Anxiety! The Musical.
June 3, 2014 10:17 PM   Subscribe

So, it's been a mothereffing year, and really longer than that, and I have some anxiety that I thought was okay, but is really, it seems, not.

Without getting into identifying details, from fall 2011 on my primary relationship was on the rocks and there was a major illness in the family. The illness ended in death and the end of the relationship both occurred early this/late last year.

During this high stress time, there was a triggering event that caused me to have unresolvable anxiety that I chose to medicate. The doctor started with Celexa. In the end, the sexual side effects were not okay, along with the fact that I felt like I was 10,000 feet above my own life at all times. I went from I FEEL EVERYTHING ALL THE TIME to "I am not sure I have feelings."

I tapered down off the celexa and never went back to being medicated. I felt like I was dealing with everything fine, but lately there have been events in my work and personal life that have caused the anxiety to spike. Outside of these spikes, I feel like it's pretty manageable, but obviously sometimes these precipitating events have long tails, which is what I'm dealing with now.

I know that it's happening and I mostly am able to deal with it on an intellectual level, but I feel like just being very self-aware and quote-unquote "self-identifying" is not enough. I KNOW that my anxiety manifests in ways that I'm not 100% aware of until it's in progress, and then the fact that I feel like I'm being offputting causes me MORE anxiety. It's a vicious cycle.

I am freaked out about medication again. I feel like the CBT things I know are not enough to resolve the issue. I don't feel like I have anything to say to an actual therapist at this point, but I could be wrong. I just feel like if I go to talk therapy I'm not going to have anything to say, because I feel talked out about everything. I have no idea how to proceed without wrecking my sex life (medication), which is at this point pretty high on my list of things I'm actually happy about right now. I'm looking for suggestions about how to move forward managing my anxiety, in particular when it spikes, as I'm dealing with now.
posted by anonymous to Health & Fitness (17 answers total) 15 users marked this as a favorite
Good question! I can't wait to read the answers.

My suggestion is yoga. Regular yoga gradually loosens the mental clenching and hyper-reactivity that are anxiety for me. Parts of yoga are also like meditation for me, where I can see my thoughts floating by and look at them without reacting to them. Good luck.
posted by salvia at 10:29 PM on June 3, 2014 [4 favorites]

I'm in the same boat as you - having had a similar experience with anti-depressants, I won't go back on them again either. I started meditating a few months ago and it's really helping me keep my anxiety in check. Are you staying active? Exercise helps a lot, too.
posted by deliciae at 10:35 PM on June 3, 2014

My suggestion: meditation. Whenever and wherever you need it. Even one minute mediations while waiting in a queue or at the traffic lights can have a meaningful cumulative effect.
posted by Kerasia at 10:36 PM on June 3, 2014 [2 favorites]

Related to the ideas of yoga and meditation: exercise. Running has been really helpful for my anxiety issues. Exercise can have meditative aspects, if that's what works for you, but it can also be very focusing in an aggressive way (competition or self-competition). Also, a good run, swim, game of soccer, etc. is physically exhausting to some extent, which can help with sleep. For me, the worst part of dealing with anxiety is not being able to sleep.
posted by mr_roboto at 10:55 PM on June 3, 2014 [2 favorites]

Dear anon,

Although our issues are different, I think I share the same boat with you--previous suggestions are right on the dot with regard to yoga, meditation and staying active.

I sometimes practice mindfulness based stress reduction/mindfulness based cognitive therapy,
you can find several of these guided meditations online--this series of short ones by Mark Williams is something I'd like to practice more. As suggested in other questions here, the exercises in reducing stress in the Relaxation Response could be helpful too.

Good luck!
posted by wallawallasweet at 10:58 PM on June 3, 2014 [2 favorites]

Like you and deliciae, I had a similar issue with medication and I haven't figured out any perfect solutions yet. Definitely cut back on caffeine as much as possible and get on a regular sleep schedule if you haven't done these things already. Yoga and guided meditation have helped me, as well as regular exercise (but not too much or it can be its own cause of anxiety). Fit in time to do things that relax you, like reading a book.

Make sure, even if you aren't in therapy, that you talk to people about how things are going - confide in someone, even if only on a surface level, about how you feel.
posted by Red Desk at 10:58 PM on June 3, 2014 [1 favorite]

When I saw a doctor for anxiety, I said that I'd previously tried a lot of the SSRIs and wasn't interested and so I was prescribed buspar/buspirone, which is not an SSRI. She happened to mention that it was unusual to start on it but it was often what was prescribed to people who had issues with sexual side effects of the common SSRIs. It seems to be somewhat hit or miss from what I read about it online prior to taking it, but it was very much a hit for me, like flipping a light switch. If a friend came to me with your story I would definitely recommend they ask their doctor about it.
posted by feloniousmonk at 1:07 AM on June 4, 2014 [2 favorites]

benzodiazepines (e.g. Clonazepam) won't affect your sex life. And they work for almost everyone immediately.
posted by persona au gratin at 2:10 AM on June 4, 2014 [1 favorite]

Benzos and Buspar, mentioned above, tend to have very mild to non existent side effect profiles. (Buspar in particular is often felt to have no effects at all. That hasn't been my experience but YMMV.)

The other basic move I have is to acknowledge the anxiety and move on.
posted by PMdixon at 3:55 AM on June 4, 2014

Interrupting your thought spirals can help. Do you like puzzles? For me, solving a difficult crossword (for example) completely engages a different part of my brain than where the anxious thinking lives. A little TV also helps.
posted by the_blizz at 4:34 AM on June 4, 2014

If you're just looking to manage anxiety spikes, how do you feel about antihistamines? I have a prescription for Vistaril (Hydroxyzine Pamoate), and I take it once in a while. It helps to reset me somehow.

The next day, I am groggy as heck, but I find I don't have to take it every day. See if you can get 'script and try it on a night when you don't have to work the next day. I've also known people who take Benadryl, ymmv, this other stuff has something in it that I feel really does help break the cycle.

Definitely yoga or exercise, like walking.

Hobbies, I like gardening, very peaceful having to take care of plants, even a pot of herbs or flowers. Rocks, something very calming about holding a millions of years old rock in your hand. They make worry stones with a hollow spot for your thumb, great for keeping in your pocket and rubbing, especially in places where you can't escape (like work).

Essential oils can help. Since you seem to have a willing partner, try putting some essential oil drops into some olive oil and having them give you a massage (take turns!). Super relaxing! Go to a health food store or Whole Foods and smell them and pick one out that appeals to you. If this isn't possible, massage the oil on your temples (lavender is relaxing, but it's your preference, you're the one managing your anxiety).

For things like muscle tension, I have those herbal packs that you can put in the microwave and drape around the upper back and collar bone.

I also take a B-complex and Vitamin D (as mine is low). Magnesium can be relaxing, as can a bath with Epsom Salts. I don't notice the B vitamins unless I forget to take them. Then I really notice.

Diet and nutrition: a nurse practioner told me a long time ago to start eating avocados. Here is an article about some foods that can help manage stress. I see almonds on the list, and just realized I eat a handful of almonds most every afternoon. Cooking and getting into those aspects of managing your stress that way can also be relaxing and gives you a sense of control over it. Make sure you're eating enough and the right things to keep your blood sugar from dropping too low.

And really, it's okay to take a mental health day just for yourself once in a while. Run a hot bath or take a hot shower and throw on some comfy clothes and watch your favorite TV shows or movies.
posted by Marie Mon Dieu at 7:18 AM on June 4, 2014

As another possible SSRI alternative, my psychiatrist has had me on neurontin for a few months now and it has done WONDERS for me. Like feloniousmonk said about buspar, according to what I've read online it sounds like neurontin is also rather hit or miss, but I don't believe reduced sex drive is among its side effects and again, my anecdotal experience has been that if it does work for you it really works.

Additionally, I've found Edmund Bourne's Anxiety & Phobia Workbook to be helpful.
posted by DingoMutt at 7:22 AM on June 4, 2014

+1 to people suggesting benzos -- but the key as I understand it is that you get them prescribed "as needed", for when your anxiety spikes, not for every day, and you take the smallest dose that works. I had great success with clonazepam for anxiety spikes and especially for when my anxiety gave me insomnia. I had .5mg tablets and a quarter or half of one was enough to be effective. (I'm a small person and react readily to meds, though, so your physiology may vary.)
posted by clavicle at 9:24 AM on June 4, 2014

I'm looking for suggestions about how to move forward managing my anxiety, in particular when it spikes, as I'm dealing with now.

For acute anxiety episodes, really benzos are the best thing. Many people have the experience even of just having them on them, and not even taking one, to be enough to calm their anxiety down quite a lot, because people (including my anxiety-prone self) tend to panic about becoming anxious, and you get in this cycle. So just knowing you have an emergency button that will cease all panic can be immensely effective.

Benzos are fast acting drugs that increase the amount of GABA (a primary inhibitory neurotransmitter) in your brain and calm you down. They were originally developed to treat epilepsy and other seizure disorders, but at low levels (say 0.25-2 mg of something like Klonopin, as opposed to 10-20 mg Klonopin for a big seizure), they are very, very effective anxiety reducing drugs. They are immediate onset (half an hour on average, depending on the exact benzo), and don't have any lingering side effects if taken on a sort of as-needed basis. There's no 'ramp up' period like you'd have with Celexa, and none of the sexual issues.

It's a fairly big class of drugs, with the most common drugs being probably Xanax, Valium, Ativan and Klonopin. The biggest difference really among them is the degree of their effect and their half life (how long the effect lasts), with Xanax on the short end (effects lasting 1-2 hrs) and Klonopin on the long end (effects lasting 6-8 hrs).

Now, if you google benzos you will find lots of scary stories about dependence. The fears are not totally without merit, but like all medical advice on the internet, take with lots of salt. Benzos are a controlled substance and you can build a tolerance to them and if you take them regularly (everyday) and use them to treat a general anxiety disorder as opposed to acute episodes, you do run the risk of dependence and related problems. But for many (probably most) people with a benzo prescription, it's not really a worry. For me and lots of folks I know, the tiniest bit can be pretty effective - even just a quarter of the smallest tablet available.

Like I said - benzos are really best for acute type anxiety. Yoga, meditation, diet, CBT, SSRIs, etc are better treatments for long-term, general anxiety disorders, where you need to sort of reduce your overall, all-the-time anxiety. But for spiking anxiety periods, benzos can be a real life saver. I'd talk to your doctor.
posted by Lutoslawski at 9:59 AM on June 4, 2014 [1 favorite]

Mindfulness meditation really helped me, particularly the guided meditations by Jon Kabat-Zinn (who developed the mindfulness-based stress reduction that is used in clinics, hospitals, etc.). I think this video is a good starting point, particularly for people who are new to meditation and find it extremely hard to get out of the constant stream of thoughts and commentary running through their minds.

It's a very down-to-earth application of mindfulness, and Kabat-Zinn's insights are just great. There's nothing spiritual or 'new-age' about it. I do one of these guided meditations a day and when I started I noticed an improvement almost immediately.
posted by sweetshine at 10:28 AM on June 4, 2014 [1 favorite]

I think it would be useful to go back to the doctor with the information you now have about what works and doesn't for you. (Including which and how well things like vigorous exercise, meditation, and long walks work or don't for you.) There are a number of different types of meds for anxiety, both long and short-term, so maybe give another kind a chance.
posted by Margalo Epps at 5:08 PM on June 4, 2014

Celexa made me a total zombie. I know people who are on it and love it, but I also know a lot of people who had similar zombie-esque issues on it. I have been very happily medicated on Zoloft, Lexapro, and Cymbalta (in succession, not all at once!).

Other antidepressants will not necessarily have the same negative side effects as Celexa.
posted by jaguar at 9:26 PM on June 4, 2014

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