Why have I been having panic attacks almost everyday for the past 10 years?
April 8, 2011 11:32 AM Subscribe
A Medical Conundrum for the Hive. Why persistent panic attacks occurring during twilight, as the light dims and the outside gets darker, since the onset of puberty?
Does anybody know of any neurobiological or physiological reason why an individual would experience a rush of anxiety--pulsating heart rate, worry, nervousness, tension--during a specific point in time during the day without any external provocations. The best way to describe the sensation to somebody who hasn't felt it is to ask if they have ever been in a play and just before coming on the stage they get immediate stage fright. Now imagine experiencing that for 2 1/2 hours each day, for no particular reason, while waiting for it to go away on its own while you continue to engage in your work. I have been suffering from this condition for since I entered puberty at 12, some 12 twelve years ago. First I explored the possibility that external events were eliciting this response. However, after numerous cogntive-behavioral approaches the problem still persisted unabated. I am positive that the cause is not psychological in nature but rather a combination of neurobiology and physiology, perhaps even hormonal due to it coinciding with entrance into physical adulthood.
I have tried several "alternative approaches" to treat this problem. I have cut out caffeine out of my diet, engaged in meditation, and pursued other forms of alternative therapy to assuage these anxiety attacks. Nevertheless, the efforts have been futile. There are several methods I've found that alleviate this anxiety. First, for some reason 20 minutes of cardiovascular exercise where the heart rate is elevated is capable of alleviating some of the tension and nervousness. If the anxiety is at an 8, running around for twenty minutes will lessen it to a 6. Second, watching certain movies and/or TV shows over and over and over again when the panic comes on seems to have a mollifying affect for some reason. This only works with certain movies and tv shows. It also never works with entertainment offerings that I'm seeing for the first time. In other words, it has to be something I've seen ad nauseum. So certain tv shows have become fair game for a long time as I've watched and rewatched them for at least two during which I experience a minor diminishing in my heart rate and level of anxiousness.
I am not posting on AskMeta as an alternative to going to the doctor. Quite the contrary, I have seen a doctor numerous times. The outcome hasn't changed. What I am seeking are possible neurological and/or physiological reasons for this. Cases in medical literature would be especially helpful as it would allow me to bring it to the attention of medical personnel. This isn't an attempt on my part to avoid medicine or doctors all together. In fact, unlike the current wave of anti-depressant, anti-psychotropic sentiment percolating out there, I'm quite content in relying on medicine to stabilize this condition. Instead, by asking this question on Metafilter I'd like to tap into the hive mind, as it were, and see if anybody has heard of anything like the symptoms I'm describing . I am looking for an answer that would direct me to some possible maladies, non-psychological origin that could be responsible for this.
Also, I have had a thorough medical check up with blood tests and all. My thyroid, which is often traced to this condition, is perfectly fine--knock on wood!--as is everything else. The only potential health conflict I have is that I persist in being overweight. Does anybody know what these anxiety attacks could be attributed to?
Finally, I'd like to offer a reason why I don't think its primarily a run-of-the-mill panic disorder as most of you are thinking. For a while I too was certain that what I had was generic panic disorder, readily treatable with Paxil and some variant benzodiazepine. I am however skeptical of this diagonses for several reasons. First, Panic Disorders, as defined in the DSM-IV rarely include the frequency that I am experiencing. Scrolling through the DSM, you'll find that people experiencing panic attacks need the equivalent of four-six per month to qualify for the diagnoses. Nowhere is there a case of such frequent and predictable disorders occurring literally everyday with no abeyance. To take another example, observe Manic Depressive Illness. For frequent cycling--cyclolythmia I believe it's called--there is something like at least a month interval in between manic and depressive stages. It would be outstanding if an individual would cycle every week, to say nothing of cycling everything other day. Second, the predictability of these attacks--they almost always occur as day shifts into dawn--suggests there is a circadian aspect to this illness that is not mentioned in the Panic Disorder literature.
Thanks.
Does anybody know of any neurobiological or physiological reason why an individual would experience a rush of anxiety--pulsating heart rate, worry, nervousness, tension--during a specific point in time during the day without any external provocations. The best way to describe the sensation to somebody who hasn't felt it is to ask if they have ever been in a play and just before coming on the stage they get immediate stage fright. Now imagine experiencing that for 2 1/2 hours each day, for no particular reason, while waiting for it to go away on its own while you continue to engage in your work. I have been suffering from this condition for since I entered puberty at 12, some 12 twelve years ago. First I explored the possibility that external events were eliciting this response. However, after numerous cogntive-behavioral approaches the problem still persisted unabated. I am positive that the cause is not psychological in nature but rather a combination of neurobiology and physiology, perhaps even hormonal due to it coinciding with entrance into physical adulthood.
I have tried several "alternative approaches" to treat this problem. I have cut out caffeine out of my diet, engaged in meditation, and pursued other forms of alternative therapy to assuage these anxiety attacks. Nevertheless, the efforts have been futile. There are several methods I've found that alleviate this anxiety. First, for some reason 20 minutes of cardiovascular exercise where the heart rate is elevated is capable of alleviating some of the tension and nervousness. If the anxiety is at an 8, running around for twenty minutes will lessen it to a 6. Second, watching certain movies and/or TV shows over and over and over again when the panic comes on seems to have a mollifying affect for some reason. This only works with certain movies and tv shows. It also never works with entertainment offerings that I'm seeing for the first time. In other words, it has to be something I've seen ad nauseum. So certain tv shows have become fair game for a long time as I've watched and rewatched them for at least two during which I experience a minor diminishing in my heart rate and level of anxiousness.
I am not posting on AskMeta as an alternative to going to the doctor. Quite the contrary, I have seen a doctor numerous times. The outcome hasn't changed. What I am seeking are possible neurological and/or physiological reasons for this. Cases in medical literature would be especially helpful as it would allow me to bring it to the attention of medical personnel. This isn't an attempt on my part to avoid medicine or doctors all together. In fact, unlike the current wave of anti-depressant, anti-psychotropic sentiment percolating out there, I'm quite content in relying on medicine to stabilize this condition. Instead, by asking this question on Metafilter I'd like to tap into the hive mind, as it were, and see if anybody has heard of anything like the symptoms I'm describing . I am looking for an answer that would direct me to some possible maladies, non-psychological origin that could be responsible for this.
Also, I have had a thorough medical check up with blood tests and all. My thyroid, which is often traced to this condition, is perfectly fine--knock on wood!--as is everything else. The only potential health conflict I have is that I persist in being overweight. Does anybody know what these anxiety attacks could be attributed to?
Finally, I'd like to offer a reason why I don't think its primarily a run-of-the-mill panic disorder as most of you are thinking. For a while I too was certain that what I had was generic panic disorder, readily treatable with Paxil and some variant benzodiazepine. I am however skeptical of this diagonses for several reasons. First, Panic Disorders, as defined in the DSM-IV rarely include the frequency that I am experiencing. Scrolling through the DSM, you'll find that people experiencing panic attacks need the equivalent of four-six per month to qualify for the diagnoses. Nowhere is there a case of such frequent and predictable disorders occurring literally everyday with no abeyance. To take another example, observe Manic Depressive Illness. For frequent cycling--cyclolythmia I believe it's called--there is something like at least a month interval in between manic and depressive stages. It would be outstanding if an individual would cycle every week, to say nothing of cycling everything other day. Second, the predictability of these attacks--they almost always occur as day shifts into dawn--suggests there is a circadian aspect to this illness that is not mentioned in the Panic Disorder literature.
Thanks.
Response by poster: Yes, it happens even without light cues. The only thing that helps, like I said before, are some repetitive acts like watching the same show that I've seen millions of times or sometimes--very rarely- exercising so that the increased heart rate is used for some better use other than fear. It's completely spontaneous. I've long thought it had something to do with issues I wasn't addressing or external causes until I finally found myself in numerous circumstances where for all practical purposes I was happy and content (knock on wood, please). Then and only then did I realize that there was something strange going on. Again, I hope this post doesn't make me appear crazy or socially dysfunctional, which I'm not. In fact, I have numerous friends, have taken part in many activities, enjoy public speaking, etc, not the traits you associate with heavy neurotics or agoraphobics.
posted by lackadaisical at 11:44 AM on April 8, 2011
posted by lackadaisical at 11:44 AM on April 8, 2011
This is my best guess (which could easily be wrong). At some point when these panic attacks were just getting started, you actually were panicked about something. There was some reason, rational or irrational, for you to be worried. Maybe you thought that the light was fading because you were going blind, rather than because the sun was going down. Whatever. When this happened to you a few times it became a conditioned Pavlovian response. You began to associate twilight with fear. The more times you experienced fear during twilight, the more well established the response became. Now it happens automatically.
The fact that you can distract yourself with a familiar TV show or movie seems to be consistent with this hypothesis. If you are not thinking about the alarming time of day, you feel less alarm. Ideally, I would suggest counter conditioning. Do something you really like at that time of day and try to create a positive association rather than a negative one. Do it consistently, every day.
posted by grizzled at 11:45 AM on April 8, 2011
The fact that you can distract yourself with a familiar TV show or movie seems to be consistent with this hypothesis. If you are not thinking about the alarming time of day, you feel less alarm. Ideally, I would suggest counter conditioning. Do something you really like at that time of day and try to create a positive association rather than a negative one. Do it consistently, every day.
posted by grizzled at 11:45 AM on April 8, 2011
Given the circadian component, have you looked into SAD? Does your condition vary with the seasons or is it day in/ day out? There is a pretty rare form of it that can last year long. You can try bright light therapy in the afternoons and see if that helps.
If you travel to a different time zone, does that have any effect? I don't mean one hour; I mean at least 3 hours, and preferably more.
Do you eat a particular food each day or take medication in the morning or afternoon? If so, try cutting it out or try it at nighttime. Allergic reactions/intolerances can create something like what you are describing.
Have you had your blood sugar levels checked? If you fast for a day, do you still get the late day episodes?
You can get a test to determine if you are getting a sudden surge of adrenaline. You did not mention whether you had tried beta blockers. If it is adrenaline related, the beta blockers should help. If they don't help, it is not adrenaline. The beta blockers might also help if it is anxiety related. Worth a try.
I am not a doctor but it sounds like you have researched this thing. Just looking for off-the-wall ideas.
Good Luck.
posted by PickeringPete at 11:47 AM on April 8, 2011
If you travel to a different time zone, does that have any effect? I don't mean one hour; I mean at least 3 hours, and preferably more.
Do you eat a particular food each day or take medication in the morning or afternoon? If so, try cutting it out or try it at nighttime. Allergic reactions/intolerances can create something like what you are describing.
Have you had your blood sugar levels checked? If you fast for a day, do you still get the late day episodes?
You can get a test to determine if you are getting a sudden surge of adrenaline. You did not mention whether you had tried beta blockers. If it is adrenaline related, the beta blockers should help. If they don't help, it is not adrenaline. The beta blockers might also help if it is anxiety related. Worth a try.
I am not a doctor but it sounds like you have researched this thing. Just looking for off-the-wall ideas.
Good Luck.
posted by PickeringPete at 11:47 AM on April 8, 2011
Further to my post, how much caffeine are you consuming and when do have your last "dose"?
Many people find that they don't tolerate caffeine and end up with palpitations (which can include a racing heart) and anxiety that can occur at fairly regular intervals. Try going caffeine free for a while.
posted by PickeringPete at 11:52 AM on April 8, 2011
Many people find that they don't tolerate caffeine and end up with palpitations (which can include a racing heart) and anxiety that can occur at fairly regular intervals. Try going caffeine free for a while.
posted by PickeringPete at 11:52 AM on April 8, 2011
Response by poster: The Pavlovian suggestion is an interesting one but I find it unlikely for several reasons. One is that the duration of these attacks have been going for too long for some Pavlovian response in the past to still affect. Another reason I doubt the Pavlovian explanation is that I've also acummulated many good experiences that occurred during the change from light to darkness. Some of these experiences were social, while others were of a more intimate manner, while others were involved with scholastic and athletic accomplishments that I've achieved. So although it's a good idea, I think perhaps it might not be a sufficient enough explanation. I will look more into it.
As to the other explanation regarding fasting and food, I'm not sure I've tried that. However now that you mention it, I do think it would be more technical and thus more precise to say that I feel like I am getting a release of adrenaline in some way. I think the best way to capture the feeling I'm experiencing is by likening it to "stage fright," or the sense of nervousness one gets right before performing in public. Take away the stage part and the audience part and you have a very close match with what I'm feeling.
Thanks for all the suggestions. Please keep them coming. I am very curious as to what this illness/disorder might be. I am currently on Xanax btw and have no problem taking it, but I'd really like to know what I'm treating first. I also don't want to have to take it everyday as I'll certainly build up tolerance.
posted by lackadaisical at 11:58 AM on April 8, 2011
As to the other explanation regarding fasting and food, I'm not sure I've tried that. However now that you mention it, I do think it would be more technical and thus more precise to say that I feel like I am getting a release of adrenaline in some way. I think the best way to capture the feeling I'm experiencing is by likening it to "stage fright," or the sense of nervousness one gets right before performing in public. Take away the stage part and the audience part and you have a very close match with what I'm feeling.
Thanks for all the suggestions. Please keep them coming. I am very curious as to what this illness/disorder might be. I am currently on Xanax btw and have no problem taking it, but I'd really like to know what I'm treating first. I also don't want to have to take it everyday as I'll certainly build up tolerance.
posted by lackadaisical at 11:58 AM on April 8, 2011
The beta blockers should help with adrenaline, which is why some stage musicians take it: it keeps their hands from shaking. Poker players often take them as well for similar reasons. Although those are not medical reasons, they do illustrate what adrenaline can do and how it can be dealt with. Given that you are already doing a lot of the stuff for stress reduction (exercise, meditation), I would give it whirl for week.
To figure out if you are getting a surge of adrenaline, you collect your urine for 24 hours and have it analyzed. Straight-forward. I gather that it is a rare condition which is why your doctor may not have considered it but I would rule it out.
posted by PickeringPete at 12:07 PM on April 8, 2011
To figure out if you are getting a surge of adrenaline, you collect your urine for 24 hours and have it analyzed. Straight-forward. I gather that it is a rare condition which is why your doctor may not have considered it but I would rule it out.
posted by PickeringPete at 12:07 PM on April 8, 2011
This happens to me too. I have a panic disorder. I talk Zoloft, which helps, but I still have minor episodes. The attacks are worse if my blood sugar is low. I do think it is biological.
posted by wandering_not_lost at 12:23 PM on April 8, 2011
posted by wandering_not_lost at 12:23 PM on April 8, 2011
Along the Pavlovian lines.... is it possible that as a young child you were abused right before/after bedtime (which for children is often just as the sun is setting)?
I very much hope this is not the right answer; best of luck in figuring this out.
posted by CathyG at 1:55 PM on April 8, 2011
I very much hope this is not the right answer; best of luck in figuring this out.
posted by CathyG at 1:55 PM on April 8, 2011
Dysautonomic disorder somehow mediated by circadian rhythm? Neurologist might be able to figure that out.
posted by fairytale of los angeles at 2:34 PM on April 8, 2011
posted by fairytale of los angeles at 2:34 PM on April 8, 2011
Sounds like blood sugar problems to me, too.
Eliminate artificial sweeteners and if that doesn't do the trick get evaluated for hypoglycemia/diabetes.
posted by jamjam at 3:33 PM on April 8, 2011
Eliminate artificial sweeteners and if that doesn't do the trick get evaluated for hypoglycemia/diabetes.
posted by jamjam at 3:33 PM on April 8, 2011
I don't have a citation for this, but I was just told that getting angry (or even with practice, just inducing the physical tension and other effects of anger) can offset similar symptoms - might try experimenting with mentally inducing strong, righteous anger.
Second, this sound like the kind of thing that if there is a biometric measure of what your increased arousal then biofeedback might be very effective at teaching yourself to counteract your symptoms. (Hypnosis - with a really skilled person - might also be capable of helping but I think it would be harder to find the right person than trying biofeedback).
posted by metahawk at 12:42 AM on April 9, 2011
Second, this sound like the kind of thing that if there is a biometric measure of what your increased arousal then biofeedback might be very effective at teaching yourself to counteract your symptoms. (Hypnosis - with a really skilled person - might also be capable of helping but I think it would be harder to find the right person than trying biofeedback).
posted by metahawk at 12:42 AM on April 9, 2011
Response by poster: Jamjam: I will try your recommendation to remove all artificial sweeteners from my diet. However, it's almost certainly not hypo- or hyper- glycemia. I've checked my blood sugar and I think it was 86 in god knows what units.
Metahawk: Interesting observation. I do find myself involuntarily inducing anger in myself when I do feel the anxiety catching up with me. For two hours, usually from 7PM to 9PM, I have a rush of thoughts in my head about something i really hate or am annoyed by. It doesn't actually reduce the anxiety but it does slightly dilute it with a good amount of self-righteous rage.
Also, the problem with the bloodsugar hypothesis is that I wouldn't be able to actually measure causation. I tcould be my blood sugar rises/lowers with the anxiety or it could be that the blood sugar rises/lowers AND causes the anxiety in question. One wouldn't be able to gauge correlation vs. causation. Still good suggestions.
posted by lackadaisical at 11:47 AM on April 9, 2011
Metahawk: Interesting observation. I do find myself involuntarily inducing anger in myself when I do feel the anxiety catching up with me. For two hours, usually from 7PM to 9PM, I have a rush of thoughts in my head about something i really hate or am annoyed by. It doesn't actually reduce the anxiety but it does slightly dilute it with a good amount of self-righteous rage.
Also, the problem with the bloodsugar hypothesis is that I wouldn't be able to actually measure causation. I tcould be my blood sugar rises/lowers with the anxiety or it could be that the blood sugar rises/lowers AND causes the anxiety in question. One wouldn't be able to gauge correlation vs. causation. Still good suggestions.
posted by lackadaisical at 11:47 AM on April 9, 2011
Just wanted to add that this very same thing happens to me too, exactly at dusk.
Also, I also recommend cutting out artificial sugars, and especially aspartame.
posted by lhude sing cuccu at 6:21 AM on April 10, 2011
Also, I also recommend cutting out artificial sugars, and especially aspartame.
posted by lhude sing cuccu at 6:21 AM on April 10, 2011
This thread is closed to new comments.
So this happens at 6 in the winter and 10 in the summer (those are kinda random... but not at the same time every day, but syncing with sunset regardless of the seasons)?
Does this happen even if you are and have been for a while in a space with no external light cues (no windows, no ability to know if the sun is setting)? How about without any time cues (So no knowledge of where the sun is or what time it is)?
posted by brainmouse at 11:37 AM on April 8, 2011