I have suffered with panic disorder for roughly 14 years now, along with occasional episodes of generalised anxiety disorder and depression thrown in for good measure (the depression comes mostly after prolonged periods of anxiety, though, so it is more of a secondary problem). Prior to that, I was always a "worrier" as a child, so I guess I've probably always had a problem.
Up until the last year or so, my panic disorder was relatively controlled. I could get by so long as I avoided certain things (not good, I know, but it worked), and carried around benzos for use as needed, but now I have developed fully-fledged agoraphobia.
Last year was really bad. I got stuck in the house for a few weeks, and it took me a long time to be able to go out and do things again (like work or shopping), but I haven't improved much. I'm still stuck within roughly a 5 km radius of my house, and even within that radius there are places and situations that I can't be in for fear of getting stuck. (e.g., driving on certain roads, meetings at work, buying too many things at the supermarket).
I think I was able to manage up until now, because I could accept that the panic attacks weren't dangerous, just unpleasant. Well, since then, I've been diagnosed with a heart condition (SVT), and the panic attacks can (and have) triggered episodes of SVT. So now I'm desperate to avoid anything that could trigger a panic attack, because SVT is really not nice and pretty incapacitating when it happens. I have atrial tachycardia, too, so there's not really anything I can do to stop the episodes. I just have to wait it out.
The thing is, I just don't know what to do anymore. There's never ever been a period in my life where I've been totally free of anxiety, so I think I am one of those people who will probably always have to take some kind of medication. I'm ok with that, but I can't tolerate the medications that are usually prescribed for this sort of thing.
Antidepressants don't work and/or have intolerable side effects. Most make me hypomanic, within as little as a few days. The only one I could tolerate was mirtazapine (30 mg), and that was only if I also took quetiapine (an antipsychotic) at the same time. I was on that combination for 5 months or so, but it was horrible, so I came off both.
I have tried at least one antidepressant from the following classes: SSRI, SNRI, TCA, and NaSSA, so no one can say I haven't given them a good go. They are all way too activating for me, even at tiny doses. The only difference between them is the side effects. (This was all under the supervision of a psychiatrist by the way, so I've been doing the right thing, but I don't think even he knows what to do in my case).
I have also tried CBT. I really stuck with it (did it for well over a year), but it was like trying to put out a forest fire with a water pistol. Pretty much a waste of time.
Right now, I'm getting by (barely) with benzos. My GP (who I am too agoraphobic to actually go and see in person) has been prescribing me diazepam (10 mg per day in divided doses). I've been taking them for 3 or 4 months now, but it's not enough, and she doesn't want to give me a higher dose. I understand the issues of dependence and possible tolerance, but I think benzos may be my only hope. Over the years, I have used temazepam (prn), alprazolam (prn), oxazepam, and diazepam, and they've helped (with minimal side-effects). The cognitive side effects of diazepam are a bit of a pain (my short-term memory is pretty much gone, but I can live with that if it means no more anxiety).
I have also been experimenting with metoprolol (a cardio-selective beta blocker), which my cardiologist gave me for the heart problem. It does help with the anxiety, but I'm super sensitive to meds that lower my blood pressure and I don't think I can get it up to a therapeutic dose to block panic attacks. The most I have taken is 25 mg, which will drop my blood pressure down to around 95/70 and lower my resting heart rate to around 50. That's no big deal, but given that 25 mg has proved utterly useless at blocking the effects of a panic attack (my heart rate went right up to 160-180 during one), I am worried about going to a higher dose, since the effects on my blood pressure (and maybe heart rate) will probably be more pronounced.
So... I'm wondering, what can I do? Antidepressants are not an option. I am never going to take another antipsychotic again, and I'm not too keen on the idea of mood stablisers or anticonvulsants (assuming that the last two even work for panic at all -- the evidence seems pretty sketchy).
My GP has referred me back to my psychiatrist, but I'm not sure that he is going to know what to do either. Best case scenario is he tells my GP it's ok to prescribe a higher dose of benzos.
Does anyone here have any experience of being in a situation like this (i.e., where you can't take antidepressants), and/or does anyone have any experience of long-term benzo use?
Just how likely is tolerance? From what I've read in the scientific literature, some people become tolerant quickly, while others never seem to develop it. (Dependence is another matter, but I don't give a damn about that).
I could really use some advice, because I've just about reached the limit of what I can cope with. Although I'm in no immediate danger of ending my life, life does seem pretty pointless. Anxiety has ruined everything: my social life, my career, and I sometimes I really do wonder if I'd be better off dead. Agoraphobia makes me feel like I'm in prison, and it's all just so draining.