I've had it with this!

In 1999, I sought help for anorexia and bulimia with a college campus counselor.  The eating disorder behaviors alleviated my anxiety.  The counselor wasn't too bright, ended up telling me "you're going to have a heart attack and die" and two days later I landed in the ER with my first of many panic attacks.  For four months, I suffered crippling anxiety from the attacks, and only when I got angry enough about my fear did I finally overcome it and knock the panic down to once a day instead of one big day-long panic event.  I took Ativan 0.5mg three times daily.

I'm know the mother of a 10 month old.  I don't have actual panic attacks anymore like they used to be (thinking I was having a heart attack - my biggest worry), but I have constant low-level anxiety that makes me extremely edgy and irritable.  I take the Ativan 0.5 mg before bed. When I don't take it, I have horrible nightmares.

I had been getting much better until last summer when I was pregnant.  I had heart palpitations frequently, and went to get them checked out one day.  They made a lab error, told me my cardiac enzymes were elevated and admitted me to cardiac care overnight on the basis that they believed I'd had a small heart attack, maybe from a blood clot.  Turned out to be nothing (aside from my worst nightmare come true) and I was sent home.  I did not even get to enjoy the last three months of my pregnancy, nor the first five months of my child's life because I was so overwhelmed with fear about that cardiac lab error that I spent every free moment researching it until I could be convinced I was safe and not actually dying.  Nothing like worst case scenario for a panic patient, eh?

So now I have this constant irritability/anger thing going on.  I'm always tense.  I'm always aware of my heartbeat.  I worry constantly.  I guess I've always had bad anxiety, but it has manifested in different ways.  

I have major reservations about taking SSRI medications, but the Ativan is clearly not helping anything but the nightmares - and I'm not wild about benzodiazepines.  Pills are a major phobia for me and anything that affects heart rhythm is completely out of the question.  I've heard Lexapro is a new medication with fewer side effects and I am considering asking my doctor about it.

My questions:
1. Does Lexapro sound like it might be a good fit for me?  
2. Does Lexapro cause any heart rhythm disturbances?
3. Does what I have described sound like GAD?
4. Do people like me ever get better, or is this something I'm going to just admit I need medication for?

I really feel quite hopeless at this point, and I'm left wondering if this is what my life will always be.  I have a lot I should be enjoying, but instead I'm just always afraid and edgy.

I just worry that medication could possibly make this worse, and I really don't think I could handle that.  But this isn't so easy to handle anymore either.  I need to do something, so...here I am.

[Roger Gould, M.D.]

I suggest you see a psychologist or a psychiatrist for a consultation and consider some combination of psychotherapy and medication, like lexapro. Yes you can get over this, but you need this combination...good research says this would be best for you.

[cardiogirl]

You're an MD?  And I paid actual money to hear you spew mindless drivel to me about what research says is the best?  I could have located the information you gave me in two seconds on a Google search on a website created as a community service project by some sixth grader.  I spent my hard earned money to hear actual thoughts from an actual human being, particularly one who is supposed to be educated in this sort of area.  This isn't square zero for me, pal, it's five years of taking anxiety and trying to live with it and realizing I probably do need medication - which is a BIG accomplishment in itself because of the stigma - and you offer me the equivalent of a slap in the face?  The doctors over in the cardio forum allow FREE POSTS and actually ANSWER QUESTIONS that people ask.  This is ridiculous.  You answered nothing.  What a waste of time and money.  This is thievery here.  It is obvious that the "professionals" in this forum care nothing about the people, only about the money.  It's like a mill, there is no compassion.  We're not just vapor here, we're human beings, and we deserve to be treated with dignity and compassion.  There are real people suffering with real problems behind these screen names.  It is people like YOU that have prevented me from seeking treatment from a psychologist.  It is garbage like this that made me abandon the college degree I have in the field of psychology to pursue SALES because it does the world a better service than steamers like you wrote.  Ha.  Your a doctor and I knew more than you know now in my first ten minutes of college.  Tonight I'll be praying for the poor souls that come to you seeking actual help.  God knows that's not where they'll find it.

Yeah, darn...you underestimated my intelligence.  I hope people here read this post and realize it isn't worth wasting their money and find real help elsewhere.

[CertPsychRN]

Back in '99 when you became anorexic/bulimic, was there ever any discussion with this therapist about the CAUSE of these symptoms suddenly appearing? I think it's important to look at your personal history...when you were a child, was this underlying fear and anxiety present?  At what point did anger and irritability enter the picture, adding to the fear and anxiety?  My reason for asking is that, often times, panic and anxiety can't just be attributed to GAD, which is a DSM-IV-R DIAGNOSIS. Panic and anxiety can also be SYMPTOMS of another underlying diagnosis....such as PTSD, or OCD.  The fear and irritability may be undiagnosed Bipolar Disorder.

With the information you provided, I can only offer these few suggestions for further exploration.  However, from a Psychiatric aspect, the expression of eating disorders is one of trying to regain control over yourself, thus leading one to believe that some past events have left you feeling powerless and out of control.  Perhaps with your pregnancy and ensuing birth of your child, feelings are surfacing that may have been long repressed, and are triggering a stronger set of symptoms.

Yes, I believe that medication and therapy will help you.  Since you were not proven to actually have a heart ailment, I'd TRY to bypass the thinking that medication will cause heart irregularities and evoke a heart attack...that's the anxiety and fear talking. And,if you read alot of these posts, you'll go nuts trying to figure out what is best for you based on OTHER people's reaction to a certain drug.  Truly, the medications available today are many and varied and SAFE, and your reaction to one over another cannot be predicted, but I DO know that most times, with patience on your part as well as the Physician's part, you WILL find a good combo and obtain relief from your symptoms as you deal with the issues that are causing them..  Good luck and God bless you!

[cardiogirl]

Thanks.  I'm really actually impressed with the time you took to answer that for me, and I do appreciate it.

I was screened for bipolar, found not to have it.  I do have PTSD.  The eating disorders were very much about control, and wanting to disappear.  I am a rape victim and an incest survivor.  I also lost a baby boy to miscarriage 2 years ago due to a near-fatal bout with hyperemesis, after years of trying to conceive and being told I might never be able to, and still hurt very deeply over it.  It seems when something happens to me, it's big.

I thought I was over the whole abuse thing, but maybe I'm not.  Maybe the way it's manifesting has just changed from fear to anger and irritaility because I know I'm not supposed to be afraid anymore now that I'm "all grown up".

Anyway, I'm just rambling now.  More for my own benefit/release than anything else.

Again, thank you for the response.

[CertPsychRN]

Thank you for your kind words, and I'm happy to do what I can to help.  I DO want to address something you said in your last post..."I thought I was over the whole abuse thing, but maybe I'm not. Maybe the way it's manifesting has just changed from fear to anger and irritaility because I know I'm not supposed to be afraid anymore now that I'm "all grown up"."~~~~~~~~~~~~~~
Just because you are an adult doesn't mean that you are SUPPOSED to not be afraid...fear is not an emotion that expires as we age!!  What is more significant is the wording you used...rape and incest ARE big deals, and you trivialize the enormity of both on you life by saying "I thought I was over the whole abuse thing..."  Maybe you HAVEN'T dealt fully with your issues, because it seems that you do alot of negative self talk(as addressed above.)  If you're still grieving the loss of your first baby and you're now the mother of a 10 month old, there is SOMETHING you need to delve into...perhaps issues of loss...loss of childhood, betrayal and loss of familial bonds(to incest,rape,) Loss of control over your body(which then tried to compensate by trying to regain control thru anorexia/bulimia).  Was the hyperemesis truly pregnancy related, or might it have been linked to pregnancy but really a reoccurance of the bulimia brought on by fear/anxiety/unresolved issues but manifesting itself in a different way?
Although issues may still exist,you need to get on a good anti-depressant..Lexapro(and Celexa) really aren't the BEST,and certainly aren't working if you still suffer this degree of emotional impairment. Paxil and Zoloft are particularly good for dep. with anxiety.  It's good that you don't like benzos..I applaud your wanting to stay away from them; HOWEVER, you might find that a low dose of Clonazepam(0.5mg. twice a day) may be a real boon for you to use in conjunction with an antidepressant...it is the longest lasting of the drugs in that group(has a long half-life.)  Ativan, Xanax, Valium, etc. only last 3-4 hours in the system, while Clonazepam lasts 12 hours.....therefore, a more constant level of medication stays in the bloodstream, eliminating the need to "take something" every 4 hours...also takes the mind off wanting/needing more be- cause you have enough in your system to last until the next dose.
DON'T GIVE UP!!!!  Remember, you've lived thru the worst and have come out the other side safely...you never have to go back to that space and time again, and, YOU SURVIVED!!  Obviously, you've got more strength than you think you do...who said you haven't regained control over yourself and your life?  You're on the other side and you WANT to help yourself!!  Good job!!

[hangin'in there!]

Thank you, medhelp. for responding to this case in both a proffessional and case-sensitive manner!!

I have really appreciated the effort you put in to helping this young women, and am extremely glad to see this case progressing the way it has. You have given someone a map along the road to their recovery and I believe with your expert help this individual need not take the long way there!!  Your proffesionalism has probably saved this girl many years of wondering what is happening to her. You have really hit the nail on the head with this one!!

PTSD is often misdiagnosed as a range of other illness'.  The symptoms are often very closely tied to depression and anxiety so it is easy to understand why the condition is often overlooked.  This can leave it's sufferer's confused when they do not respond to medication alone, and can have them wondering (and sometimes their DR.'s too) if they are just going crazy.  This is a shame because it often leads to undesirable and antisocial behaviours appearing in patients with the condition.
The only way to properly diagnose the condition is via an extended consultation IN PERSON with a qualified behavioural therapist ie; psychiatrist/psycologist etc. There fore it is good to see you encouraging this individual to seek help from the experts!  

What do I get out of the forum?  Well, I enjoy helping others as I was helped. I am interested in people and their thoughts and have basically 2 messages to give in my comments;

1)  Therapy should be encouraged where needed.
2)  Sound medical advice should be sought from a doctor (in
    person) and the need sometimes arises to seek a second
    opinion.

There is such a stigma about therapy that unfortunately many people who could benefit greatly from it are reluctant to go. I am aware of how hard it is for many to get the ball rolling, so to speak.  It is also very hard to offer this option to people that are very closed minded about it.  The teacher comes when the student's ready ... and a good psycologist can help anybody understand themselves better.  It is fashionable in America to have a personal therapist, like the show 'Ally Mc Beale' and similar tv. shows demonstrate, even if you have not been diagnosed with a "mental illness".  So why is it so abhorred that we recommend them to people?  Why do people offend at the suggestion? Therapy is a very powerful self developmental tool, I encourage people to use it for their own advantage.  I would like to remind people that therapy cannot be used against you, it can only stand in your favour!!

Jitterybrat - we have alot in common. Mum's with small kids and PTSD!  If you would like to make a friend, feel free to email me directly and let me know how you're going with everything.

ts.***@****

Hopefully you get a therapist like this one! (I have!!)