Hello,
Thanks for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
The condition that you are having is basically a generalized anxiety disorder. This is a disorder of anxiety and occurs cause of imbalance of certain neurotransmitters in the brain. especially serotonin, nor adrenaline, and dopamine to some extent. There need not be a trigger each time for a panic attack to get precipitated. Anxiety disorder can persist without trigger and the neurotransmitters can persistently stay low to keep the anxiety disorder persisting. Medicines are the best options to take care of these symptoms. Paroxetine is the the most popular medicine and my drug of choice. I generally prescribe my patients 12.5 mg per day at night which takes care of anxiety symptoms. Also certain medicines like propranolol and clonazepam can be give as required when there is a panic episode or expected situation where panic attack can appear.
Hope this helps,
In case if you have any further query, do let me know.
Kind regards
Dr. Srikanth Reddy
Patient replied :
Thanks for the input.It has benefitted me greatly.
As I mentioned previously, I had my first GAD/Panic attack in 2000 when I thought I was having a heart attack. I will skip back 5 years to get my GAD issue a good picture. 20 years ago, My father a few bad health issues and died. Four years later, I lost a brother to a heart attack. Two years later, I lost another brother to and Automobile/Semitruck accident. 5 years after that I lost a sister. Finally in 2012, my mother passed away at 91 of COPD. For each one of these deaths I was involved in clean up and estate settlement.
Each of these carried enough stress by itself but I had all of them on me. The deaths of Dad and my siblings were always put on my shoulders to tell my mother of the tragedy. Not only telling her was bad but I had to be her caretaker as she declined and eventually passed away of COPD. Fortunately she was capable of living on her own but I had to check up on her everyday.
Also during these years, My marriage crumbled, I had to manage by self, rental property that I owned. I had a relationship that was stressfull, a bad job stressing me. and operating my health issues causing stress.
When ever I get the slightest bit stressed, the sensation that triggers is one that I remember as a child growing up. I can remember that when I did something wrong, whether intentional or unintentional, and knew I had to pay the consequences when dad came home, the fright I felt like it was out of breath, shaky, scared, nervous, NOT calm, brain thoughts going so fast that I couldnt make heads or tails of a straight thought or idea. Hope you understand what I am saying here. This sensation is triggered constantly and the area that I mentally focus on is my breathing and I find that it causes me Shortness of breath beyond what a person my age is supposed to get with aging.
OK, if you compile these issues, you will find an awful lot of stress and anxiety. Place that with the diagnosis from a Pulmonologist in 2001 that you have "A minor Ventilary Defect" you can comprehend that I have let GAD take control.
Now you have listed a few medications and the dosage level you like. My therapist has me on Lexapro twice a day, lowest dose. Also he has given me Xanax .5Mg two per day or 1mg/day Not sure how these levels work with you but in the past 10 days, I added 1/2-1 more xanax a day to my current level. This doseage seems to be helpful that I can unwind, relax and lower my stress.
I want to face my issues head on and work at eliminating the root cause so I can back off the level of meds. Is the amount of xanax too much or an issue because its more than the Dr prescribed.
Is there a supplement or something one can take that you agree with that help with adjusting the levels of GABA and serotonin or what ever works to compliment the meds so that I can come down from this?
Oh, from what I described, would you agree with the initial diagnosis that the main breathing issue is in my mind. Do Dr.s adjust meds on a patients word of mouth or get upset by not following directions. I think that the increased dosage for a controlled time period then cut back could/would get me to a point that I can become relaxed again.
Hello
I wont be comfortable using the term 'Its in your mind' which implies that its imaginary. I would put it as a disease of the brain neurotransmitters causing psychological and physical symptoms. The medication that you have been put up are good but the doses of lexapro that you have been put on should be at-least 20mg. With time you may reduce the requirement of xanax as the illness will be well controlled with lexapro.
Regards.
Patient replied :
So the doseage should be increased if my prescribing dr agrees?
Answer me one question, in our first discussion, we mentioned that there actually need not be a trigger present to set anxiety stress hormones in action once the body has become so sensative and pressured for so long? correct. These hormones can cause many different reactions or sensations.
My Underlying issues of GAD are two conditions, I mentioned the first, the belief that 15 years ago I had a heart attack. This I have overcome. The second issue is the extended period of time watching my mother die from COPD and the stages that she went through,and knowing that I have been told I have a Very Mild Ventilary defect. The second has bothered me tremendously, I feel it shouldnt but my mind wanders to consider if and when the PFT Tests will change and show decline. I should mention that I have taken 6 Pulmonary Function Tests in 14 years. Each one has varied slightly with the greatest change being in the category of PEV 25/75 where it has gone up and down and up over the years. The last test from July of 2014 had numbers higher than those in 2002 less the 25/75 which was down only by 10percentage points.
Knowing myself that I have been dealing with GAD for 14 years and ordinary Anxiety/stress compounded on top of it, Have you heard or would you consider that the overload of these hormones can be responsible to have compounded so much that simple bouts of exercise and movements can trigger the sensation of being out of breath. I wonder if I have so much noradrenaline and epinepherin or vice versa in my system that the excess triggers my strangest complaint. Please address all points in this paragraph!!!! My biggest complaint is that for some strange reason I can be talking and then run out of breath. ALSO, If I am at any distance from my cell phone or any phone and it rings, I start to feel panic because I am worried that when I get to the phone and answer, I am out of breath. This has been only over the past year.
This is a lot to address but the pulmonologist has indicated that my life should be almost as it was 14 years ago, so I wonder how much the panic can mess with my breathing and strange feeling in the traechea and talking issue. Oh, just a little over 2 years ago, the SOB when talking came on and left after a month, I chalked it up to stress and anxiety and it was gone for a long period before it returned. would you feel that that is more Psychological than physical?
Thanks for Listening and responding, it helps
Hello
I agree that the breathless of respiratory disorder and the feeling of being breathless of the anxiety disorder do mimic each other a lot. But if your PFT reports have remained stable, it appears that the breathlessness that you are experiencing could mostly be due to the neurotransmitter imbalance in your brain. Yes the dosage of escitalopram needs to be increased with the consent of your treating doctor.
There is no continuous overload of these chemicals. Its onlly at the time of panic or anxiety that the levels of these neurotransmitters increase in the brain. A long standing anxiety disorder will not deteriorate your respiratory issues, however vice-a versa the respiratory distress caused by the respiratory conditions can increase the anxiety issues.
Ans yes you understood it right as the trigger may not be always present for the anxiety disorder and many a times anxiety disorders can start without any trigger.
Regards