Danger Will Robinson, Danger!

I'm having a panic attack. Trembling, having trouble concentrating, scared, wanting to run to a safe place and be alone, you know the drill. I leave for the airport in two hours, my anxiety is going nuts, I'm having trouble concentrating. I'm worried about just sitting in the airport for hours, you've gotta hate all the long delays of sitting in the airport due to all the aftermath of 9/11. I'm also worried about my mom, she will be driving to the airport to pick me up when I get there, and she has a problem driving on the freeways and driving long distances alone, so I'm worried for her. I'm worried that I'm going to miss packing something, or that I'll have to go through some search at the airport.

Yep, this is all the negative, self-defeating anxious thoughts those of us with anxiety disorders obsess on and drive ourselves into panic.

So, I first have to put some logic into all these negative obsessions, replace them with positive self dialog. For example, it's not likely I'll be searched, the wait in the airport will give me time to sit with my laptop and update my journal. I've got a DVD movie I brought with me for the flight. I've got medicine to help me with the pain I experience during pressure changes, and while my mom may have trouble with driving to the airport, she'll make it just fine. And I'll arrive with a nice tan, so I can show off to all my family and friends who are still stuck in 50-60 degree temperatures, whereas in California we've been around a hundred degrees and I've been able to spend a lot of time at the pool and suntanning. I've flown probably close to a hundred times before, so I know what to expect, it's no big deal. The only pain is trying to find a place to go smoke, and having to go for four to five hours on the flight without a cigarette, but I can do it, I've done it before.

I've also got an interesting book that I can read called Synaptic Self: How Our Brains Become Who We Are that I may read on the flight. I've read the author's (Joseph Ledoux) previous book,
The EMOTIONAL BRAIN: THE MYSTERIOUS UNDERPINNINGS OF EMOTIONAL LIFE, which is a good read for those who have some background in psychology and the brain, and talks at some length primarily about one emotion, the emotion of fear, which is the emotion that science understands the most, and is most relevant to people like me with anxiety disorders.

Haha! I told you so!

Link:CNN.com - Study: Playing video games not so mindless - May. 28, 2003

Researchers at the University of Rochester found that young adults who regularly played video games full of high-speed car chases and blazing gun battles showed better visual skills than those who did not. For example, they kept better track of objects appearing simultaneously and processed fast-changing visual information more efficiently.

HAHA! I knew all that time I spent playing Doom and Quake had to be doing me some good! But on a more serious note, playing these fast-paced "violent" games is a great way to distract myself from all of my anxiety and depression while boosting my self-esteem a little bit and also improving my hand-eye coordination. Not to mention that making those games work on my computer keeps me up to date on all my computer skills, whithout which I wouldn't have had that nice cushy career I had prior to becoming disabled.

Minor update

Just a little note that I added some minor updates to the "History of my disorder" page.

Lions and tigers and bears, oh my!

Actually it should be "anxiety and nerves and uncertainty, oh my!". Today I leave for my trip that will eventually take me back home to see the rest of my family and friends. I'm shaking, I can hardly concentrate enough to figure out what I'm supposed to pack, I'm afraid of the trauma I'll experience on the plane (I'm not phobic of airplanes or confined spaces, I just have a horrible pain reaction to the changes in air pressure), I'm afraid that my friends will see me have a panic attack (even though I know they understand), and I'm afraid because since I'm having so much anxiety just packing my bags it frightens me even more to think that it's such a short trip, how will I find the time I need to spend with the family and friends.

Yeah, yeah, it's all in my head. Just relax. It's a vacation. It's a chance to see my family and my old buddies. Take some deep breaths. There, that's a little better, isn't it? Just go at your on pace. You've been on close to a hundred trips like this before, you know you can handle it with ease, and everyone is understanding and supportive. There's no real pressure.

OK, that's better. That's one of the things people like me learn, how to talk yourself out of your own anxieties. Now if I can just get on the right medication to take care of the other half of the equation.... but let's not get started on that again, shall we? ;-)

I had a dream last night that I returned to Germany on a second study-abroad trip, and I was helping all the first-time students cope with life in a new country, and it actually felt quite good. I don't think I've ever talked about my trip to Germany on this web page. It was the most wonderful experience of my life, even though I was having severe panic, anxiety and depression while I was there. One of my goals is to overcome the severe anxiety so that some day I can return and pay a visit to the friends I had met while there. If you're curious, you can check out the website of the Junior Year In Munich program which I went through for my study-abroad trip. Und, wenn Sie Deutsch sprechen koennen, bitte schreib mir einen Email. Ich will mein Deutsch verbessern.

Trouble concentrating

I've noticed over the past few weeks I've had a real hard time concentrating on anything, due to my high anxiety levels. It's like I'm too scared, or in other words, my mind is overcome by the fear response to have much ability left to concentrate on other things. It makes it really tough to do things like pay bills or plan dinner.

I've been starting to let myself put less effort in trying to control my anxiety and depression. Much of anxiety centers around the concept of control, so I'm backing off on using coping skills, and just let the anxiety and depression happen, and basically just ride them like a wave.

My therapist noted today that I am very left-brained, while at the same time I do have a lot of creativity. He really wishes I would do some artwork. When I was younger I was a pretty good artist with a pencil, but for some odd reason after puberty I lost the ability to draw and now I have trouble drawing even stick figures. My handwriting is as bad as a nutty professor too.

Hmmmm.... left brain versus right brain. Makes me think. Maybe I should try to develop my ability to write and draw with my left hand (I'm right-handed), which would be controlled by my right brain. Hmm. I'm also thinking that since I'm so analytical (that's an understatement), maybe I could come up with some way of combining art with a chart diagramming my thought patterns. Something to ponder. But, I really feel that I am more right-brained than left-brained by nature, when you really get down to it. Simply being over-analytic doesn't necessarily mean I'm left brained. It's one of those theories or concepts that broadly generalizes personalities and approaches to solving problems, but there is a lot of disagreement on the validity of having a left brain versus right brain model.

Where's my funny bone?

Well, yesterday we had a birthday party for my cousin, and had a whole bunch of people over, enjoying the pool and barbecue and stuff, it was a real nice party. But I didn't have fun. Why? Not because of anything anybody did or didn't do, but because despite my best efforts I couldn't relax. I mean, I'm glad I was there, and it was a nice party, and I tried to enjoy it and even pretend I enjoyed it, but inside I was having a panic attack the whole day. Makes me wonder if my therapist is right and that I don't have enough of a certain chemical in my brain that allows me to enjoy things.

My anxiety and depression keep getting worse rather than better. My level of daily functioning continues to decline.

This isn't a result of lack of effort on my part. It takes all of the cognitive effort and tools available just to do some of the most simple things. I think it just goes to show, like my psychiatrist said, that my problem is more biologically based than psychologically based (more nature and less nurture), and I'm one of those rare people who are highly resistant to medication.

In a couple days, I'll be driving with my dad out to his place outside Las Vegas, then the next day I'll fly with my brother back home to see some family and friends in Detroit, then after a couple days flying back to Vegas, then driving home the next day. I'm very nervous about this trip. Not in the sense that I'm catastrophizing it, just that I know it will push my coping skills to their maximum. Especially the long plane ride, I have a problem with changing air pressure in airplanes, as an airplane descends and the cabin pressure changes, I experience excruciating pain in my head that mimics a stroke, it's like someone is plunging a knife into my head while simultaneously the blood vessels in my head are trying to explode, it always leaves me with a red face, tears running down my face, and me gripping the arm rests in a death grip. Although if I take large amounts of pain killers and decongestant drugs then it's usually not so bad.

Anyway, I was supposed to go to a family memorial day party today, but I just couldn't, I've been fighting back a panic attack all morning, and decided that I didn't have the strength to fake it through another party, and I wanted some time to just chill out before I go on my trip.

More medication changes...

Well, I had a good long meeting with my psychiatrist last night, and I brought my aunt (who is an RN) along with me so she could ask questions on behalf of the family. I find that when you bring family members with you to doctor appointments, the doctor spends more time with you and takes your comments more seriously.

Anyway, we're going to gradually get me onto a new class of medicines. Currently I'm using Effexor XR, which is similar to an SSRI but also acts on norepinephrine; Xanax, which is in the habit-forming benzodiazepine class; and Imipramine, which is in the tricyclic class. Over the next two weeks, I'm going to wean myself completely off of the Effexor XR and the Imipramine, and immediately increase my Xanax from 6mg a day to 8mg a day (which is an almost alarming high dosage). After the two weeks are over, I'll start taking 200mg of Wellbutrin SR a day, then two weeks after that I'll see my psychiatrist again, and he is going to choose an MAOI class of medicine to start me on.

The MAOI class of drugs are an older class of drugs used to treat psychiatric patients for anxiety and depression, they came to market some 20 or 30 years ago. Since then, the newer classes of drugs, like the SSRIs are now used as the first choice for patients. Tricyclics came around in before the MAOIs and are some of the oldest types of drugs used for these problems. But tricyclics and MAOIs aren't often prescribed much anymore. The reason being is that the newer drugs have less side effects, and the side effects they have are less severe, and they also have less problems in regards to complications while taking other types of medicine.

But the MAOIs for the most part still do a better job at relieving the symptoms or causes of major depression and severe anxiety. The drawback is worse side effects; for example, those on MAOIs are also put on a special diet to help compensate for the side effects. Lastly, they can't be used at the same time as tricyclic or SSRI class medicines, so after I am off of these medications, I have to wait two weeks for those medicines to be completely removed from my body.

In the meantime, I will have started the Wellbutrin, which is kind of in a class by itself, known as an NDRI, and from anecdotal stories I have heard works very well. I've also seen evidence that Wellbutrin is chemically identical to Zyban, the anti-smoking pill, so if I'm lucky this Wellbutrin will not only help alleviate my anxiety and depression but will also help me cut down on my smoking.

Virtual Hospital: Aging Begins at 30: 1998: Panic Attacks

Link:Virtual Hospital: Aging Begins at 30: 1998: Panic Attacks

With appropriate treatment 30% recover, 45% are much improved, and 25% remain the same or worsen. Panic disorder is a lifelong illness which waxes and wanes. It is two to three times more common in women. First-degree relatives are about five times more likely to develop panic. Losses from unemployment and health care costs are over $100 million yearly

No relief yet...

Well, I've now been at the maximum dosage of Imipramine for a couple days now, and so far it hasn't had any impact on me. So, on the good side, I haven't had the typical side effects of low blood pressure, but I haven't had any of the positive effects either. On this amount of this drug I should be higher than a kite, ready to take on anything, but instead I remain depressed with very high levels of anxiety.

Anyway, tonight I meet with my psychiatrist, I have a number of questions for him, I'm going to ask him about brain scans (there's a chance I suffered brain injury as an infant), see what he thinks of the results of my MMPI test, and find out what medicine options we have left. As far as I can tell, most of the medicines I've tried so far have targeted serotonin and norepinephrine, maybe we should instead target dopamine?

Most of my days have been spent fighting high levels anxiety, with frequent naps.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2)

Link:Pearson Assessments: Minnesota Multiphasic Personality Inventory-2 (MMPI-2) - personality assessment, psychological assessment, forensics, psychopathology

Relevant to a range of contemporary applications, the MMPI-2 instrument remains the most widely used and widely researched test of adult psychopathology. Used by clinicians to assist with the diagnosis of mental disorders and the selection of appropriate treatment methods, the MMPI-2 test continues to help meet the assessment needs of mental health professionals in an ever-changing environment.

I took this test a couple weeks ago and I got my results back. My therapist admits that he doesn't have much experience interpreting results from this test, but my scores were very high regarding anxiety, depression and post traumatic stress, and if the the test were interpreted in absence of any other data would show that I have a psychosis, possibly like schizophrenia, but since that's obviously not the case, it would be more accurate to pull out a term that psychologists stopped using about twenty some odd years ago and call me neurotic. In other words, my anxiety and depression severely interfere with my life. While on the surface this sounds like one of those "well, duh!" conclusions, it helps us pinpoint a few areas that we can address in therapy. The test also showed that I may have been trying to make myself look worse than I am (there are ways to tell if you are trying to make yourself look better or worse based on the answers you give on the test) I'll have my psychiatrist look at the results when I see him on Friday to see if the results can help him in his decision on which medications to try.

Another link that describes the MMPI in further detail can be found at this page: MMPI: QUESTIONS TO ASK

The MMPI has ten clinical scales and three validity scales plus a host of supplementary scales. The clinical scales were originally intended to
distinguish "pure" groups with psychiatric disorders. Therefore, the actual names of the scales assert bold and, sometimes, exotic-sounding
psychiatric labels. For example, Scale 1 is referred to as the hypochondriasis scale, Scale 8 is labeled the schizophrenia scale, Scale 9 is labeled the hypomania scale, Scale 4 is the psychopathic deviate scale, and Scale 7 is the psychasthenia scale. Other scales reflect more understandable symptoms such as Scale 2, depression; Scale 3, hysteria; Scale 5, masculinity-femininity; Scale 6, paranoia; and Scale 0, social introversion.

Researchers quickly found out that the scales were not able to be "pure" measures of the psychiatric diagnostic groups (in part this is due to the overlap in symptoms in some of the disorders). Thus, an elevation on Scale 8 did not mean that the client was definitely schizophrenic. As a result, the numbers of the subscales quickly replace the psychiatric labels in common usage. Thus, instead of talking about the hypochondriasis scale, the clinician will talk about Scale 1.

Heavy metal rules!

I love heavy metal, the real loud, fast kind. Why? Because it's so loud and chaotic, it effectively drowns out all of the negative, depressing thoughts I have. It's kind of like the music that drives a sane man mad, can drive an insane man sane. Anyway, I brought this up because this morning, as usual, I had level 9 anxiety for more than several hours, and I finally decided to go for a walk while listening to my heavy metal MP3s at top volume. It was quite effective in that I was able to have a good walk through the park for almost two hours, and it kept the anxiety down for a little while thereafter, long enough to pay my bills, before my anxiety bounced back up to level 9 and I had to take a nap to escape the insanity of it. I can't wait to see my psychiatrist on Friday so we can try yet another change in medicine. I'm depressed that the Imipramine that I'm on isn't doing anything at all for me, when my cousin took it she said it made her higher than a kite.

I've been studying brain chemistry and neuroscience, and I've got an emerging theory as to why my medicines aren't working, but unfortunately it's not a theory I could prove without putting my own brain under a microscope. But in any case, I'm going to see if I can get my psychiatrist to order some brain scans. If nothing else, they'd be interesting to look at.

Behavior: The Neurobiology of Depression

Link:Behavior: The Neurobiology of Depression
There is, in fact, some clinical evidence that the various depressive disorders might have differing physiological explanations. These differences may explain why some patients benefit from one antidepressant and not another. Continued persistence, for example, of high levels of stress hormones (hypercortisolemia) after antidepressant administration in depressed patients has been associated with relapse and poorer treatment outcome. Some clinical studies have found that tricyclic antidepressants are more effective than SSRIs in the treatment of melancholia. Melancholia is a severe form of depression characterized by complete loss of the capacity for pleasure, psychomotor slowing or "retardation" and worse symptoms in the morning. Patients with melancholia also tend to have high cortisol levels. Venlafaxine (Effexor®), an antidepressant with both norepinephrine and 5-HT reuptake activity, was reported in one study to be more effective than fluoxetine in treating melancholic depression and in patients with both depression and anxiety. In spite of this, we cannot predict accurately which specific antidepressant will be the "right one" for a particular individual, and it often requires a process of trial and error.

Downward spiral

As you can probably notice, I haven't posted in quite a while, I've been in a major downward spiral and I didn't want to post nothing but depressing thoughts, but some of you have asked that I say what's been going on anyway.

Well, the short story is that I've been very depressed and thinking suicidal thoughts.

The long of it is that my recovery is taking longer than I was expecting or ready for, and my care providers are telling me that I shouldn't even think about going back to work for another year, and that I have years of therapy and medications and tests, etc before I can expect any real relief. So I'm hearing these things after I've already been thinking that I've had this disorder for almost thirty years now, and I've been in active treatment for it for almost three years already, I've been on 15 different medications already, my therapist pretty much tells me that there aren't any coping skills or techniques left that I don't already use, and that he's never seen anyway try as hard as me to get over this. Then the guilt and shame started to hit me on top of that, because I already feel bad that my dad has had to cash in his retirement to cover my butt while I go through recovery, and to think that I have years to go and the stress that will put on my family was just as hard to bear as my everyday struggles with the anxiety and the persistent intrusive negative thoughts. Not to mention that the levels of medicine I'm on are extremely high, enough to "put a horse to sleep for days" and they don't even phase me one bit. To sum it up, there are very few things left to try, and I've been told that the idea of electro-shock treatment may be an option! Great, just what I need, amnesia!

I cried everyday for over a week. I decided to start planning to say my last good-byes to all my loved ones, plead with them to understand and it's not their fault, but I want to be euthanised.

Well, my cousin caught wind of this and called 911 and had the police take me to a mental clinic, where some idiot nurse told me to just stop thinking so much. God, I hate people that are so ignorant.

The next day, I held a family meeting and explained to them in great detail what it's like inside my head, and why I had come to this conclusion, and made them understand that if I decide to live through this and struggle each day, it may take years before I get over this, and it is in the realm of possibility that I may never get over this, and that I will be dependent on them the whole time for my well being. Yeah, I've recently applied for federal and state aid like social security and stuff like that which will help, but it will still be a drain on them.

Well, I'm very lucky to have such a supportive family, they understood and they're on board for the long haul. I was glad I had a chance to talk with them so candidly, but it didn't improve my mood. I just took the attitude that well, now I'm stuck having to live through this hell, I'll just bear it and wait for a miracle.

My depression and anxiety have been so bad I went for a week without a shower. Constant level 9 anxiety. That's even after an increase in my medication dosages.

And what really pissed me off today was at my group therapy session, the doctor who runs the session and everyone else said Dave, you just have to try harder. You just have to stop thinking. They gave me a homework assignment for this week - my assignment is to stop thinking for 15 minutes. HELLO! If that were possible, I wouldn't be in therapy! For crying out loud don't dare tell me to try harder! Ask my therapist, he knows I'm trying harder than any other patient he's seen. And if you think I can just say fuck it and stop thinking, then you are one ignorant SOB! OK, technically, I think I stopped thinking on two occasions where I was under full surgical anesthesia. Then one girl told me I just have to control my mind. Hello! The chemical imbalances in my brain are stuck on! All I can do is redirect the thoughts or try to rationalize them or just accept them or change my train of thought. But I can't just stop thinking. I've tried all kinds of mediation, sure, my muscles relaxed a bit, but it either didn't work or left me with scary visions.

So, I am very frustrated and depressed.

My therapist also has me on an exercise where I have to write letters to all the significant women in my life (without actually sending the letters) and in the letters write about all the good and bad things about the relationship. I'm reluctant to do that right now, because I am feeling very vulnerable and I'm afraid to open up even more bad memories from the past.

OK, I guess that's enough for now. Say a prayer for me.

Expressing Love

I had a realization of sorts tonight. About purpose in life, and what makes life worth living. And you know what it is? It's the chance to express love. When I express my emotions, I feel alive, but when I express the emotion of love and don't hold back, I not only feel alive, I feel hope as well.

It's a great feeling. Expressing love can bring me out of the darkest depression.

American Holistic Health Association (AHHA) - 1st Step Booklet - HealthWorld Online

Link:American Holistic Health Association (AHHA) - 1st Step Booklet - HealthWorld Online

Motivating your team
By now, you are probably beginning to realize that achieving wellness in your life will involve changing some of your behaviors. However, human beings are creatures of habit and ingrained attitudes. It takes a strong desire to overcome our natural resistance to change, but the more we want to change, the easier change becomes.
We usually change our behavior or attitudes for one of two reasons:

• We are afraid of what will happen if we don't change, or
  
• We are excited about what will happen if we do change.

While fear is a useful motivator when we are in immediate danger, it is not a good motivator for long-term change. People who change their habits out of fear often find themselves backsliding and returning to their old ways. Even people who have survived a life-threatening illness may find it difficult to maintain the kind of lifestyle necessary to promote continued health.
When we change because we genuinely want to experience the positive results of change, we are much more likely to succeed. Anyone who smokes cigarettes knows how difficult it is to break the habit, but every year thousands of expectant mothers do it out of love for their unborn child.