New, unreasonable anxiety
June 5, 2014 6:59 PM   Subscribe

I've recently started to experience unreasonable anxiety about a lot of everyday activities.

Over the last six months to a year, I've started to live in paranoia about a lot of things I used to do comfortably. I'm terrified of what could happen. I used to ride my bike to work (on busy streets without bike lanes), but now I can't imagine riding it around the block. I'll fall and hit my head! Same with hiking -- I read about a rattlesnake bite in the neighborhood, and now you couldn't pay me to get off the sidewalk. Take my dog to a restaurant patio or the dog park? She'll bite a kid or get in a fight. Drive on the freeway? Certain death. I outright refuse to use the gas grill on the porch, and I used to use it all the time. I'm certain it will explode. I'm worried when we run the dryer -- don't they cause fires?

I can't avoid driving. I'm somewhat comfortable once I get behind the wheel -- muscle memory kicks in -- but I still take the long way on surface streets when I can. Anything else I can avoid, I avoid. I spend a lot of time at home reading and watching TV, because I'm too scared to do anything else. If it weren't for my job (where I'm doing okay, for the most part), I wouldn't leave the house at all.

I'm in my early 30s, happily married, no kids. I have bipolar 1, diagnosed about three years ago, and take Abilify, Wellbutrin, and Synthroid. The fear more or less corresponds to the time I've been taking Abilify. I have a prescription for Klonopin, but I try to avoid taking it because I think it contributes to the fatigue I associate with depression. I do not have a diagnosis of GAD, nor do I have a diagnosed thyroid problem (I take a small dose of Synthroid to manage my mood, metabolism, and fatigue, and my thyroid labs stay on the high side of normal).

I've complained to my psychiatrist, but he doesn't seem concerned.

My therapist, whom I've been seeing for almost two years now, says that I'm anxious about big-picture stuff -- a potential cross-country move, planning to have a baby, a new job. Since I can't do anything about the big-picture stuff, I place the anxiety instead on avoidable activities, so I can feel like I'm doing something about it.

I feel like that's kind of a cop-out. Yes, I am anxious about that stuff, but I've always had something to worry about and it's never crippled me like this.

I've tried meditation, yoga, and exercise to little to no effect. Meditation I could never stick with. I feel great while I'm doing yoga, but there's always the fear in the back of my mind that I'll have to drive home. I used to run a lot too -- 20 miles a week or so -- but I've gotten out of the habit, and I still felt anxious when I was running then. In fact, I can't even run my favorite routes anymore, because they're on a busy road and I'm scared. Part of the reason I've stopped running is because I'm stuck on boring .5-mile laps in my neighborhood to avoid traffic.

In regards to sleep, I either don't sleep at all or sleep too much. I'm in a sleeping-too-much phase right now. I'm coming out of an insomnia phase, which we treated with Klonopin. Even when I sleep a lot, I still wake up frequently because my arms to go sleep almost regardless of the position I sleep in. (That's relatively new and weird too.)

Should I make a bigger fuss to my psychiatrist and therapist? Is there any chance this paranoia is related to medication or something else that can be addressed medically? SSRIs make me manic, so they're not an option. Should I ask for a different benzo? Do you have any suggestions for techniques to talk sense into myself? I read this thread and found it helpful, but deep breathing's not necessarily going to help me ride my bike again. And I know I need to start running again, but some encouragement would be welcome. Thank you.
posted by anonymous to Health & Fitness (11 answers total) 9 users marked this as a favorite
Should I make a bigger fuss to my psychiatrist and therapist?

Yes. It doesn't matter if you're secretly worrying about "big picture" stuff--it's manifesting as anxiety that's getting in the way of your life. Print this post and bring it with you, even. It has a list of all the things you aren't doing for reasons you know are fears blown way out of proportion. I had this sort of anxiety show up out of nowhere like a year and a half ago. I've always been a kind of anxious person, but it just got ridiculous. I made a list of examples and took it with me.
posted by hoyland at 7:52 PM on June 5, 2014 [1 favorite]

I had this sort of anxiety and it got worse and worse until I couldn't leave the house, answer the phone, or open the mail. I finally got on 1mg/night of clonazepam (Klonopin) and it got better within days.
posted by Jacqueline at 8:06 PM on June 5, 2014 [2 favorites]

I would encourage you to dwell a bit on what your therapist said. Those are major life changes, 3 of them. Much bigger than run of the mill, always something to worry about kind of stuff. How much time are you putting into talking over the big picture stuff with your partner and others you're close to, or thinking through and daydreaming and imagining and feeling and journaling your thoughts on the big picture stuff? Bringing that stuff to the forefront of your anxiety management efforts might help.

Your post reminds me of a therapy session I had where I went in with legit medical evidence that my anxiety was Worse and I wanted to know Why and How To Fix It. My therapist was all, I believe you that it's worse, I suspect it's because of X, Y, and Z that we've already discussed, and you could choose from among tools A, B, and C that we've already discussed. Part of me was disappointed not to get a new/different/better explanation. But part of me was relieved that I might not need any new answers. It was a lightbulb moment where I realized that my panicked search for why am I so anxious right now, this feels different, why is it worse, why is it itself partly driven by the anxiety, even if it is provably different and worse by the numbers. For me, it meant I wasn't going to be in therapy forever, constantly learning new tools; I just needed to use the same tools with a bit more persistence.
posted by Bentobox Humperdinck at 8:10 PM on June 5, 2014 [4 favorites]

Hoyland is exactly right.

And to add to that, anytime you're on psych meds (or any kind of meds) and something changes like this, you need to make a fuss to your docs (and if they won't listen, find new docs - which I know is the last thing anything on meds wants to have to deal with, and finding the energy for the fuss is hard even when you're well, but.) Psych meds are powerful stuff, and things can go wrong (ask my partner about the negative interactive with the Tamiflu and the lithium poisoning, and that was just in the last 6 months). I'm not trying to scare you, I'm just saying - you are experiencing life altering anxiety, you know something isn't right (it oozes out of your post), and your docs should be taking it more seriously.

Hang in there. (And if the yoga helps you feel better, there are a ton of free do it at home yoga videos online. That would let you get some practice in without the driving anxiety hanging over your head. You can work within the limits you have at this moment, you know?)
posted by joycehealy at 8:10 PM on June 5, 2014 [1 favorite]

I went through something similar and CBT changed my life.

I wasn't able to leave the house without panicking, I had to stop running daily, it was bad. And I couldn't attribute it to anything in particular, so talking it out just made me freak out more because I had no idea WHY I couldn't leave the house and I kept panicking.

So I found a CBT therapist and learned how to just deal with those thoughts, those barfy feelings of, "OMG I'm going to have a panic attack!" and now years later, I'm back to fine.

Every few months those unreasonable Anxiety Monster thoughts rear into my brain, but I can deal with them now.

I would find a therapist who specializes in CBT and get started. It's really good stuff; I went to a 12-week program and the benefits are with me every day.
posted by kinetic at 3:36 AM on June 6, 2014 [1 favorite]

For what it's worth, when I was on a really high dose of Wellbutrin (450 mg XL) and added in Abilify as an adjunct because the Wellbutrin wasn't helping much, I started to experience a ramp-up in anxiety--I'm apparently not the only one, either.

I do think your psychiatrist should be taking this more seriously: "If it weren't for my job, I wouldn't leave the house at all" is a pretty serious level of anxiety. It sucks that an SSRI is not an option, but there are other non-SSRI options besides Wellbutrin that may be worth exploring.
posted by drlith at 3:36 AM on June 6, 2014

(I should note that I don't have anxiety issues in general and I didn't experience anxiety in response to Wellbutrin monotherapy)
posted by drlith at 3:37 AM on June 6, 2014

Definitely kick up a fuss. That's what you're paying your doc for. I haven't taken Abilify, but I have taken Zyprexa. And while it helped for a while (I took it for severe PTSD), it took a turn and I started having panic attacks right and left. When I wasn't panicking, I was pretty much crawling the walls with anxiety. I couldn't function on that stuff. So it is definitely possible to have an opposite reaction (damn it, I can't think of the right word) to the drug.

Keep working with your therapist and make an appointment to see your doc ASAP. You don't have to live like that. Good luck.
posted by kathrynm at 7:05 AM on June 6, 2014

I live with anxiety that was managable, right up until it wasn't. Since you're on a lot of meds, you need to get buy in from your Psychiatrist, but fuss until you get something for anxiety. I use Celexa and now I can actually drive through tunnels and over bridges and fly-overs without crying.
posted by Ruthless Bunny at 8:17 AM on June 6, 2014

Yeah, make a BIG FUCKING DEAL to your psychiatrist about this, ASAP. This is a huge problem that s/he should be managing. Make sure you mention that it corresponds to the Abilify.

Anxiety could be a too-much-thyroid thing. It could be a Wellbutrin or Abilify thing. In any case, your meds aren't working and that's a big, big deal.
posted by the young rope-rider at 9:41 AM on June 6, 2014

Is there any chance this paranoia is related to medication or something else that can be addressed medically?

To be more clear, very much yes. Synthroid, Abilify, and Wellbutrin can all contribute to anxiety, and with klonopin you can get bounce-back anxiety. In fact, all of these things are so strongly associated with anxiety that I'd assume one of them is the culprit before assuming it's about major life stresses or something.

Also, cut caffeine if you're on it.

Honestly, I'd try to find another psychiatrist, because this one is letting you down in a really serious way right now--the described change in your quality of life is severe and really not something to wave away.
posted by the young rope-rider at 9:44 AM on June 6, 2014 [3 favorites]

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