered that I have not been living an authentic life at all. I've been trying to make everybody else happy, and not myself.With all of that being said, I realize it's not just the job... but the job does play a major role in my stress and did help lead to the panic attacks. I know I am the only person who can make a decision for me, but from a mental health and medical standpoint, I'd like to know if it seems like staying in this job while dealing/recovering from panic attacks is the right approach or if it would be better to get out of this work situation/environment and do something on a part-time basis elsewhere, which I feel comfortable doing?Thank you again for any insight and advice :)Forgot to add... I certainly don't want to feed into the anxiety by avoiding stressful situations, but I also don't want to stress myself out more by putting myself in a situation where I will be overwhelmed. For example, I hate being in small spaces or where I feel I can't escape (airplanes, elevators, traffic jam on the highway, etc...). I tend to avoid these places if possible, as not to put myself in a situation that I know will cause undue stress, but I also want to make sure that I will be ok when these situations are unavoidable. The research and articles on dealing with panic and stressors are just so contradictory that it is hard to determine whether it's best to tackle all stressors head on, or accept that some things are not meant to be if they are causing stress and cut ties and move on... ??Thanks :
Customer reply replied 1 month ago
Hi Leah! I'm not sure if you received this question because it was closed earlier, but I was just told to resubmit it through this page, So here is the question I sent this morning:I spoke yesterday about the frequency of my panic attacks, whether I could recover without medication, and whether I should quit my job or stay. After giving the responses much thought, I felt it necessary to add a few pieces of information.Is it doing more harm than good regarding my recovery to stay in a job that was causing me an immense amount of stress before I even started having the panic attacks? I stress about getting enough sleep and being late to work, I wake up stressed thinking about work and how I don't want to go. My colleagues and bosses are wonderful, it's just not the job or environment for me, and I had been stressing over how to leave before I started having panic attacks. I've only been in this job for one year (same company (71/2 years), just a different department and different building). Besides not being a good fit or what I want to do, my father was the president of this organization for 17 years... it is a reminder everyday that I'm still living life for my parents and not myself.There are other factors that have contributed to the stress - two dogs I've had to put down within two years of each other - I had one for 14 years and the other one for 15, stressful relationship with my family and in-laws - we have completely different religious beliefs (my boyfriend and I ended up getting married only because our families made us feel so bad and guilty for living together before marriage - yes we are adults in our mid-30's), new marriage and the social changes that come with it (we did elope, and I still hate the attention we're getting and pressure to have a big party), financial difficulties from the past that I'm trying to recover from, and the list goes on. Overall, after doing some therapy, I have discovered that I have not been living an authentic life at all. I've been trying to make everybody else happy, and not myself.With all of that being said, I realize it's not just the job... but the job does play a major role in my stress and did help lead to the panic attacks. I know I am the only person who can make a decision for me, but from a mental health and medical standpoint, I'd like to know if it seems like staying in this job while dealing/recovering from panic attacks is the right approach or if it would be better to get out of this work situation/environment and do something on a part-time basis elsewhere, which I feel comfortable doing?Thank you again for any insight and advice :)Forgot to add... I certainly don't want to feed into the anxiety by avoiding stressful situations, but I also don't want to stress myself out more by putting myself in a situation where I will be overwhelmed. For example, I hate being in small spaces or where I feel I can't escape (airplanes, elevators, traffic jam on the highway, etc...). I tend to avoid these places if possible, as not to put myself in a situation that I know will cause undue stress, but I also want to make sure that I will be ok when these situations are unavoidable. The research and articles on dealing with panic and stressors are just so contradictory that it is hard to determine whether it's best to tackle all stressors head on, or accept that some things are not meant to be if they are causing stress and cut ties and move on... ??Thanks :)

Hi, above all else, if you have something in your life that is causing you great stress and only getting worse, problem-solve it to minimize it's impact. So yes, if you can consistently lay out reasons why this job is not for you, then I do not think you should just ride it out for the sake of confronting anxiety. I apologize if that was the impression I gave. For things that are less controllable but anxiety-provoking, it is ideal to learn to roll with the anxiety in these things (airplanes, responsibilities, family stress you are not the cause of, etc.)

Problem-solving comes first, Coping/Adapting comes second.

It sounds like you have made some good strides in therapy with some deep revelations about how you have made many decisions to please others. You are a work in progress, as is everybody. Never strive for perfection. Strive to make the best choice you can after accounting for pros and cons of numerous options. It sounds like you have done this with your job aplenty, and the answer, as you share it, seems like a calling for you to push harder for a change. That in itself will not necessarily be easy but life isn't always about making the easy choice. Sometimes, there just isn't one offered!

No shame to you in getting out of a place where you know you are miserable. So much of the other stuff that causes us distress is out of our control and doesn't even have the option of starting anew!

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Customer reply replied 1 month ago
Thank you for that; I appreciate it. I certainly understand where you were coming from in your original response. The panic/anxiety does not always allow the brain to think clearly, and I have doubted myself and my thoughts throughout all of this. Your responses have been a huge help though, and have allowed me to gain some more perspective. I actually was motivated to tackle a couple anxiety producing situations today while at work, and gained a little confidence and hope in moving forward in doing so. Thank you again :)

Yes! You get it and you are welcome! Anxiety and depression can warp the way we think, feel , and act which can make things seem worse than they are. I love to hear that this dialogue motivated you to push through some things at work and to maybe think about things in a slightly different light. Facing anxiety pays off as it makes the anxiety less relevant in your assessment of things so you can be more assured that decisions you make are for the right reasons. Keep up the good work!! I remain a resource on this site so if you need my again, don't hesitate to reach out :)

-Leah

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Customer reply replied 1 month ago
Thank you, Leah! I appreciate your thoughtful responses. Sometimes we look for, hope, and expect the right thing/answer to just happen more easily or reveal itself in an almost "angelic" way with the sky parting and choirs singing... haha... but you are so right. The right decisions aren't always easy ones. And in dealing with those difficult decisions and owning my choices, I know I will gain the confidence and encouragement to live a more authentic life moving forward. I know I will have struggles dealing with this panic disorder, but I do feel more encouraged moving forward... so thank you :). I will be sure to reach out in the future if need be. Have a great week!

I love your attitude!! keep fighting through the anxiety and the panic battling it with objective thinking and acceptance. You have a great weekend as well :)

-Leah

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Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

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