What a drag it is being anxious
July 7, 2014 6:26 PM   Subscribe

I've finally (I think) figured out that the dreadful speedy feeling I get every day when I wake up (and then off and on throughout the day) has a label: Anxiety. What now?

Following a recent medical appointment, I was prescribed two pills of Atavan so that I could sleep the night after a difficult procedure. Taking this medication (I took half a pill, .5 mgs, and still have the other 1.5 pills), I started thinking about something that typically produces a buzzing feeling under my feet and in my armpits and my stomach, and I realized that I couldn't feel it at all. It was like something clicked: that feeling that I have every morning, like bees are flying around in my veins and butterflies are dancing in my stomach? That's anxiety. I feel these physical sensations every day when I wake up. To curb this, I usually immediately reach for a distraction upon awakening: Metafilter on my phone, my warm cat, a book - and I don't get started on work for roughly four hours after I wake up, no matter what time I wake up. If I rush things, I feel awful all day - discombobulated - and that bee-blood feeling persists throughout my day. And don't even get me started on alarm clocks: I can't use one. It makes me feel like that, but multiplied by a thousand. Sometimes the distraction works and sometimes it does not.

I have a therapist. She is an LCSW and we do CBT. I have been with her for over 3 years. We've been working on some really heavy stuff - I was in an abusive relationship when I started seeing her, and I left him two years ago. We've finally started focusing on things that are not about him during our sessions. I see her every three weeks or so. She has never said the word "anxiety" to me, and I'm not even sure how to bring it up with her. I'm afraid that it will be a bit of a dead end, and that she'll tell me to "focus on the present" and to "be kind to myself as I work through this." That's all well and good, but I want to be more functional and to rid myself of this monkey on my back, sooner rather than later.

I have a lot of "reasons" to be anxious - an uncertain future with my career, lots of medical concerns, financial instability, etc. But I don't seem to have an anxiety trigger - it's just always there, humming away. It really impacts my life. What would my life be like if I could get some control over my anxiety? How would it feel to not feel this way? And how do I get there from here? I am looking for practical advice on everyday things I can do, as well as tips about how to approach this with my therapist and with myself as I work through this issue. I am also struggling with depression, which may be relevant to the question (as well as a host of other health problems that I do not think are germane, except for the uncertainty I have about my lifespan and my quality of life that result from any chronic condition).

I tried looking through the tag here on AskMe but there were over 1,000 posts tagged anxiety and I couldn't wade through more than the first three pages. I apologize if I missed a relevant previous post, and would definitely appreciate a link to it if it is available.
posted by sockermom to Health & Fitness (29 answers total) 19 users marked this as a favorite
I am not a doctor, but you might want to ask your doctor about the condition postural orthostatic tachycardia syndrome (POTS).
posted by Seeking Direction at 6:43 PM on July 7, 2014 [1 favorite]

Is medication an option? Perhaps a visit to a specialist who understands anxiety and depression inside and out would lead to a solution. I think if you print out some or all of what you wrote here, and have a doc go over it with you, you might find out there is a medication that will dial your anxiety down.

It's worth a consultation, do you think?
posted by nacho fries at 6:55 PM on July 7, 2014 [1 favorite]

CBT is a great resource for learning how to cope with anxiety. You should go to your therapist and say something along the lines of "I think I have anxiety. It's really disruptive and negatively impacts my life. Can you help me with gaining some control over my anxiety using CBT techniques?"

One of the funniest things about anxiety is that those of us who have it get anxiety over bringing it up with our therapists/doctors, like we think that they're going to tsk-tsk and say we need to lighten up and that there's nothing wrong with us. In reality, these professionals know that anxiety is a real thing and they WILL believe you if you say you have anxiety that is crippling your daily life and that you need help.
posted by joan_holloway at 7:03 PM on July 7, 2014 [9 favorites]

During a time of particularly high anxiety (and depression) for me, my doctor recommended this CBT-related web site: MoodGYM. It's based on both CBT and Interpersonal Therapy and, as the name implies, contains exercises and so forth that you can work through on your own. At the end of the day, I found the "characters" a little too culturally irrelevant for me (if I recall--too young and college-aged, and Australian which is ok but some vocabulary that left me confused at times)--but it did have some useful quizzes (including a depression quiz and an anxiety quiz) and exercises that did provide a useful basis for discussing some of the issues with someone else. It's free to register--you may want to check it out and if nothing else then perhaps use the quiz or other exercise results to begin a dialogue with your therapist or doctor to explore some therapy or medication specific to anxiety.

I also find those relaxation/meditation type things you listen to sometimes helpful, if a little corny.
posted by freejinn at 7:11 PM on July 7, 2014 [1 favorite]

One thing that might help a lot, if you don't already do it, is doing fairly high-intensity cardio exercise when you get up (maybe running). Even walking could help, but I think the more you can raise your heart rate for an extended period, the more your body will help you get rid of the anxiety.
posted by three_red_balloons at 7:15 PM on July 7, 2014

I was just about to be like--okay, so this is very much me, I have anxious thinking problems but I've always been what I thought of as "high strung" even when I'm not. In I-presumed-unrelated news, I've been having really *noticeable* problems keeping my blood pressure up lately, and so I scanned the comments, and was looking at Seeking Direction's Wikipedia article, and--uh, I think I have to make a doctor's appointment.

What I was going to suggest tends to make me feel better is actually a bunch of stuff mentioned there anyway, so: staying hydrated, beta blockers, exercising regularly. I guess the up side is that maybe all I need to do is make sure I'm more religious about that, and maybe it'll help you, too!
posted by Sequence at 7:17 PM on July 7, 2014

When I was on meds for anxiety, when it first clicked in and my stomach relaxed, I thought - dear gods, this must be what it's like to feel NORMAL. It was amazing. Definitely listen to the above suggestions (exercise works especially well for me) but also talk with your therapist and doctor about this. You might be able to find something that works for you, to help you not feel that way all the time.
posted by RogueTech at 7:21 PM on July 7, 2014 [1 favorite]

Exercise helps (at least 40 minutes, including warming up, at least three times a week was the last recommendation I read). Giving up caffeine made the biggest difference for me, until I finally went on an antidepressant that also helped with anxiety. Lexapro helped a bit, and then my doctor switched me to Cymbalta, and the bee blood (great description!) suddenly disappeared. I hadn't ever really noticed it, either -- it was just background noise -- until it was gone.

After a few years, I just weaned off the medication, and the anxiety is much more controllable now. I think that using the medication to help my neurons rebuild in non-anxious ways gave me a much stronger foundation for putting all the CBT-ish anti-anxiety solutions into place.

If I were you, I'd write down the symptoms you're experiencing (basically your second paragraph here) and get to a doctor. Anxiety that's keeping you from doing anything productive for four hours every day, even after being in therapy for three years (even if you weren't focusing on anxiety, basic self-care skills and basic relationship-building should have made the anxiety better) counts as a fairly big impairment. I would then show the same paragraph to your therapist and see if she has concrete suggestions. You can also check out The Anxiety and Phobia Workbook for other exercises and information.

But, really, you've just said that medication is extremely effective in making you feel better. "Be kind to yourself as you work through this" by finding a way to stop the anxiety for now while you work on ways to keep the anxiety away for good.
posted by jaguar at 7:45 PM on July 7, 2014 [3 favorites]

I don't get started on work for roughly four hours after I wake up, no matter what time I wake up.

If I do something low-key and relatively cerebral in the morning, I take *forever* to get going, too (if I ever do get going that day). To get and keep my morning routine on track, I need to do two things *immediately* upon waking up:

1. Make my bed.
2. Go running.

I highly recommend you try doing those things when you first wake up -- before checking your phone, before coffee, before breakfast, before a shower, before anything. You can't possibly be less of a morning person than I am, and it really helps.

Also, running first thing in the morning really helps in terms of loosening up my muscles and keeping me from being too (physically) tense, and I think that you might find exercising upon waking up to be helpful for those reasons, too. I don't have problems with anxiety, but I have problems with being physically tense to the point of muscle and stomach aches, and with being extremely fidgety -- and in some ways it seems similar to the kind of "buzzing" or internal sense of twitchy-ness that you describe. Strenuous exercise helps me with that more than anything. Heat generally helps, too, so if you're having a difficult time you might want to try at least a hot shower, or time in a sauna or hot tub if you have access to either of those.

I am also struggling with depression, which may be relevant to the question

For a lot of people there's an overlap in both symptoms and in treatment for anxiety and depression, so I think that's it's likely relevant. I also think it makes sense to discuss the symptoms you're experiencing that you think are related to either anxiety or depression with your therapist at the same time/within the same conversation, because of that possibility of overlap.

Are you already taking any medication for depression? A lot of the same medications are recommended for both depression and anxiety, though the doses for anxiety usually seem to be slightly lower. If you're open to trying medication for both/either, I would tell your therapist that explicitly. If she can't prescribe, but you're interested in trying medication, you might have to go through your GP and/or your insurance's behavioral health office/psychiatrist. In general, anti-depressants aren't a big deal to get, though, because they don't really have any street value and aren't addictive -- so it's not some awkward thing or a production for you to ask about or for them, and nobody's going to think you're scamming them or anything like that.
posted by rue72 at 7:47 PM on July 7, 2014

The physical symptoms you're describing don't strike me as anxiety, more like chronic pain or discomfort. I would look info that first, especially since you mention other medical issues.
posted by deathpanels at 8:42 PM on July 7, 2014

Please consider starting with your regular medical doctor. In addition to anxiety, it could be anything from sleep apnea to other things mentioned above.
posted by wintersweet at 9:17 PM on July 7, 2014 [1 favorite]

I'm wondering if maybe the 3-week span between your therapy appointments might be playing a role as well. Is seeing your therapist once or more a week an option? Especially since you've been doing a lot of heavy lifting, emotionally speaking, in your therapy for a long time -- maybe you need a bit more "holding" right now. If additional sessions aren't an option, maybe some other form of nurturance from a trusted, caring person -- massage, etc. -- would help your body be calm and de-buzzed.
posted by nacho fries at 11:03 PM on July 7, 2014

I second beta blockers, and I love exercise, but be careful if you try them in tandem. I was put on beta blockers to try to deal with an unusual type of headache and when I ran while on them I got severe exercise-induced asthma as a side effect.
posted by vegartanipla at 11:19 PM on July 7, 2014

There are some genetic b12 related conditions like pernicious anemia that cause anxiety. You should look into those maybe of your anxiety is so pervasive.
posted by fshgrl at 1:54 AM on July 8, 2014

To me this is akin to 'I have terrible allergies at the start of the day. I'm sneezing all over the place and my eyes water and itch... It really impacts my life. Recently I took an allergy pill for an unrelated issue and I sneezed only once, no watery eyes. What should I do?' If the pills work, ask your doctor about taking them regularly, and stop sneezing. Yes, there are risks as with most medications, but I think a little cost-benefit analysis on that would be worthwhile.

You may find (as I do, and as many others seem to) that simply having Ativan (or similar) available can reduce anxiety. 'Well, if it gets worse, I have this effective option to dial it down' can be reassuring on its own.
posted by kmennie at 4:47 AM on July 8, 2014

I'm concerned that asking for regular Ativan will make me seem like a drug seeker. Also, it's a highly addictive drug, and I don't want to use something so addictive on a long term basis.

This isn't a medical issue that I am misattributing, like sleep apnea or anemia or POTS. I have had medical problems my whole life and I've been checked over thoroughly on a routine basis. I am certain this is anxiety.

Maybe I just need a new doctor and a new therapist. I tried discussing my intermittent anorexia with my GP and she told me I looked great and didn't need to gain or lose weight, which really turned me off. And my therapist isn't super helpful either. If I hear "be kind to yourself" once more, I'll scream. I am trying, but I don't know how.

Thanks for the helpful suggestions re: exercise and discussing medications. I'll give those both a shot.
posted by sockermom at 5:04 AM on July 8, 2014 [1 favorite]

I had almost the EXACT same experience as you - I got a prescription for something like 10 Ativan pills to help with flight anxiety about a year ago, and was SHOCKED when I took them to discover that the maelstrom of thoughts in my head suddenly quieted down and I felt like a normal person, without ever having realized that the persistent background stress I'd always felt before wasn't normal. It took me several months after that before I did anything more about it, though, for the exact reason you just stated - I was afraid that if I talked to my doctor or asked a therapist about medication, they'd think I was a drug seeker.

For what it's worth, I finally did get a therapist and talked to her about my experience with the Ativan, and she immediately referred me to a psychiatrist to be evaluated for anxiety. The psychiatrist agreed with her, and I've been on a low dose of meds ever since - and oh my GOD, what a difference it's made. I am still working with the therapist to develop healthier behaviors to handle the anxiety as well, but I can't believe how long I let myself suffer when the tools to help manage it were there for the asking - my psychiatrist says this is a source of constant frustration for him, the fact that so many people COULD be helped if only they could bring themselves to ask for what they need.

I hope I'm not being naive when I say that I suspect most mental health professionals can recognize the difference between someone suffering from a condition which could be helped by meds, and someone who is seeking drugs for other purposes. The fact that you already have a therapist who knows you seems like a point in your favor - and Ativan isn't the only option if you're concerned about addiction (for what it's worth, while my psychiatrist offered me Ativan as an option, he also suggested Neurontin, which - while it doesn't work for everyone and definitely has side effects of its own to consider - apparently doesn't have the addiction risk. It's been amazing for me).

At the very least, you deserve to talk to your therapist about this - that's what she's there for. Even if she recommends against meds, I doubt it'll be because she thinks you're suddenly seeking drugs for unhealthy reasons, and you'll still have opened up a conversation where you can talk more explicitly about anxiety-managing strategies (or you'll more concretely know you need a new therapist). Whatever approach you ultimately take, I can say that finding ways to be free from (or at least manage) the 'frantic squirrel-on-a-wheel' in your head is SO worth it. Good luck!
posted by DingoMutt at 6:07 AM on July 8, 2014 [3 favorites]

I don't know about GPs, but a lot of psychiatrists actually prescribe Ativan almost automatically (except to former or current addicts of any sort) when prescribing SSRIs or SNRIs, especially for treating anxiety, because the medications can actually ramp up anxiety for a few weeks before the desired effects kick in. (I didn't notice it on switching medications, but it definitely happened when I first started SSRIs.) When you talk to your new doctor, it's definitely worth mentioning that Ativan really helped (it's helpful for doctors to know those things, because not all medications work for all people) and that you're looking for something more long-term.
posted by jaguar at 6:58 AM on July 8, 2014

I wouldn't worry too much about becoming some sort of drug addict unless you've had a history of addiction. I also wouldn't worry about looking like a drug seeker - I don't ask for a specific dosage and medication, I just say "Klonopin has worked well for me in the past" and 99% of the time Klonopin is prescribed for me without them blinking an eye. I imagine the effect is like Ativan even though it's a different drug.

I don't even take it that much; just knowing it's there has reduced my anxiety tenfold. I'm also on a nightly "maintenance" drug (Lamotrigine) that stabilizes my moods. You wouldn't hesitate to take insulin if you were diabetic, right? This is not that different - anxiety is a real, physical thing. And even if you take medication now, that doesn't mean it's indefinite.

What would my life be like if I could get some control over my anxiety?

It is the greatest fucking thing ever. Recent changes in my life have greatly reduced my anxiety and it is sheer bliss. If you can't make any short-term changes, meditation is really helpful. I know "focus on the present" seems like a stupid cliche but once you learn how to do it, it's magic, it's like a switch you can flip. Meditation can teach you how to pay attention to the physical manifestations of anxiety and let it go before it overtakes you.

I agree with getting out of bed right away - don't even think about it, just jump in the shower. Have something to look forward to, like a breakfast treat or luxurious shower gel. I wouldn't read mefi as a distraction, there is too much depressing and worrying stuff on here (the economy! war! sexism!).

I get that buzzy feeling when I've had too much caffeine. How much do you drink? Try reducing it or tapering off completely. My anxiety was also reduced when I discovered I was lactose intolerant, because finally my stomach wasn't upset all the time. It's possible you have other food triggers.

Eh, this is disjointed but hopefully you'll get something out of this comment. In summary, there are a number of ways to approach this and one or more will work for you, I promise.
posted by desjardins at 7:05 AM on July 8, 2014 [1 favorite]

You say
I'm concerned that asking for regular Ativan will make me seem like a drug seeker.
If I hear "be kind to yourself" once more, I'll scream.
Also you say
I have a lot of "reasons" to be anxious - an uncertain future with my career, lots of medical concerns, financial instability, etc.

You don't list your relationships among the "reasons," though you seem concerned with how people see you. You say "you'll scream" but I don't think you will. I think you will try to be "good." CBT is useful for many things but one of its weaknesses is that the patient becomes responsible for everything. An anxious person doesn't feel comfortable with all that responsibility and may even feel blamed for not "getting better" quickly. It becomes your fault for not being kind to yourself, or at least, that's how it may feel. You say you were in an "abusive relationship" which I, without more to go on, am taking to mean that you gave this other person too much power over you. And I think you do that in general, with your therapist, and with us too. You would like us to be able to handle your problem, but you don't really trust us and feel it's all your responsibility and that makes you feel anxious. IANYT so I will stop here, but this is the issue you need to explore.
posted by Obscure Reference at 7:50 AM on July 8, 2014

I'm having a bit of trouble following. What is the issue that I need to explore? Giving people too much power over me, or giving myself too much responsibility? Those do not seem to go together.

I don't think it's my fault that I'm not getting "better" quickly as much as I think this particular path of "be kind to yourself" is not really working. I think I need a bigger boat, here, I guess. I don't want to seem like a drug seeker not because I'm afraid I will look bad but because I actually want help with my anxiety and that perception could thwart my mission.

By "abusive relationship," I mean my ex-boyfriend verbally and physically assaulted me on a routine basis. Boiling that down to "you gave this other person too much power over you" really does shift all that responsibility of being abused on to me, which doesn't sit well. Anyhow, my personal relationships are not a focus of this question, as I no longer find them to be anxiety-inducing, after much work on my part.
posted by sockermom at 8:04 AM on July 8, 2014 [1 favorite]

I think they meant in general.

When you care a great deal what others think of you, wondering if they think you are this or that way, or whatever, you give them power over you, without it actually having to be a relationship.

I let a dead person have power over me for years because her stupid voice always was there, chiding me and being disapproving no matter what I did, just like when she was alive.

This is more of a social anxiety than a general anxiety, as told to me by my pdoc and therapist.

Ativan is not.going to set off drug seeking bells. Doctors rx that for stuff all the time. My pdoc gives it to me so I have it around to take as needed, so did my last one.

GPs will give it at the drop of a hat.

If you go in asking for valium and hydrocodone, THEN they might think differently.

Ativan might help calm things down a bit and let you either figure out what's not working with current therapist or move on to another one.

You can also work with a psychiatrist separately. Or only. I took a break from therapy for a bit and just saw the pdoc.

Drugs are helpful, I have found. They make me.drink way less, if it all, because my mind and body are not a constant mass of bizzy bees making me tired and wired all at once.

Feel free to memail if you want.
posted by sio42 at 8:34 AM on July 8, 2014

I don't want to seem like a drug seeker not because I'm afraid I will look bad but because I actually want help with my anxiety and that perception could thwart my mission.

Hm, you lost me. Drugs will actually help with your anxiety. You can go on medication and do talk therapy at the same time (it's usually recommended). No responsible doctor or therapist is going to think "oh, she just wants drugs instead of actually working on her anxiety."

I recommend the Anxiety and Phobia Workbook mentioned above because it goes into the brain chemistry of anxiety and explains how medication works on that.
posted by desjardins at 9:35 AM on July 8, 2014 [2 favorites]

Maybe I just need a new doctor and a new therapist.

That is the feeling I'm getting, esp. given your updates. Sometimes you just outgrow or outpace a particular therapist's capacity, or your needs evolve to where going with a different approach makes more sense.

And your MD's "advice" about your sometimes-anorexia is unhelpful, to put it diplomatically. A new MD is in order, I think. I bet you can do some online research and find one who will be a much better fit for you.

I think it's great that you are re-assessing the care you are getting, and beginning to advocate for the best possible treatment you can get. I think too once you are able to entrust some of that re-assessing to a trained, compassionate professional, you will feel some relief from the buzzing anxiety, whether or not you opt for medication.

Growing pains are part of the growth process, but it would be great if you can get some help reducing the pain part a bit. Hang in there.
posted by nacho fries at 10:50 AM on July 8, 2014

FWIW, those drugs don't publicly exist and received FDA approval because they are there for people to abuse, they are there to help people with this condition. I see a therapist and take klonopin for my anxiety AND exercise and limit caffiene and quit alcohol. It helps. I think as long as you have tried other avenues than just the drug route then if they help, then that is why they are there.
posted by floweredfish at 12:52 PM on July 8, 2014

Giving people too much power over me, or giving myself too much responsibility? Those do not seem to go together.

They go together for me and my anxiety. It is putting too much responsibility on me if I try to meet every demand (spoken, unspoken, and imagined) that other people put on me. Especially when other people aren't actually being demanding; they're just making reasonable requests or going about their day not doing anything, and it's my anxious mind giving them the power to crush me if I don't anticipate and comply with their (imagined) demands.
posted by Bentobox Humperdinck at 1:52 PM on July 8, 2014 [3 favorites]

My anxiety trick, which I remembered today, is to hold my fingers to my neck/chin and feel my pulse. For some reason it is the most calming thing I can do. As well as having an adequately full stomach. Which is easier said than done because anxiety is an appetite wrecker for me. But I have a few go to meals (rice and tuna is one) that are simple and filling and often help a lot.
posted by ambrosen at 11:56 AM on July 9, 2014

oh, I totally forgot my favorite quick anti-anxiety trick! The mammalian dive reflex.
posted by desjardins at 12:19 PM on July 9, 2014

Oh, I just noticed that the article specifically says to avoid this if you have an eating disorder, so caveat emptor.
posted by desjardins at 12:20 PM on July 9, 2014

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