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Can Anxiety disorder cause chronic dyspnea?
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Can Anxiety disorder cause chronic dyspnea?

Folks,

I've been dealing with increasingly frequent bouts of what I would consider to be 'mild' dyspnea for about the last year.  I'll give you a little bit of my medical background:

When I was in college I was diagnosed with Generalized Anxiety Disorder.  I was prescribed Effexor XR, which I took for about 7 years.  I tapered off that drug and for a few months was 'drug free', but found that I was starting to have anxiety problems again.  My doctor then put me on Lexapro, which I took for 4 years.  I got off of lexapro about 3 years ago and haven't been on anything specifically for anxiety since then.  About a year ago I had some sort of mysterious digestive issue that came and went over a period of about a month.  I was basically glued to a toilet for that entire time.  When whatever 'it' was went away, I was left with slightly less than satisfactory digestive irregularity.  My doctor diagnosed me with IBS and prescribed me a small amount of amitriptyline, which I have been taking now for about a year every night.  I have a few bottles of Xanax to take if I have anxiety problems.

Up until about 6 months ago, my anxiety problems presented with the standard symptoms (restlessness, issues staying asleep, butterflies in my stomach), but NEVER problems breathing.  I haven't really had anxiety issues in a 'chronic' manner for a couple years now.  Within the last year I've started having bouts of dyspnea.  They started shortly after I got sick last year.  Initially I would have one bout a month, and now I'm up to several a week.  I basically have a feeling that I can't catch a good breath, a tightness in my chest, and sometimes a very dull pain.  I've never felt faint or felt like I couldn't breathe at all; just a sensation of not being able to get a really good breath.  These bouts can last anywhere from 1/2 hour to several hours.  It doesn't seem to matter whether I'm trying to sleep or awake, standing, sitting or lying down.  I actually tend to experience this more in the middle of the day or in the evening than I do in bed or at night.  I'm usually not doing any strenuous physical activity, and the issue is usually not preceded by any stress.  I've taken Xanax and can't really tell if it helps.

Of course, the first thing I did was visit my physician.  They ran some oxygen saturation tests and listened to my lungs and heart and told me that everything was just fine, and sent me home with some steroids and an inhaler.  When these bouts started becoming more frequent, I went back for a follow-up.  They again checked my oxygen, ran some more informative blood tests, took a chest x-ray and did a lung function test.  The doctor couldn't find anything wrong with my heart, my lung test results were 'better than normal', my oxygen tests were fine as was everything else.  

At that point my doctor and I decided that the most likely cause was anxiety related.  He recommended I try to see if I could regulate the issue with Xanax, and otherwise not to worry about it unless it becomes unbearable.

Since then the bouts seem to be increasing in frequency, I'm thinking about going back to my physician to see if anything else can be done.  My primary questions to this forum are; is this something that other people have dealt with related to stress / anxiety?  Is it a common symptom?  If I do choose to go back to my physician, what are some things I might ask him to look at?  

Any help in this area would be much appreciated.  At this point I can't tell if I'm stressing out because of the breathing problem, or if I'm having a breathing problem because I'm stressing out (though I don't actually know it at the time).
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Avatar_m_tn
During my attack (which have been daily in recent weeks) I always experience dyspnea. I've had an anxiety disorder for the last 20 years and with each one is difficulty breathing. I don't know if it can be/is chronic but something I thought of just today was that maybe (MAYBE) it might be actually related to it.  I don't know if one causes the other but I thought perhaps it could be some type of hay fever like reaction which then triggers an attack or vise versa. I guess all in all I wanted you to know someone else feels the same way.
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Avatar_m_tn
Thanks.  I've scheduled another Dr. appointment for next week to see what else we can do, but I'm hoping it's just a 'panic attack' type situation.
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Avatar_f_tn
Hey cmcneil
Your symptoms, how they present, right down to the frequency and duration, literally match my own. I've been to the doctor twice just like you, and like you they performed every oxygen every test including an x-ray which I don't know if you received? But it sounds like that would be a waste for you just like it was for me in that they had no explanation.  Anxiety was their best guess also, they prescribed me Klonopin, and that was that. Like you it's done very little (I think) to relieve the condition. However I'm also suspect of the interrelationship between my dyspnea and conscious borderline hypochondria. I wish I could give you a cure-all, but just like you do I continue to try just about everything every combination and stay vigilant in attempting to isolate the cause. Please let me know just like I will for you if you find anything.

Actually, just before posting this I remembered that I have been pursuing a potentially promising treatment, and basically it works like this: at the highest level we Westerners have forgotten how to breed. That is to say that we breathe with our upper chest, almost lazily in contrast to the right way, which is more in our stomach area, I know that we don't release with her stomach but it helps me to expand and contract mine in order to breathe more productively. Anyhow, I've read up on this topic to know that I still not breathing properly by the technical definition and continue to work on it. My hope is that when I learn how to correct three some decades of breathing wrong that hopefully all breathe better and perhaps have fewer episodes.

There're are tools for biofeedback learning that you can get online at Amazon for instance which I found very helpful in regulating my short shallow breathing, perhaps that might help you.

Best of luck.
Thanks,
-Christian
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Avatar_f_tn
Ugh! I obviously meant to spell "breathe", not "breed", as far as I know, we Westerners have no problem with the latter. Thanks,

CH
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480448_tn?1397235344
Dyspnea is a common symptom of anxiety, and anxiety tends to cause or exacerbate the dyspnea.  As for which causes which in a person, it's hard to tell.  It's a lot like the "which came first, the chicken or the egg?" question.  In the end, the answer is not nearly as important as what you do about it.

You've had a pretty thorough work up, so I think assuming it could be anxiety related is very fair.  You have a history of anxiety, and you have a history of shortness of breath WITH your anxiety.  Another telltale sign, for ME, in your description is that you feel like you can't "get a deep breath in".  That's a very common description given by anxiety sufferers who are having dyspnea.  

You have to try to reassure yourself with a few facts...one, you've been checked medically, more than once.  The outcome was that your pulmonary function is better than that of the average person.  That's fantastic!   Also, if there was some medical cause for your dyspnea, the tests would not have been normal.  Also, you probably already know (you seem very well versed in this topic) that even if you are not really getting that "deep" and satisfying breath in (we've all been there, anxiety or not), you are still getting ample oxygen.  It's just a sensation.  We don't like the feeling because we FEEL like we need that deep breath.  That leads us to start really focusing on our breathing, yawning to obtain that intense inhale.

MY advice to you is to of course, keep working with your doctor.  You may want to consider getting back on an SSRI.  Also, have you ever tried CBT for your anxiety?  I think you should give it a try...the therapist can teach you all kinds of ways to cope with these issues, and how to handle the breathing symptoms.  

Unlike many others, I disagree that you should start doing breathing exercises of any sort.  ALL that does, in my opinion, is increase your attention to those sensations, often making it worse.  Us anxiety sufferers catastrophize every sensation we feel, and doing something that requires our undivided attention is just asking for trouble. PERFECT example...as I read your post, and while penning my reply, I've caught myself a few times concentrating on my breathing.  A few times, I couldn't get that "deep breath" in, just as you describe.  Ahhh, the power of suggestion.

Very best to you, please be sure to update us when you can.  I hope you find some relief soon.
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Avatar_f_tn
I  have been on klonopin for years to battle my frequent attacks. They come on out of no where about 85% of the time and I am literally on hands and knees trying to breathe. My heart rate goes up to 150 plus per minute,  I often have terrible chest pain and or complete numbness in all of my extremities.I am sweating, having hot flashes and praying I won't faint before I can dial 911.Living like this is a damn joke. The worst part is I am no longer embarassed of these attacks around family members but instead begging them for help by simply talking me through it to get air inmy lungs and get my mind intoa place thats far from whatever the hell brought on this crap to begin with. They tell me get away from us you are being dramatic it's just panic. All that said - I do have Dyspnea,acid- reflux and a neuralgia in the right leg. Trying to find or keep employment living this way is extremely difficult. I take klonopin, spiriva, prilosec (omni- somethingfrom the pharmacy) along with any aleve, advil, aspirin or what not to relieve the headaches aches and pains that accompany all of this. I'vetried counseling,  meditation,  eating bananas for seratonin lifts, brisk walks, cold showers,etc etc etc. One thing that often helps is when a person is nice enough and willing to hit my back repeatedly so Ican get up some gas.This doesn'tmake the attack dissapear but seems to help which of course is acid-reflux related. I really am sick of doctors and I hate going to theE.R. It is pricy and for me most often a waste of time as my ekgs and bloodwork are almost always totally normal. What a crazy life I have here. I'm praying for the magic cure.-
Sincerely, Chris
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