What do you do about longterm chronic anxiety becoming acute?

April 12, 2018 1:21 AM

I have had many sessions with good therapists over decades and am fluent in CBT and ACT. I dislike the impact drugs have on me. Recently I have experienced an increase in anxiety that is impacting significantly on my life (without an external triggering event). I have flexible, rewarding work, sufficient income, loving partner, great friends, reasonable health, but my anxiety has increased to the point it is interfering with my daily life (daily panic attacks, chest pain, speech impediment, avoidance of necessary tasks). I still apply the tools of cognitive behaviour therapy and acceptance committment therapy. After years of experience, I dislike using SSRIs to manage my moods because they flatline me, and reduce the level of happiness I can experience. Is there anything else I can do? (Cis-F, 50, Australia, autistic, post-hysterectomy, still have ovaries, social anxiety rules out social support options).
posted by anonymous to Health & Fitness (13 answers total)

It's quite possible that at fifty you're experiencing the hormonal shifts of what would be menopause, except that you don't notice it directly because you're post-hysterectomy. A sudden increase in anxiety can definitely be the symptom of a hormonal change. Checking with your doctor to see if you are, in fact, menopausal might help you determine a treatment plan. There are all sorts of things that people recommend for mood swings in menopause, including diet changes, exercise, and possible hormonal supplementation, which would at least not be an SSRI.
posted by Rush-That-Speaks at 1:26 AM on April 12, 2018 [3 favorites]

Also anxiety is one of the side effects of your thyroid deciding to be weird. Worth going to your GP and talking to them about it- you can get blood work done every so often under medicare, so it's free. Could also be vitamin D deficiencies, these are things that can all be diagnosed with a simple blood test.
posted by freethefeet at 1:50 AM on April 12, 2018 [4 favorites]

You don't mention it but do you exercise? I feel the same as you about SSRIs but the only other thing that helps me manage sometime crippling anxiety is to move, frequently.

It's not easy to motivate myself because honestly, my preference is always to stay in my head, not in my body, and I detest spending time on activities that feel artificial (so standard gyms categorically do not work for me). As such cycling is my preferred form of exercise because I have a decent length commute and it's a functional activity, but running or even fast walking circuits around my home work at a pinch. Absolutely no managed activities though - races and events are not for me - sporting competition is an anxiety inducer that I can do without.

In summer I spend time digging and weed clearing in the garden - basically anything that involves breaking a sweat outdoors is good. Exertion helps a lot, but sunlight and air crank up the benefit exponentially.

Communal activities that involve natural spaces without a lot of social pressure also helps with social anxiety. I belong to a local conservation group (we clear overgrown spaces, repair fences, thin foliage etc), and I also like to climb outdoors when I can.

Maybe some things you could explore there?
posted by freya_lamb at 3:41 AM on April 12, 2018 [5 favorites]

I’m a raging bag of anxiety and my gp prescribed swimming as menopause loomed. To just be in the water. It works when I have time to do it. It sounds simple and too simple to be effective. But it does work.

If you message me I may have other suggestions that can help. But water settles me in crisis. My sister’s son has autism and he also settles with water.

( A thought-have you ever used NAC ? )
posted by taff at 3:46 AM on April 12, 2018 [3 favorites]

After years of experience, I dislike using SSRIs to manage my moods because they flatline me, and reduce the level of happiness I can experience.

I was recently prescribed propranolol for anxiety symptoms. Given that you're describing a lot of the physical symptoms of anxiety, it could be worth exploring this route. I haven't noticed any significant mood changes, but it does quell the physical stuff I get like chest pain, tingling and sweating, and can be taken at need rather than being a regular course. The other things that help are swimming and mindfulness meditation. Anything that slows my mind down is beneficial. Also, you don't mention if you drink, but alcohol, even in moderation, can be something which causes an anxiety backlash the next day. Of course, small amounts of alcohol can also provide a genuine positive pleasure, which might be beneficial to some people, so it's not cut and dried on that one.
posted by howfar at 3:59 AM on April 12, 2018

Another +1 for propranolol - I took it for a long time for anxiety (can't take SSRIs due to bipolar) and it was particularly good for reducing the physical anxiety symptoms enough that I could function much better. I also didn't notice any mood/psychological effects, but I will say that it only really worked on the physical anxiety symptoms and didn't do a lot for psychological anxiety symptoms like specific worries and rumination. But getting the physical anxiety under control gave me a lot more space to work on the other ways that anxiety manifests.

I also agree with everyone who said exercise is the biggest non-drug game changer. I feel so much better when I exert myself enough that I can feel it at least once a day. Doesn't have to be huge/time-consuming - I started with ~5mins of rowing or weights every day and then gradually added more activity in (because I was enjoying it so much and it was working so well, rather than because I had to work out for a longer period to keep feeling good).
posted by terretu at 4:43 AM on April 12, 2018

social anxiety rules out social support options

With kindness, if you are "fluent" in CBT and ACT then you know that this is not the attitude that will help you. Avoidance is the fuel of anxiety. Avoiding social interactions is a double-whammy -- you feed the social anxiety itself, while also depriving yourself of a HUGE source of support and wellbeing.

Both CBT and ACT emphasize taking an approach orientation to your life. It's not just about what you tell yourself (the cognitive restructuring/accepting thoughts) -- it's about doing things that you are anxious about, but will ultimately increase your functioning and help you to live your values. Discomfort is not your enemy, avoidance is.
posted by Bebo at 4:48 AM on April 12, 2018 [6 favorites]

I have recently read about Vagal stimulation for decreasing inflammation. It's not so much woo as not yet tested rigorously. It always gives me a respite.
1. In this case surgical, cited for reference.
2. Psychology Today writer Chris Bergland has written a lot about this.
3. Vagal Maneuvers. You can make yourself woozy with the Valsalva Maneuver, but you can do it gently to assist with feelings of acute anxiety or panic. I use it to control abnormal heart rhythm as well as anxiety. It's not a bad idea to talk to a health care professional about this 1st.
4. Very cold water on the face, I use a cold wet washcloth, stimulates the Mammalian Dive Reflex, and slows heart rate. I learned this from a therapist, for controlling panic attacks.
posted by theora55 at 5:36 AM on April 12, 2018 [2 favorites]

Another +1 for propopanol. It's a beta-blocker; it has no effect other than halting the physical symptoms of an anxiety episode; it is utterly non-addictive; you only take it as needed.
posted by DarlingBri at 6:02 AM on April 12, 2018 [1 favorite]

I’ve never tried it, but have been reading a lot about CBD oil for anxiety lately. It seems many people find it very effective and without the flattening effect of SSRIs or other side effects. They describe it as simply the absence of anxiety.
posted by HotToddy at 6:07 AM on April 12, 2018 [2 favorites]

I also started taking a beta-blocker, though not propopanol. In my case it's daily; my blood pressure was apparently borderline high when I went for help with anxiety and they suggested trying this medication for the blood pressure + anxiety. It really reduces the physical symptoms I associated with anxiety (but may have been aggravated by blood pressure).
posted by BibiRose at 6:35 AM on April 12, 2018 [1 favorite]

I also used a beta blocker when my anxiety symptoms started to really interfere with my daily life. I took a very small dose daily then weaned myself off after about a year.

Have you checked whether you have any vitamin deficiencies? A magnesium deficiency can contribute to anxiety, for example.
posted by ukdanae at 2:38 PM on April 12, 2018

I wonder if it's the stability of your life that is triggering the anxiety.

I am the most anxious when everything is on an even keel. Not that I'm encouraging you to sabotage yourself, but maybe you are not fulfilled by normalcy and stability.

If you can find something that you are passionate about that is just a bit disruptive it may help you focus your anxious energy. Moving into a more intense area of your line of work could use up the tension you seem to accumulate.

Failing that, grueling physical labor is the best cure for an anxious mind.
posted by ticktickatick at 7:10 PM on April 13, 2018