Long Distance Trip

[JustWant2bWell]

I've met this girl on a 'good' online dating site (not the nvm, it doesn't take a genius to know a site that's for genuinely good ppl and a site that's just for hard-core bangin' or hook-ups).  We've spoken amply enough to earn trust and now she's taken a weekend off in December for me to come visit.  She lives 170 miles away. 
I cannot do this.  I am in no shape to make this trip with what I suffer from and not having relief from the doctors and therapists, and I have no clue why I even got myself in this situation. 
I take klonopin 1mg 3x a day, the slowest acting narcotic antianxiety agent they make bc 'it stays in your system longer' and they won't increase it bc according to them 'you're on a high dose already.'  As well as depakote 250mg 3x a day.

Now, idkwtf to do.  I mean, in the end I'll live with not meeting her dont get me wrong but that's beside the point.  This is a rl example of how debilitating gad and panic disorder can be with interfering with someone trying to have a real life. And why there's so much deliberation with allowing me/anyone in my shoes relief just compounds the individual into further debilities (depression probably, ocd probably, HA eventually) which is all counter-productive is completely beyond my comprehension.  Most importantly aside from the girl is being able to sit through college lectures again, of which it seems I'll never be able to do at this rate.  And if I can't, then what's the point to anything?  My gpa is still well above avg b4 they switched diazepam to klonopin and y they wont switch back I'll never know.

The girl says she understands, as I've already explained to on probably the 2nd phone call the 'real' me behind the photos and bio.  I have nothing to hide and if it's a problem, God'll send me someone else. Nbd. The real me with the gad and panic disorder of which she was rather understanding too, surprising me I won't lie. 

Fast forward to tonight: And we just got off the phone regarding meeting literally 10 minutes ago.  To me, she understands as much as someone possibly could without suffering from it themselves, of which I wouldn't wish on anyone's worst enemy and I put that on everything.  It's like seeing a woman in the grocery store trying to care for a child with down-syndrome.  You can Try and understand how hard it must be but none of us that I know of can truly say we know what that is like 24-7.   

All I know is that I'm going to TRY and make the trip bc she really seems like a good girl, and, to challenge my own fears as best I can.  I already know I'll be checking every exit on the way for the blue "H" sign for hospital just to be safe.  (Is that ocd already and i'm not aware it is?)  Still, I'll go as far as I can and just pray and pray that nothing physiological takes over from the stupid-a$$ amygdala.  Even if I DO make the trip somehow, idk how this relationship suppose to continue unless, well, she's already mentioned that I move there.  I know that sounds early, WAY early (to me) but God love her she works 12 hour days, 60 hour workweeks and Still finds time to be a Sunday school teacher for kids.  I'm not concerned with the future of it so much I havent even made the 1st trip but that's not the point.  The point......I guess I don't have one and this post is a bust. 

I just called (it's midnight here) and left a msg with my dr because I'm going thru the same sh@#, day in and day out, even if I put up a better 'air' in chat that would surmise otherwise bc once again, this gad and panic disorder is controlling me and I've got to find a way to break free (without harming myself or doing something stupid).  I'm trying to push my late dec appt to earlier but the thing is, it's like i can't get thru to these doctors even if I do get my appt pushed sooner.  It's like they believe me, but they prescribe a narcotic (which ooh, is such a no-no) but not one that lets me do normal things.  I do cbt, meditation, exercise, you name it.  It's that God-forsaken amygdala and I'll just stop myself here.  I understand no one here can do anything about it, even if anyone posts to this, but it's all just getting hopeless as I age.  I'm kicking 30s door down.  I need relief not just for this one occasion but for life.  And again, I can't seem to get this thru to drs. 

What am I doing wrong?  What am I suppose to do to get them (drs, therapists) to understand and I don't have to live this way?  If I have to live this way the rest of my life (sorry chat ppl that may have come to respect me) then what's the point of living?  Am I suppose to go live in a 'home' and kiss my life goodbye?  Share half of a tiny room with someone who's crazy and lose what freedom I DO have living on my own?  I refuse to continue with these asphyxiations.  It's not human, it's not how we were made, it's stark suffering and it's bull@#$% that I continue to live with them. 

Any advice is welcome.

[insights]

I take klonopin 1mg 3x a day, the slowest acting narcotic antianxiety agent they make bc 'it stays in your system longer' and they won't increase it bc according to them 'you're on a high dose already.'  As well as depakote 250mg 3x a day.

For anxiety, 3 mg/day of Klonopin is a highish dose. The fact it is slow acting, and it is but not by much compared to say Xanax, is of no significance given you are taking it continually. It isn't a narcotic.

My gpa is still well above avg b4 they switched diazepam to klonopin and y they wont switch back I'll never know.

How much Valium were you taking?

I do cbt, meditation, exercise, you name it.

What having you been doing with CBT, and has it made any difference?

What am I suppose to do to get them (drs, therapists) to understand and I don't have to live this way?

Have you tried antidepressants? If so, did it/they help?

Ian

[JustWant2bWell]

The Klonopin is definitely not working.  I was not aware it was not a narcotic, just that it was a controlled substance and considered them one in the same in any dr's eyes that I've ever met.

That was from 03 to 05 I believe, and I do not remember the Valium dose.

CBT I have went through talk therapy, attempting to challenge these thoughts, and almost hypnotherapy (which worked for that one session).  It came to a point where 15 minutes before the past 3 sessions he would try and force the catastrophizing of an attack out of me, almost on cue.  Having me leave disgusted and with worsened symptoms of which the klonopin does NOTHING to ease when the disorder gets worked up like that.  Also, therapists tend to get on the defensive if you have any type of medical terminology background (or the ones that I have dealt with) and they immediately become intimidated, for lack of a better word.  After those 1st few sessions, it's back to the drawing board with trying to find a suitable therapist that isn't just looking for someone with the simplest of anxieties or easiest to deal with.  So, I'm seeing a new one come early December.  Other ones in the past didn't seem to do much helpful or I would see that they were taking my case as a by-the-book measure if you will, of which wouldn't do anything and when a therapist talks to you as if something that theyve recited 10x on the day already, it's hard to pay attention to them bc there is no genuine concern.  Its as if, if your symptoms aren't too bad then I can work with you.  If your symptoms are severe, I have to find a way to run you off so I can find a more malleable client.

I have tried a few antidepressants and I do not know why I am not on them now.  The most recent I believe was effexor but it would spiral me INTO an episode, of which I'd rather die than live thru another panic episode I'm so sensitized to the asphyxiation and dread of impending doom that wont go away.  There, I've said it.  I mention and research antidepressants (of which 90% of anxiety theoretically comes from) but they all seem to cause panic.  If you know better, please advise.  Thanks for responding btw Ian.

[JustWant2bWell]

*update,
also they tried prozac.  And did a bloodwork study.   And according to them, I think i was on 20mg? I honestly dont remember, but they said that my body wasn't metabolizing it.  So it was just building up to the point of eventual toxicity.  It did not that i remember, however, cause bad anxiety.

The last emergency room visit (thanks to the effexor) the benzo/klonopin didnt even show up in my system.  None whatsoever, which lead me to believe that if my body won't metabolize some of these drugs, maybe others it metabolizes too fast, of which I still believe. 

And do you want to know what the dr (Not the therapist) had the gall to say when I had an emergency visit two days later?  She said 'some ppl dilute their system before going to the emergency room...' and to myself I'm like Really?! O M F G just kill me now! I didn't say that tho. I wanted to fly off the chain on that comment.  After the sickening shock to be accused of that and quickly realize that yet again these doctors just looooove trying to point the finger, I think I said 'Do you think I ENJOY these episodes or something??' and a rather upset way.  And all I could do was weep, believing that yet again, I've run into hopelessness. 

I have never tested once for anything illegal in my system.  It made me rather emotional I wont lie.  After all I've subjected myself to with trying things that don't agree with my system, things that wont metabolize -or- metabolize too fast in my system, that these doctors Still have the gall to Still try and label me as something I'm not.  I swear there is a special place in hell for drs and therapists like this.  Ever since the dr retired that I saw back in college, it's just a repeat of the same thing with each doctor or therapist I seek for help.

Which only ruins my credibility more as a doctor hopper or something.  I'd rather be dead than try and be out in public or even be at home and suffer another attack without some kind of relief to pull me out of it.  Turn me into the authorities for saying that, Idc.  Not that I would harm myself, but that, again, I'd rather be dead whether taken quickly in an auto accident or however He wants to take me.  Then I get fearful for thinking these thoughts because I feel He'll punish me with some illness or deformity I'll have to live the rest of my life with.  I'm definitely a God fearing man and that's as far as I'll take religion on this site.

Can't get any help in chat there's too many ppl complaining about problems that arent even problems or life threatening.  Or ppl bragging on how good they feel and how medicated they are and still live functional lives.  I think I've determined a handful of people, if even that, that are genuine people that have either been thru and overcame what I'm going thru, or are caring enough to try and understand.  Try logging in, you'll see Just what I mean.

My regards,
~T

[insights]

The Klonopin is definitely not working.  I was not aware it was not a narcotic, just that it was a controlled substance and considered them one in the same in any dr's eyes that I've ever met.

It is a benzodiazepine (BZD) just like Valium.

That was from 03 to 05 I believe, and I do not remember the Valium dose.

Well you must have been on a very high dose if 3mg Klonopin isn't as effective. This much Klonopin is roughly the equivalent of 60mg Valium.

It came to a point where 15 minutes before the past 3 sessions he would try and force the catastrophizing of an attack out of me, almost on cue.

Do you mean he was trying to get flood you with anxiety? If so, such exposure therapy does work for some. It may have been worth trying.

I have tried a few antidepressants and I do not know why I am not on them now.  The most recent I believe was effexor but it would spiral me INTO an episode,

Antidepressants often do make anxiety worse at first. It is possible to limit this by starting on a small dose and ramping it up by the same amount every 7-10 days. But it can't be completely avoided. It is a matter of white knuckling past the worst of it. Antidepressants can greatly change lives, so it could be worth the emotional pain. It has been for me. But this is your call.

My suggestions would be to try one of the old tricyclic antidepressants such as imipramine. These have a number of drawbacks, mostly nuisance long-term side-effects such as dry mouth and constipation, which can be managed, however, they have one huge advantage for someone in your situation, their therapeutic dose range is high, typically 100-300mg, yet some come in comparatively small dose tablets.

For example, imipramine (Tofranil), for long the 'gold standard' antidepressant for panic disorder, is available in 10mg tablets, or 1/10th the usual minimum effective dose, which is very good compared to say citalopram (Celexa) which has a dose range of 20-60mg, but the smallest tablet is also 10mg, or half the usual lowest effective dose. Moreover, you can cut the 10mg imipramine tablet in half which means you're starting on only 1/20th of the initial target dose. This is tiny and unlikely to cause much, if any, added anxiety. So, something for you and your doctor to consider. The downside is that it will take you several months to get to 100mg (once you're at 25mg/day you can try increasing the dose in 10mg steps), and you might need to go even higher (I've been up to 350mg), so it isn't going to solve your current problem. But then there is no acceptable way of solving it in the short term anyway. Sorry. 

Best wishes

Ian

[JustWant2bWell]

I'm aware it is a benzo, of which doesn't show in my urine screens from the hospital.

At this time last year, I was on 1 mg klonopin 4x a day and rarely had any episode or obsession of fear of an episode, nothing like what the situation does to me now.  They recently passed a KASPER act in my state which was geared for the pain medicine seekers, but ended up affecting the psych doctors as well and honestly, it doesnt make much sense that 1 mg would make this much difference but what I Can say is that things havent been the same. 

The therapy wasn't working at all.  I was (and still) am in no shape to be forced into this frying pan of suffering.  Maybe a little gentler and I could have been able to systematically desensitize myself to things better but not at the repeated route he was taking at all.  He wanted someone easier to work with as previously stated.

Good point.  They Have mentioned the tricyclic ones but we went with effexor, and in retrospect (i believe it was a 60mg or the smallest they make) and with the increased symptoms, we went down to breaking it in half.  Still worsened anxiety so we literally went down to 1/4 of the smallest dose they make.  I'm kind of afraid of medicines tbh.  But when we went to 1/4 of the smallest dose, it didnt make any sense at the time because it definitely wasnt working and we had taken 1 pill to half, then to half again.  In retrospect, maybe I should have found a way to 'white knuckle' it.  It's just with these symptoms man, the LAST thing you want is for something to spiral out of control into (no I dont have HA that I know of) but a heart attack/panic attack that you live thru.  I can't allow that to happen to me ever again.

I can mention imipramine come the next visit.  Things were going so well until your final paragraph.  I guess it was the truth but I'm well aware these drs (3 now) are not willing to try anything to ease 'the current problem.' 

I believe I've mentioned it before but is there not a fast-acting medicine specifically designed for this problem?  It is the year 2013 almost.  To not have these symptoms under control enough to where therapy will be beneficial dooms the situation to begin with.  Ativan is what I have heard of that suppose to nip these episodes in the bud.  And when I mentioned that two months ago, the doctors eyes got larger than a cartoon characters and said no no no.  We are sticking with the klonopin and that's it.

It's just rough man, and being prisoner to not only myself but doctors with ruining what future I know in my heart I'm capable of achieving without this disorder just touches darkness on every single day of my life, and I feel it's only compounding into other psych problems as well (depression, obsessiveness like just this morning I didnt even want to get out of bed bc within 2 hours, BAM!, the anxiety kicks in that I endure the rest of the day with until I can finally fall asleep again.

Thanks for your concern and replies.  Btw, I do not always get notifications when someone has responded to something I've posted, such as this one.  So I started the day looking for some responses or encouragement and the only way I've found to do that is log in, go to profile, then summary and posts and look at each of them individually.  On the occasional one that says notify with the (!) I'll hit it and it say something to the extent of "do you want to de-notify responses to this'.  Otherwise, I'm going to miss out on things that could help me better understand how to tackle this and be just like the majority of ppl: out working, having lifes normal ups and downs, finishing school, going to the nieces parties and nephs football games, hanging with the family, even going out to see a movie without freaking out.  So it would be nice to know what I'm doing wrong if you have insight on that as well.

Thanks in advance~

[LindaRK]

I'm curious as to why your docs are completely against Ativan.  It's a benzo like Klonipin and Valium.  Life is 6-8 hours.  It's my med of choice and I've been on alot of meds for both depression and anxiety.  Currently med-free, but I have a prescription of Ativan in my closet in case of emergencies.  For me, it usually kicks in within about an hour.  For some reasons, most medications take an hour to 1.5 hours to kick in for me, while others it's alot less.

Anyway, I've found during my 35+ years with anxiety that using a short term benzo course while learning to manage your anxiety in other ways works well.  You've done the CBT route.  Do you exercise at all?  I'm talking about cardio-type - not just walking around the block.  Something to get your heart rate up on a regular basis.

I'm employed and have adult children - I volunteer, I try to keep myself busy, but when I have downtime, the anxiety can really kick in.  It's all about distraction and re-training my brain to NOT amp up when the anxiety creeps in.  All that does it give it more power to come back again.  It's a vicious circle, but one that can be tamed with patience and persistence.

[JustWant2bWell]

I wonder the same thing myself Linda.

My rationale is to the drs is 'look, lets stop what's happening, and cbt, rebt, and the like should All work much better.  I am in no state to have these episodes be drawn out of me like grabbing a lion by its teeth.'  They recently passed a K.A.S.P.E.R. law in my state and i'm pretty sure that's the culprit.  It's aimed at the pain pillheads but at the same time it affects All drs so any doc i see wants to stay with what a previous dr has been working on.  Completely destroying my rationale of having a fresh face take a look at the situation and circumstance.

I walk around the block with the dog, who doesnt, but I have my own weights and bench at the house to keep the upper body matching the lower body and aerobic exercise I get from p90x (even the yoga will make you sweat), all the p90x but the plyometrics dvd bc i live on the 3rd floor and dont want to hear no crap from anyone for trying to remain in shape.  I have a treadmill that I use in the winter but it sounds like thats 'just walking around the block.' 

About two years ago I was well enough to volunteer for a local nursing home to keep myself busy and get out on the road or do something with my life.  It went well until, well, once you build a bond with these ppl they can't help but ask you to do things you cannot do.  I was slapped on the wrist (not literally) for getting him an extra orange juice for lunch but the deal breaker was when they ask me to take them to the dr appts for them.  Of which I have no say so in whatsoever, so rather than build a bond then disappoint, I've refrained from them.

And yea!, the anxiety Reeealy kicks in with downtime.  At the same time my gad and panic disorder prevent me (on my life it's true) from getting out enough so that there isn't downtime.  It's a horrible cycle.  I'm going on 8 years with this and just want to 'get out there again' but THANKS PILLHEADS!!! No doc out of 3 this year will provide relief thanks to you and with all that on my records, I'm sure I'm labeled as a doctor hopper or substance seeker which circles back to the kasper act and how sometimes when a governor does something that seems to be best for the overall good, if he and his advisors would've not made psych drs so afraid to help their victims and written a few extra clauses this wouldnt be the case.  But that's done and there is nothing I can do about it.  But go to the er when things get bad, have the automatic urinalysis show that no drugs, not even the benzos are in my system (of which my body metabolizes too quicky) and then have the finger pointed at me from my doctor.  It's a mess Linda.  Idk what to do, but believe you me that I have been trying to tame this with patience and persistence or I wouldnt be here today.

[JustWant2bWell]

I guess this topic's over.  I haven't heard from her since. 

Can't rly blame her.

Thanks to my state and mayor, I'll just stay prisoner until I'm old and gray bc he passed such a naive bill to target the pain pillhead abusers that it also caught the psychiatric benzos in the process and doctors frankly won't prescribe them.  I'm lucky I even get klonopin I guess and it obviously isn't doing the trick in conjunction with cbt, rebt, meditation, exercise... everything the therapist suggests.  I'm doing everything on my end but thanks to a mayor that has NO idea what a life like this is like just decides to up and pass a bill that robs me of a life.  Thanks so much.  Thanks sooo much for ruining my fair chance at life and abiding by the constitutional rights.  If you had any sense you would haven't written such a naive bill that included all that it encompassed and honestly, I fu#$^%$ hate my life and the thought that I won't ever get proper relief.  But who 0213%$%#^#$ cares?  It's always about someone else in the chat, probably better that way tbh.

Doesn't matter.  It's over, and I can't blame her.  I'll find relief or die tryin'.  Deuces.

[insights]

Ativan is what I have heard of that suppose to nip these episodes in the bud.

It doesn't really. It does begin working a few minutes earlier than Klonopin, but still takes 20-30 minutes to hit the bloodstream and doesn't reach peak effectiveness for 1-2 hours. Most panic attacks only last 10-15 minutes, however, they in turn trigger high anxiety which can last hours and it can be difficult to pick when the attack ends and the anxiety begins. IMHO, it is far better to prevent the attack with a long acting BZD than limit the damage with a short acting one taken when the attack starts.

But when we went to 1/4 of the smallest dose, it didnt make any sense at the time because it definitely wasnt working and we had taken 1 pill to half, then to half again.

The point is to give the body time to adjust to the drug at a dose so small that the side-effects will be mild enough to be tolerable. However, the lowest dose Effexor tablet is 37.5mg, which is still fairly high compared to its therapeutic rtange, and to complicate things, the immediate release version which you were on has a very short half-life, about 5 hours, plus another 12 hours or so from its main active metabolite. At low doses the short half-life means the drug cuts out suddenly which many find uncomfortable. This is why I suggested imipramine. Its half-life is about 20 hours, plus another 120 hours from its active metabolite, desimipramine. Together, they make for a much smoother 'ride.'

I believe I've mentioned it before but is there not a fast-acting medicine specifically designed for this problem?  It is the year 2013 almost.

Unfortunately, no. Nor is there likely to be any times soon. The pharmaceutical companies seem to be giving up on psych medications, in large part because of big law suite payouts in recent years. Some of these may have been justified, but many probably aren't. The problem is that the drugs often get blamed for things actually caused by the mental illnesses they're treating. Another factor in the companies thinking may well be that is some parts of the world, particularly Britain, antidepressants are becoming as demonized as benzodiazepines have been and this will inevitable spread. It is now nearly impossible to get a BZD prescription in that country and as you've discovered it is becoming increasing hard in parts of America too.

Btw, I do not always get notifications when someone has responded to something I've posted, such as this one.

Outside my area, I'm afraid. If you message one of the moderators listed towards the bottom of this page, I'm sure they'll look into it for you.

Take care

Ian

[JustWant2bWell]

Thanks for your help Ian.

[scaredca]

Justwant2bewell-  Did you go?  I am having that similar problem.  We were supposed to be driving a couple hundered miles away for a conventiona and because of this stupid problem we did not go.  We are going to try again in the morning hopefully it will be okay.  My attack lasted a couple of hours then I was so weak and slept from about 9:30 this morning until about three this afternoon.  I HATE this.  It could cost me a wonderful relationship and my daughter a wonderful stepfather.

[stevo1111]

Both my father and myself have benefited from Anafranil (clomimpramine) for chronic panic attacks.Through CBT I was able to stop having them, although I am still afraid of having one daily.

 Anafranil is chemically very close to imipramine, but the small change makes the action somewhat different. As Ian said, imipramine is the gold standard for panic disorder by which the newer drugs are all compared. I recall coming across journal articles that speculate that Anafranil is the best for panic disorder, building the argument from a small pool of data. More or less, Anafranil is a hammer, it's possible it may block your body from going into panic mode. Not good if you run into a bear or a robber, but good if you panic multiple times a day.

[JustWant2bWell]

Scaredca, I didn't make the trip. Maybe it was for the better.  It just wasn't supposed2be and I'm okay with that, but not the disorder.

I've journaled per my sisters idea and come to realize I have attacks much more often than I thought.  5/7 days a week and on some days I have more than one.  It's completely out of control, happens more often at night, and I doubt I'll ever be normal again.  It honestly breaks my spirit a little more with each and every one.

I completely understand attacks that last several hours and to think of them breaks me even more.  I get emotional and don't want to think about them but believe me, I understand and have lost so much already relationship-wise, monetarily, mentally... I don't even plan for a future anymore bc I don't see myself making it and am ashamed how far I've fallen from what I was in being that seed that didn't need much to succeed.  Thanks Drs and therapists for the relief you've allowed me over the past 10 yrs -.-  I've must've been through 7 or 8 already.  I hope your trip went well.

Stevo I tried suggesting the imipramine to the doctor, (and I think the world of Ian and always will, he was the 1st to come to my side here cyberlly and offer help) and as typical, she goes no no no there are newer drugs with less side effect et cetera and I am on celexa now.  In my experience only, it's as if a knowledgeable patient is suffering and done their homework in trying so hard to find help... that doctors and therapists become strikingly more closed minded and intimidated.  As if we are not on the same team anymore.  And it baffles me. 

My next appt is Jan 9th and it will mark 6 months or so of working with the current dr.  I have taken note of the Anafranil and thanks so much for taking the time for the advice.  A robber doesn't worry me.  He'd be sorely mistaken to try and rob me and would re-think his life of petty crime.  I'd let him live but I'm not here to be come cyber tough guy or whatever.  I'm well aware of what I am capable of physically and with other human beings, only completely helpless to this shameful disorder that imprisons me.  My nieces and nephs all wondered why I couldnt make it to Christmas with them or the family vacation this year.  Or trips to the mall or days 'out' but they don't need to understand.  It's best I stay under the radar vs them seeing me go thru a full blown attack.  But I'm not going to waste more space with the downsides of this so it doesn't agitate other readers possible symptoms.  To block my body from going into panic as frequently as it does would be a dream come true, and perhaps I could change my screen name to FinallyFeelingWell or something.

Thanks for the responses guys.