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Surviving Anxiety

80 points| gabrielhn | 11 years ago |theatlantic.com

87 comments

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jawngee|11 years ago

I can relate to this. I took klonopin for 10+ years, just recently weaned myself off of it (six months and counting).

My first panic attack happened about two weeks after 9/11 on the F train. Top 3 most terrifying moments of my life.

I did CBT, talk therapy, all kinds of anti-depressant medications (the worst being Effexor XR, that shit should be illegal) until finding klonopin to be the most effective. Marijuana was helpful too, though it had its moments of making things worse, but for the most part A+++ rating, would smoke again.

My anxiety manifested itself in some pretty severe panic attacks, extreme hypochondria and some pretty intense derealization. I miss the derealization though, but it took awhile for me to appreciate it instead of fearing it. The hypochondria I don't miss at all. The panic attacks still happen from time to time (mostly when the lights in the room suddenly change) but I'm so used to them now they don't really phase me. And I'm so practiced at having them, nobody standing around me is ever aware that I'm having a sudden bout of tachycardia and growing concerns that my heart is about to explode in my chest.

I noticed the klonopin was making me kind of a zombie, putting a mega-kabosh on the creative output, so I decided to taper my way to freedom. The first two weeks without it were pretty painful, but now it's relatively smooth sailing.

I'm not sure what happened that I got to this point now. I did move to a foreign country (Vietnam) so I'm sure the slower pace has had something to do with it, despite how much I've grown to dislike living here.

As for what caused it, all of my therapists think I have PTSD from my high school days (I was in a pretty violent anti-racist skinhead group back in the day), but I personally think it has to do with all the MDMA I chewed in the post-skinhead rave days. I guess I'll never know.

refurb|11 years ago

Honestly benzodiazepines should almost never be taken long-term for anxiety. They are fantastic drugs for short-term use, but in the long-term they tend to only make things worse.

You don't have to take them for very long to have withdrawal symptoms after stopping. The effects of stopping can include crippling anxiety. Not exactly the best thing for someone having bad anxiety in the first place.

throwawayokay|11 years ago

I've been on meds for about 15 years, with one year off. The last 11 years I've been on 75mg of Effexor, and it's been a miracle drug for me, with the only side effect being a mildy suppressed libido. And 75mg is a pretty low dose, less than half what is normal for treating depression.

I'm not keen on being a slave to meds, so I'm currently weaning myself off 1mg a day (Effexor is notoriously bad to quit cold turkey). I did this a couple years ago and got to 30mg before I felt like I was experiencing anxious symptoms. These days I'm married, I meditate, and am all around less of a spazz.

"I'm so practiced at having them, nobody standing around me is ever aware that I'm having a sudden bout of tachycardia and growing concerns that my heart is about to explode in my chest"

Believe me, I recall that sensation, and I don't miss it. If I need to take meds for the rest of my life to avoid those types of experiences, so be it. When I was preoccupied with dealing with that level of anxiety, I was missing out on more than I realized.

hvs|11 years ago

Effexor XR was very helpful for both myself and family members. Just because something doesn't work for you doesn't mean it should be "illegal".

rhino369|11 years ago

Zoloft worked great for me with Kolonpin as a backup if I had an anxiety attack. But once Zoloft started working, I didn't have to use it.

I took Zoloft for about 8 months and then weaned off and I feel back to normal.

Pot and Kolonpin (and other benzos) are really only for temporary treatment. I'd recommend taking SSRIs but you have to wait for the 6 week ramp up period to see if it works. If it doesn't, you have to change SSRIs.

foobarqux|11 years ago

Can you talk more about your experience with Effexor?

cbd1984|11 years ago

It would be great if there were better ways to get the active ingredients in marijuana into people without hoping the plant has them in the right ratios, doesn't have the chemicals that cause bad side-effects, and doesn't need to be smoked (which hurts the lungs) or eaten in a fatty solution (which causes weight gain, which hurts everything else).

someone903209|11 years ago

Weed (because it has no real downsides to me personally) and once-a-year DXM (for depersonalisation) were mildly effective, but the clincher has been learning about buddhism / the tao. I'm not talking about any kind of spiritual practice, but moreso a change in perspective that simply isn't expressed by anyone around me. Doing the unambiguously right thing in the best way in any circumstance with no effort or conscious thought is powerful. I started with the question "How do I talk to people correctly?" and found "right speech" and went from there. Nearly two years later I can say it's been transformational at lowering the anxiety that I once had. Automatic negative thoughts happen infrequently instead of constantly. Though, this is not setting me up to be rich and with lots of worldly possessions or friends, but I'm alright with that.

edit: disappointing that all of the replies are about the first word in this post, but I kind of asked for it. Talk about whatever you want to talk about.

DanBC|11 years ago

> Weed (because it has no real downsides)

Cannabis can for some users have severe downsides. We don't necessarily know in advance which those users are. People who have a diagnosed severe mental illness are probably in that group. Thus, is someone with strong anxiety a person who should avoid cannabis because it would exacerbate their anxiety; or trigger an underlying psychosis? Or are they a person who would benefit from canabis?

I am strongly in favour of legalising cannabis but I find it frustrating when people claim it has no downsides.

throwaway1|11 years ago

> (because it has no real downsides)

Ohhh boy. On this throwaway to say otherwise. I'm sorry if this post is a bit incoherent because I'm horribly tired, still getting past the nuts insomnia phase of quitting.

I've smoked a lot of weed. Started smoking in high school, heavily when I was 19 until a couple weeks ago (I'm 26 now). About an ounce a month over that time, sometimes two ounces. First it was for insomnia, then it was supposedly for my digestive health (actually, quitting gives you gas and loose stool), then for anxiety, sometimes for aches and pains (which were made worse because of poor posture -- it is a muscle relaxant, after all). At the end it was for my paranoia, so to speak -- I was convinced I had cancer setting into my guts and that it was the weed that was keeping it in remission. They did some experiment where this worked with rats, right?

Right now it seems like there are no side effects. Trust me, there will be. Your memory will turn to shit and you won't be able to follow a conversation. You will try to remember a number and forget it moments later. You'll be slow to recall your own zip code. This doesn't just happen when you're high, it'll happen the day after smoking also. Basically, if you're feeling "all right," you'll have these effects too.

You'll become dull. You'll sit around with peers and have nothing to talk about, just a stupid smile. Now, you'll feel totally at peace, but you're a basically a human blob, incapable of really interesting thought.

Your thoughts themselves will become lazy, less rigorous. You'll think you're being "chill" when you quit a debate, but really, your mind is just working much slower.

You'll edit code pointlessly, shuffling stuff around.

It's not all bad -- the ability to come up with really funny insights doesn't go away, so you can make people laugh. But there's no depth to anything you do.

Heavy smoking makes you shiftless too, and easy to abuse. It let me stay in an abusive marriage for a few years, fun (I sort of knew this but was too embarrassed to leave this woman I'd just married, so I smoked more to keep my sanity). Only when I tried to slow down smoking for a little while did I realize how bad things had gotten. Whether or not you believe it's happening, people will try to take advantage of you, if you're worth taking advantage of.

Keep in mind I'm not talking about "smoking every now and then when I feel bad," I'm talking about daily use: A smoke in the bathroom before you shower for work and constant smoking every night. Lunch break smoke if you're a real go-getter. Maybe smoking on your commute. Always making sure you have a good bit of bud or hash oil before you go on a trip anywhere (I remember smoking in a company's garage in SF after a tech meetup, and also regularly taking smoke breaks in my employer's garage in a less tolerant state).

In this industry, people will let you get away with it if you're any good, because the fact is that a half-baked person who can still write decent, reliable code is 10x as valuable as an regular guy with no skill/aptitude/motivation. And as you might have noticed, most people don't take to this stuff all that well, which is why (compared to other working schlubs) we get paid pretty well.

Also, YMMV, but it completely robbed me of my sex life when sober because I'd orgasm so fast.

It took several years of heavy, daily smoking for these serious symptoms to fully manifest into what seemed an indomitable form, probably when I was 24-25. I know for sure that heavy daily smoking of high-grade buds in California took it to the next level.

I had to stop smoking. I realized how stupid I'd become, even if I was raking in the dollars (not doing consultant BS either, senior developer stuff at a good tech company and respected by my peers).

Holy crap, I'd forgotten how smart I was. Suddenly I could remember everything. Issue numbers. My train number. Dates, times, places. I could remember things (addresses and stuff) I learned when stoned, knowledge I didn't know was in my head. Weird!

Now I can't imagine smoking again, except rarely with friends. Having my brain back is so wonderful. Feel free to ask my questions, though I probably covered the uninteresting life of a stoner programmer pretty well here.

taterbase|11 years ago

For me, the most difficult part of conquering anxiety is the physical symptoms. Stomach duress, stress, sweating, and bracing for the next wave of anxiety. These symptoms feed into each other and can set off a new attack or make an existing one worse.

I've found Hope and Help for Your Nerves by Claire Weeks to be the most helpful book on dealing with the physical symptoms. Once you're able to remove or at least tame the physical aspect you can better fight the mental manifestation.

This book literally changed my life and I'd recommend that you don't hesitate to check it out if you suffer from anxiety in any capacity.

http://www.amazon.com/Hope-Help-Nerves-Claire-Weekes/dp/0451...

aantix|11 years ago

I had been feeling a little blue the past few months. I didn't want to take an anti-depressant (too heavy and too many side effects).

I read this book : http://www.amazon.com/The-Mood-Cure-Program-Emotions-Today/d...

She basically advocates for the supplements 5htp and St John's Wort taken three times a day (empty stomach ideally).

Her theory is that a lot of our depressive moods are due to nutritional deficiencies and that the amino acids that help with serotonin production are easily depleted (via drinking coffee, alcohol, aspartame, stresses, and lack of sleep).

Nonetheless, I am feeling better, and feeling like I am making incremental improvements each week. Much less anxiety.

No side effects to report (sexual, clouded brain syndrome).

St John's Wort: http://examine.com/supplements/Hypericum+perforatum/

5-HTP http://examine.com/supplements/5-HTP/

L-Tyrosene is also advocated in the book as a motivational booster (increases dopamine). It's effects feel like a strong cup of coffee.

I'm not in any way connected to this book or these supplements; just happy to share something that worked for me regarding depression and anxiety.

aantix|11 years ago

Why the downvote?

manmal|11 years ago

I had anxiety years ago, with panic attacks whenever I was on a train for more than a few minutes. I was also constantly afraid of having contracted fatal diseases.

No more. I did a lot of different probiotics (Mutaflor, some generic L-bacillus stuff, homemade kefir, Kombucha,...) in the last years, and anxiety has completely gone away. Here is some possible explanation: http://www.psychologytoday.com/blog/reading-between-the-head...

I know such comments are often downvoted, so please drop a comment if you do, and contribute.

throwaway_217|11 years ago

Not sure if related, but my severe social anxiety started after I had a flu (as a kid, 2 weeks in bed) and was probably treated with antibiotics. I've just recently realized that there could be a connection. Haven't got rid of it.

Edit: Just found this: http://www.scribd.com/doc/28819342/Experimental-Treatment-fo... I'm going to try it and report back.

hga|11 years ago

Definitely experiment with various probiotics. I ended up with this http://www.vrp.com/biopro-240-caps which seems to help my iffy digestion, and don't seem to hurt my anxiety and depression.

Your gut bacteria are important, why we e.g. don't need Vitamin K supplements, so I at least am not surprised by hints they also have effects on mood and the like.

monch|11 years ago

It would be great if you can provide a shopping list. I'd like to try it.

slinkyavenger|11 years ago

Would you go into more detail about this? I recently developed an annoying level of anxiety (complete with panic attacks) after a pretty long course of antibiotics.

contingencies|11 years ago

Random naturalistic option: After quitting smoking I found drinking cocoa with hot water (not milk) helped me to calm down and concentrate.

Obviously if you're flipping out properly it's not gonna help, but it does appear to have a surprising effect for the tamer challenges in life. I hadn't expected or heard of any such effects, but consistently felt so much more relaxed and focused after drinking it, which piqued my interest enough to look it up. There does appear to be some nebulous positive medical review of its effects in areas like blood pressure.

Xcelerate|11 years ago

As long as I can remember, I've always had intense social anxiety, but never generalized anxiety. In other words, interacting with people I don't know very well gives me intense anxiety, but that's about the only thing that does. I have no problem with public speaking, and I don't get anxiety when I'm by myself. Well, maybe a little bit, but not like the guy in the article. My main problem is that I obsess and overanalyze everything. For instance, I stood in the grocery aisle for half an hour trying to figure out which of two products was the better one. I ended up accessing research articles through my university's proxy service and reading them on my phone while I stood there.

I started Nardil after a very weird/disturbing relationship left me in a depressed state for many months. I had never been depressed before that. But it eliminated the depression almost instantly, and greatly diminished my social anxiety. Although I'm thinking of stopping it soon because the side effects are pretty bad. I didn't notice them at first, but they've crept up and are very noticeable now. Hopefully when I stop it my ability to handle social interactions will remain now that I've had some practice with it.

autokad|11 years ago

how I manage panic attacks and public speaking: public speaking: i pretend everyone in the audience is just 2 or 3 people, and that they are friends of mine. going into it isnt easy but once I get started that helps quite a bit. I teach a class so there is no avoiding public speaking, but I dont find that its much of a problem despite my dislike for it.

for panic attacks, they are really something separate from the anxiety of speaking to a lot of people. so far the only thing that I have as a weapon is to try and thwart them before they start or ride out the storm by distraction - 2048 helps, it really does! after 4 years of no panic attacks I thought they were conquered, but I did have an episode, so its ongoing but managed I guess.

depression: I was depressed for a long time. I was able to put an end to it by putting dark thoughts out of my mind, concentrating on good things, and not talking myself into thinking how bad things were. I consider it safely conquered. it sounds like a platitude "dont think negative things and you will get better" but its not. at first it is hard but then one day you will wake up and everything has changed.

History: I get panic attacks every (so far) only on even years and so far (only between the months of may-august). i dont know why... I can have close calls outside of those time restraints but the full blown the world is ending panic attacks have only happened during those time frames. I really dont have an ability to stop them once they trigger from happening, they can happen at 4am or 3pm at work. distraction and not thinking about them seems to help the most.

depression: I was depressed from 1998 to 2012. from 2010-2012 it was managed, but now I'm like a different person. I have never taken any medication for anything above.

A_COMPUTER|11 years ago

I guess this is a good place to mention this in case anyone experiences the same thing. I naturally have terrible anxiety, but for a while I was having even more horrible anxiety attacks. I eventually figured out that taking probiotics made it happen. If you're using probiotics it might be worth a try stopping for a month and seeing what happens.

mmastrac|11 years ago

That's bizarre, but given the amount of research lately tying gut flora and inflammation to mood and depression, unsurprising.

autokad|11 years ago

heartburn is a trigger for panic attacks, perhaps the probiotics mitigated some indigestion you were having

Apocryphon|11 years ago

I'd be curious if the author had every tried psychodynamic therapy, which has a different approach from CBT.

gumz11|11 years ago

This article is great. I have fought with social anxiety for 5 years as a result of family complications and high school drama. I have been doing talk therapy for 6 months with very positive affects on my previously negative outlook on life.

I've always viewed it as a disease, but this article portrays anxiety in a new light. Maybe my ability to view the world this way enables self creativity that I never knew existed... That thought is exciting.

Thanks for sharing!

0xdeadbeefbabe|11 years ago

> Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

Would a stoic be happy or sad that stoic philosophy didn't work for him?

Kenji|11 years ago

A stoic does not judge reality like that. He acknowledges that it did not work and moves on. He need not ponder about the fact that it did not work because it cannot be changed and no thinking should be done without a purpose.

manmal|11 years ago

He would be happy because he's thankful he isn't dead yet.

jkaunisv1|11 years ago

I think he would believe he is not far along enough in his stoic practice for it to have "worked", but happy with the progress he has made so far.

iokevins|11 years ago

Given the milieu which gave rise to stoic philosophy, I suspect the latter.

applecore|11 years ago

If you feel intense anxiety prior to public speaking, you should directly address your issues with public speaking, rather than resorting to self-medication.

mrjj|11 years ago

Guys please stop looking for the reason why you are using drugs. They are just awesome thats why. Nowadays we could be honest saying that.

When anything awesome comes to our life we forget about stomach aches, spine aches or mental aches and feel the drive. But drugs and medicines have not awesome side-effects. I could be very nervous on weed and stimulators and after psychedelics (we are not talking about opiates usually its one-way road).

The medical fact that you could be born predisposed to be nervous or could became that after the shock. So its your body nature.

And there is only two ways: 1. Be where is awesome and do something awesome. You need it more then others. 2. Radically change your metabolism, reject yourself and became a Z-Zombie.

Or the grave, but you can't avoid it, so it can wait, finally there will be no nerves to be nervous anyway.

And you shouldn't dramatize what's going on. Panic attack its just several bad hours and you are not physically damaged after that. I have a couple of them per week, and one a day in bad times, but you're not dying, event not physically disabled, just misbalance moment in your nervous system. Ok just as planned 56 hours per week for a sleep, 3 for a toiled, 25 for internet hangout, 10 for a meal and 5 for the panic attacks, everything just as planned. When you are resting well, eating enough you'll reduce this time. So there is even a good news)

When you have a hard panic attacks with adrenaline outburst (you know, you are "really dying", but before you should run to the toilet like sprinter) that's a bright moments, and you have couple bright days after them, just because its not happening with you now. Everyone wants a bright life, right? You've got a little for free, some kind of death and resurrection cycle)

Brotherhood of anxious guys and girls are just a part of big picture, there is a epilepsy, head traumas and other ns diseases and we are not holding even the bronze medal.

Want another good thing? Hypochondria, i really killing my physician with it. How dare you to say that i have no cancer! Lets check again! Two MRI per week is too much? Not too much for the such ill person, im sure that bastard is hiding somewhere between spine and lungs. My heart is ok?! I'll go to the other physician! You said something about spot on pancreas? Oh, that spot will kill me in a year for sure. (why did they asked me how long i didn't fart?). But my real hope is a inborn cyst "without diagnostic meaning" it's a real black horse, when i feel the headache i know that there is no brain left, only cyst with a liquid and alchohol inside, ready to explode.

Hypochondria helps us to visit physician in a time, discover early problems and prevent them, so, statistically, we are more bulletproof that guys which seen a doctor once a life and suddenly dying from the stroke just before 50 anniversary.

But there was a real killing thing in my life. One day i haven't sleep because i was anxious, guy from my work said something wrong (or i thought that he thought something wrong, i don't remember clearly). Then i feel strange smell, i sniffed and decided that there is a fire in my flat. So i raised a panic of the highest probe and evacuated my family. There was a real fire downstairs and all flat became filled with acrid fumes after 5 minutes.

So my anxiety save me and my family, and we are in very good relations after this accident.

a3voices|11 years ago

I've always had lots of anxiety, and I was once in a psychiatric hospital for 2 weeks several years ago. I stopped taking meds though a while ago. I figure anxiety is just part of my life, and it's not worth fighting.

spammyusername|11 years ago

I am curious to hear a little more. In many senses, worry/anxiety is endemic to humans. 'What will I eat/drink to survive?' at the most basic level if you look at how we as creatures have come about. Since these needs are largely fulfilled in modern society these questions get much more idiosyncratic; that is, they are suited uniquely to our individual situations so it's hard to proceed without knowing a little more about what drives some of your feelings of anxiety.

jawngee|11 years ago

Have you done CBT?

hackaflocka|11 years ago

Learn to meditate. It can cure anxiety.

Source: personal experience.

someone903209|11 years ago

Anxiety and the meditative state are, to put it simply, impossible to experience at the same time. Who is it that is anxious, when that anxious person no longer exists?

mikejharrison|11 years ago

I second this. Mindfulness meditation is really easy to pick up and has worked a treat for me.