Help me hold it together for the next 3 weeks
November 4, 2013 2:52 PM Subscribe
I have a history of anxiety, but two years ago began feeling well enough that I stopped all medication and treatment, and did fine until the past couple of weeks, when I experienced a trigger (dental pain). The teeth and the pain are getting taken care of--but the anxiety just continues to balloon out of control. I can't eat, I can't sleep, I am just a thrumming, chain-smoking ball of nerves. I missed work for the first time over this today, and know I need help.
So I am seeking it: I have scheduled an appointment with a psychiatrist--my previous one moved away--but his first available is in 3 weeks. (His office advised me to go to the ER if I needed help before the appointment.) So now I just have to hold it together between now and then so I don't completely lose my mind or miss enough work to threaten my job.
Oh, HiveMind, please help me.
Extra information: I happened to have my annual physical recently with my PCP, who gave me a small amount of Ativan to help me get through my dental treatment. I have some left over, and they have helped with the panic attacks--but I don't have enough for 16 days. I have left him a message explaining the situation and asking if it would be appropriate to get the Ativan refilled. I've also asked my PCP if he could start me back on the SSRI I was on before. So I'm hoping to get back on one or the other soon.
But I'm still anxious that I'll have a breakdown before I get in to see the psychiatrist. (What if my doctor won't refill the Ativan or put me back on the SSRI? etc etc.) A psychologist I've been recommended can probably get to see me sooner--should I go ahead and schedule with her and see if she can help me get over the hump? Or will that overly complicate things?
Other questions:
-What have folks found helpful in getting through a panic attack?
-If mental health issues have begun to interfere with your work, what is a good way to talk to my employer about making accommodations? I think I could safely disclose a mental health issue to my boss, who is very understanding, but I hesitate to do so before I have talked to the psychiatrist and have a treatment plan.
-What can I expect if I do end up having to go to the ER for a panic attack?
Extra information: I happened to have my annual physical recently with my PCP, who gave me a small amount of Ativan to help me get through my dental treatment. I have some left over, and they have helped with the panic attacks--but I don't have enough for 16 days. I have left him a message explaining the situation and asking if it would be appropriate to get the Ativan refilled. I've also asked my PCP if he could start me back on the SSRI I was on before. So I'm hoping to get back on one or the other soon.
But I'm still anxious that I'll have a breakdown before I get in to see the psychiatrist. (What if my doctor won't refill the Ativan or put me back on the SSRI? etc etc.) A psychologist I've been recommended can probably get to see me sooner--should I go ahead and schedule with her and see if she can help me get over the hump? Or will that overly complicate things?
Other questions:
-What have folks found helpful in getting through a panic attack?
-If mental health issues have begun to interfere with your work, what is a good way to talk to my employer about making accommodations? I think I could safely disclose a mental health issue to my boss, who is very understanding, but I hesitate to do so before I have talked to the psychiatrist and have a treatment plan.
-What can I expect if I do end up having to go to the ER for a panic attack?
Yes. Call your PCP. Leave a message with the overnight answering staff if they are already closed, and then call back tomorrow to be sure they got it and are going to work something out for you. Go do that now.
The SSRI may not kick in fast enough, but then again it might. All depends on the particular drug and how your body chemistry reacts to it.
The next step is self-care. You are totally allowed to spend as much free time as you want in a blanket fort with Netflix and a pillow or pet to wrap yourself around. Long baths or showers, if they calm you. The Miyazaki oeuvre works great for times like this.
When you feel a panic attack coming on, IAmBroom's breathing exercise is great. The one I do is a four-count instead, four in, four holding, four out, four resting, but the important thing here is to flood your blood with oxygen. People breathe shallowly during panic attacks and that does not help.
If you get physical symptoms - GI distress, headaches, dizziness, hot flashes, cold sweats - and they respond to OTC stuff or other cures (tea, ginger ale, ice packs, sweater), keep some of that with you, a panic kit if you will. There are instant hot and cold packs available, you squish them up and they get to work.
Meditation, if you do it, can be a huge help.
Also try to be aware of how tense your body is, since a panic attack is (as I understand) a giant chemical confusion of flight-or-fight signals. Massaging is not like tickling: it will work if you do it to yourself. Especially scalp, neck, temples, shoulders, people store lots of tension there.
You can do this. You'll be okay. Feel free to memail or email (in my profile, if you'd rather use a throwaway address) if you want a vent.
posted by cmyk at 3:53 PM on November 4, 2013 [1 favorite]
The SSRI may not kick in fast enough, but then again it might. All depends on the particular drug and how your body chemistry reacts to it.
The next step is self-care. You are totally allowed to spend as much free time as you want in a blanket fort with Netflix and a pillow or pet to wrap yourself around. Long baths or showers, if they calm you. The Miyazaki oeuvre works great for times like this.
When you feel a panic attack coming on, IAmBroom's breathing exercise is great. The one I do is a four-count instead, four in, four holding, four out, four resting, but the important thing here is to flood your blood with oxygen. People breathe shallowly during panic attacks and that does not help.
If you get physical symptoms - GI distress, headaches, dizziness, hot flashes, cold sweats - and they respond to OTC stuff or other cures (tea, ginger ale, ice packs, sweater), keep some of that with you, a panic kit if you will. There are instant hot and cold packs available, you squish them up and they get to work.
Meditation, if you do it, can be a huge help.
Also try to be aware of how tense your body is, since a panic attack is (as I understand) a giant chemical confusion of flight-or-fight signals. Massaging is not like tickling: it will work if you do it to yourself. Especially scalp, neck, temples, shoulders, people store lots of tension there.
You can do this. You'll be okay. Feel free to memail or email (in my profile, if you'd rather use a throwaway address) if you want a vent.
posted by cmyk at 3:53 PM on November 4, 2013 [1 favorite]
I'm very sorry to hear that you're feeling so awful - I've had very similar happen not so long back, even down to the panicked hospital visits. What worked for me was going back onto an antidepressant (citalopram), which took two to three weeks to kick in, and being able to work from home for a couple of weeks. Is that a possibility for you? It meant I didn't have the added stress of worrying about a meltdown somewhere other than home and gave me a tiny bit of control.
I told the person I was working to what was happening - they were also supportive. In some ways I don't know if I would wait until I had a formal "diagnosis" or treatment plan - all I would say is that I was having some problems related to my mental health related to severe anxiety and that I was actively seeking a solution with my doctors.
Re: emergency hospital visits - they checked heart and blood pressure to rule out anything physical but I mostly spent time waiting to be seen as I obviously wasn't a priority (and just feel embarrassed about fountains I look back - but that's the extremes of a panic attack for you).
I'm sure you'll start feeling better once you can talk it through - best of luck.
posted by Martha My Dear Prudence at 4:17 PM on November 4, 2013 [1 favorite]
I told the person I was working to what was happening - they were also supportive. In some ways I don't know if I would wait until I had a formal "diagnosis" or treatment plan - all I would say is that I was having some problems related to my mental health related to severe anxiety and that I was actively seeking a solution with my doctors.
Re: emergency hospital visits - they checked heart and blood pressure to rule out anything physical but I mostly spent time waiting to be seen as I obviously wasn't a priority (and just feel embarrassed about fountains I look back - but that's the extremes of a panic attack for you).
I'm sure you'll start feeling better once you can talk it through - best of luck.
posted by Martha My Dear Prudence at 4:17 PM on November 4, 2013 [1 favorite]
In addition to the excellent advice folks gave above - don't forget to eat. I know it's the last thing you'll feel like doing, but low blood sugar makes this kind of thing even worse. (High protein Greek yogurt and oatmeal worked for me - no chewing required.)
posted by wheek wheek wheek at 5:52 PM on November 4, 2013 [1 favorite]
posted by wheek wheek wheek at 5:52 PM on November 4, 2013 [1 favorite]
Some people find that the over-the-counter antihistamine diphenhydramine (Benadryl) has an anti-anxiety effect.
posted by Jacqueline at 8:22 PM on November 4, 2013
posted by Jacqueline at 8:22 PM on November 4, 2013
Seconding the benadryl.
Also, make sure you get enough sleep. The brain fog of sleep deprivation seems to make it easier for panic attacks to set in.
posted by itwasyou at 10:08 PM on November 4, 2013 [1 favorite]
Also, make sure you get enough sleep. The brain fog of sleep deprivation seems to make it easier for panic attacks to set in.
posted by itwasyou at 10:08 PM on November 4, 2013 [1 favorite]
if you decide to go to the ER, pro tips:
- go at 5-7am, the slowest time of day typically, to be seen faster. If you go and it's busy (especially from 2-10pmish) you may have to wait a long time since your complaint is relatively minor.
- go to an ER with a dedicated psychiatric unit if you can. These are generally found at academic medical centers. If you go to one of these, you will likely be seen directly by a social worker or PA/APRN/psychiatry resident to start with, without having to be 'medically cleared' through the ER first (an ER doctor confirming that you don't have any relevant medical issues prior to letting you see a psychiatry person, which can add hours onto your wait time).
- What will be done for you while there really depends on who you end up seeing. Some docs give out Ativan like candy (I would say this is the majority). Some docs try to avoid Ativan to the extent possible because of its addictive qualities. I think neither approach is completely wrong or right. I suggest not asking directly for Ativan and just saying you need help getting through X number of days and asking what they recommend.
I'm not sure if this is the sort of thing you meant when you asked what to expect, but if you have other questions, Memail me.
posted by treehorn+bunny at 8:34 AM on November 5, 2013
- go at 5-7am, the slowest time of day typically, to be seen faster. If you go and it's busy (especially from 2-10pmish) you may have to wait a long time since your complaint is relatively minor.
- go to an ER with a dedicated psychiatric unit if you can. These are generally found at academic medical centers. If you go to one of these, you will likely be seen directly by a social worker or PA/APRN/psychiatry resident to start with, without having to be 'medically cleared' through the ER first (an ER doctor confirming that you don't have any relevant medical issues prior to letting you see a psychiatry person, which can add hours onto your wait time).
- What will be done for you while there really depends on who you end up seeing. Some docs give out Ativan like candy (I would say this is the majority). Some docs try to avoid Ativan to the extent possible because of its addictive qualities. I think neither approach is completely wrong or right. I suggest not asking directly for Ativan and just saying you need help getting through X number of days and asking what they recommend.
I'm not sure if this is the sort of thing you meant when you asked what to expect, but if you have other questions, Memail me.
posted by treehorn+bunny at 8:34 AM on November 5, 2013
This thread is closed to new comments.
They'll prescribe something, prob after calling you back to see how the Ativan worked for you, and you'll have the safety net.
--
Panic attacks: Here's a breathing exercise I usually tell others to use as a sleeping trick, but it's originally an anti-anxiety trick.
When you feel it coming on, follow these steps:
1. Breathe in slowly and deeply, filling from your diaphragm, taking 5 secs to do it.
2. Hold that breath 5 sec.
3. Exhale slowly and completely, taking at least 5 secs to do it.
4. Take 2 normal breaths.
5. Repeat 5 times.
You will calm down.
(Sorry, but I can't answer the ER question)
posted by IAmBroom at 3:41 PM on November 4, 2013 [3 favorites]