So Iíd like to give you the backstory of my current anxiety condition, so that perhaps you can have some understanding and information about me in order to give me some advice on what Iím going through. Iím a healthy 23 year old male, and for my entire life (up until this past week) I had never lived with any daily degree of moderate to severe anxiety; at least nothing that would steer me down the path towards habitual panic attacks. I hadnít experienced my first full-blown panic attack until just two months ago, and I have always been a relatively calm and relaxed type of person. Now, I do have some level of dysthymia that I had been diagnosed with several years ago; this led me to go on the anti-depressant merry-go-round for about 2 years (from 2010-2012), and I had tried many of the SSRIís commonly prescribed, as well as Effexor and Wellbutrin. I was mainly seeking the therapeutic effect of these medications towards depression and some social anxiety, and had found most benefit with the combination of Effexor and Wellbutrin. In 2012, I decided to go off of these medications because I was gradually feeling better about myself and had more confidence in the choices I was making. This ultimately was a wise decision, I felt.
In late 2011, I had also been prescribed Adderall for ADD, and had been taking that almost daily up until last month. At first, the Adderall had given me substantial relief in my depressive moods, and I had really excelled at daily activities (such as school and work). However, earlier this year, I was noticing that this medication was becoming more of a burden than a relief for me, as it was making me more irritable, anxious, and depressed whenever I would take it. It wasnít until earlier this past summer that I chose to stop taking Adderall, because it eventually gave me a panic attack one night. Naturally, I had thought that I was dying and was going to have a heart attack. Over the course of about 20 minutes or so, my pulse was in the 150ís, and I really didnít have any idea that it was indeed a panic attack. After doing some research on the matter, I discovered that once you experience a panic attack, your likelihood of eventually experiencing another one increases.
Surely enough, I experienced my second panic attack a couple weeks later, one morning at work. That morning I had taken 150 mg of Nuvigil (I had inquired about it to my psychiatrist as an alternative to Adderall, seeking less side effects). I had taken Nuvigil a number of times before and never had experienced a panic attack while on it. However, this one morning my heart rate ramped back up, I experienced some chest pain, and my ears were ringing. I wasnít sure what I was going through, so I called an ambulance and had gone to the ER to make sure that everything was ok. I had an EKG, chest x-ray, blood work, etc., and everything came out normal. This was almost exactly one month ago.
The wisest course of action, I determined from this, was to live by learning and to discontinue taking any stimulant medication. It was becoming increasingly apparent to me to stop taking them, as even smaller and smaller doses of Adderall has been provoking greater amounts of anxiety in me. Now, almost one week ago, I began experiencing more daily levels of anxiety. The reasons for this I am really not aware of, as I have stopped taking stimulant medications. I experience PVCís (pre-ventricular contractions) and this partially led to some of my anxiety, as I would feel anxious anticipating the next one that I would get, even though I know they are harmless. Whatís really disturbing me though is that I have had difficulty falling asleep or staying asleep these past several nights, because I am just anxious and my thoughts just race and race. The only way I have been able to get to sleep is by taking ambien that I was recently prescribed for countering any residual stimulation at bedtime from Adderall. Before, I had never had to take the ambien to get sleep when not taking the Adderall. Now, these past nights, I have needed the ambien to get any substantial sleep, even though I have stopped taking the Adderall. This is something I do not want to continue doing, as I do not want to be dependent on a sleep medication to fall asleep. Sleeping has always been extremely easy for me, but now it seems not so.
Last night, I experienced another panic attack. Iím unsure of what triggered it, but I know I must have been subconsciously paying constant attention to my heart rate and my PVCís (which are more forceful with a higher pulse rate). I had not experienced a panic attack while off of stimulant medication before, so this was very, well, stressful for me. I was also experiencing strong palpitations, which was likely a byproduct of my panic.
Tomorrow I have a visit to my psych, who I have not been seeing for any substantial anxiety related issues up until now. I am wondering about any insights on medications, particularly those with the least bothersome side effects. I've read up on benzodiazepines, SSRIís, beta blockers, etc. but I donít know which might be worth trying. Iím hesitant to go back on any SSRIís, as Iíve been on those before and am not fond of the strange side effects and libido issues associated with them. Beta Blockers like Inderal and Metropolol are relatively safe and non-additive from what Iíve read, but the rebound anxiety and rise in blood pressure when going off of them somewhat concerns me. Then again, I donít know all that much about them. Benzoís are not meant to be taken long-term, as they are addictive and have some nasty withdrawal effects. However, they are very potent at stopping panic attacks dead in their tracks. Useful for an as needed basis, but nothing more.
Additionally, Iíd like to add that I am currently taking 20 mg of Buspirone daily, and have been on this medication for almost 3 weeks. It is, however, a pretty weak medication. Probably the weakest anti-anxiety med for most people.
Ultimately, what I am hoping for is a medication/psychotherapy hybrid treatment regimen. Additionally, tomorrow I am going to pick up the book ďHope and Help for your NervesĒ by Dr. Claire Weekes, as this is a highly reputed book for targeting anxiety.
Sorry for the lengthy post, but I surmise that it is best to get it all out at once so that you can be best informed about my situation. Any advice is greatly appreciated.