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Dr. Andrew Rynne

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Suggest remedy for severe panic disorder and anxiety

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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2243 Questions

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Posted on Fri, 30 Oct 2015 in General Health
Question: We spoke a couple of weeks ago regarding gad, pulmonary breathing and consistent pft results the same or close to.

In 1979 I had an first date/relationship issue that sent my anxiety through the roof. Though at the time, I did not know of the cause or resulting symptoms of inability to breathe. I guess she really did take my breath away

Nothing resurfaced until 2000 when I thought I was having a heart attack but was a gas attack. A few more of these have occurred over the years sending me to the emergency room at heart hospital
Now it's breathing issues You mentioned that you realized certain triggers when I mentioned watching my mother die of copd.
Well to get to the point of my question, since I know that panic hormones can trigger very real symptom like issues to heart, is it safe to assume that the lungs and pulmonary system can be fooled the same. This is in addition to the body's response to the fight or flight response of real triggers such as changes to body like tight muscles, breath changes. Digestion changes. Heart etc etc etc
pulmonologist says it takes entire lung to breath, if upper chest is tight from stress can it restrict breathing but should improve if stress is reduced.
doctor
Answered by Dr. Alexander H. Sheppe 2 hours later
Brief Answer:
Panic and breathing

Detailed Answer:
I remember you well. The "takes my breath away" joke in reference to you date in 1979 made me chuckle. Thanks for your question. By asking me using my direct link, I consider you one of my patients, and will give you the very best care and attention I can to help you.

I'm hearing you ask if panic attacks, since they cause very real and distressing physical symptoms, can affect breathing in a negative way.

Panic attacks, as you mention, activate the fight-or-flight system in situations where we don't really need it activated. This system involves a surge of catecholamines which does very physical things to the body like increase heart rate, dilate the pupils, send blood to our muscles to prepare to run, and does indeed affect the lungs. We breathe faster and have the very unpleasant sensation that we are not getting enough air, to encourage us to breathe more in preparation for running away. So in that sense, yes, panic attacks do affect the lungs and give us unpleasant sensations.

However, despite all of this, panic does not affect the lungs in a way that is actually dangerous. We have FEELINGS of chest tightness and being unable to breathe well, but these feelings are not based on physiological reality. Your lungs are getting plenty of oxygen and there is plenty of space in your chest for your lungs to expand and contract safely. So while panic attacks feel terrible, they are actually not dangerous at all.

This is something that is a focus of therapy in my patients with panic attacks. Realizing THEY ARE NOT DANGEROUS is key to mastering them. In combination with medication, the cognitive knowledge that you are actually breathing fine despite feeling terrible help you overcome the sensation.

Please ask me any follow-up questions that come to mind. I enjoy speaking with you and would be happy to answer them.


Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Alexander H. Sheppe 5 hours later
I know what you mean by panic attacks not being dangerous. I just hate the recurring tight feeling to my chest restricting how much I can take in as I inhale. I seem to get three seconds (one thousand one, one thousand two.......) then my lungs hit a wall and stop expanding. My ribs seem to stop anymore expanding of the lungs. My lower lungs are what's doing the work my pulmonologist said that the anxiety is keeping a bit of tight band on my chest keeping the upper from working as it would normally like you, he is convinced that it's anxiety and as soon as I can get back to a calm state I should breTh better. That's hard when you get a sudden stop when you want a good breath.
I could tell you several visual and mental cues that can trigger a panic attack. Like pavlovs dogs, I've let events that trigger a attack get ingrained and each time it occurs I work to convince myself that it's just in my mind
doctor
Answered by Dr. Alexander H. Sheppe 5 minutes later
Brief Answer:
Follow-up

Detailed Answer:
You describe a panic attack well. It is intensely uncomfortable and frightening. I would disagree with your pulmonologist somewhat, in that the top part of your chest is not being rendered unfunctional by panic, it is still working adequately but just feels tight. As you describe, it is difficult to realize this in the middle of an attack, but telling yourself the attack is not dangerous is a helpful mental exercise to help yourself deal with it in the moment.

Why don't you tell me some of the visual and mental cues you experience? We could work together to talk about these.

Are you taking any medication for panic attacks? They are very treatable. I could give you some recommendations.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Alexander H. Sheppe 18 hours later
It seems my phone is not letting my responses go thru. I am sorry to cause a misunderstanding regarding my answer to the pulmonologist response. I was trying to indicate that he too thinks that the excess anxiety has caused a tight feeling across the chest causing the feeling to be hard to inhale in the upper chest region. He was mentioning that it can cause the feeling that the ribcage will not expand when you want it to causing the lower area to try to compensate. I know its only a sensation.
The big issue is the stomach pressing against the diaphragm at the same time as the breathing seems to be in the lower lungs.

The only medication is 10 mg lexapro twice a day.

Some of the Cues are when I see a stairway to climb, i panic ahead of time knowing/thinking i will be out of breath when I hit the top.
Hearing a phone ring and hurrying to answer it makes me frightened of the shortness of breath as I answer it.
Hearing the Doorbell ring and quickly moving to get it and knowing ill be out of breath when I get there.
Having to raise my voice to the dog as she barks makes me out of breath.

All of these things I have trained my brain to be frightened of. I wish to say they are all GAD related but somedays question the conclusion on my first pft and if it will worsen or stay the same.
The conclusion was "Very mild Copd/ventilary Defect" Watching my mother go through all the stages of COPD, I got to understand the malady, sometimes I feel a bit too much understanding.
In 14 years I have visited in office 3 pulmonologist,and HCM 1. No one seems to concerned with my pft results, they all conclude that I have GAD and that my issues are Anxiety Based. I have spoken with a pulmonary PA and a Respiratory therapist. Both have seen my PFT reports. Again no one seems concerned, the therapist has said that it looks normal for someone my age and that the changes resemble aging.
I worry on this, why, I can guess that its because I do not wish to go through the same as my mother. This is not the first long term panic issue, but it is the longest running. It began two years ago last april while attempting to clean up damage from a spring ice storm. The scrambling and work to clean up triggered an event of short breathing. That sent a short lived panic attack. It returned for a one week visit later that summer. Then it went away for a year, and then it kicked in again and has been with me since. Numerous high stressing events led up to the time this began. I want to believe that the storm was the straw that broke the camels back and pushed it over the edge.

I just have a hard time anymore believing that the issues i face now is all anxiety but the doctors and my old psychiatrist whom is to far away to see anymore, all believe that there should not be any physical changes or if so very little. I wish I could describe the feeling in the lungs when I am having the obstructive breathing issue and the feeling when I run short of breath when talking. I am just hoping that a body can be so over stimulated and brain so mislead that I have psychological, not physical sensations preventing my normal living.

I once joked about people i know being hypochondriacs, I never belittled them but I have become one and know their plight. What I have to find is the point where I must believe all the doctors who all say that I should be fine and not to worry but its one hell of a challenge.

Ok enough for now. Think on this and now you know I am Nuts HA HA
doctor
Answered by Dr. Alexander H. Sheppe 7 minutes later
Brief Answer:
Follow-up

Detailed Answer:
Thank you for sharing more of your story with me.

Let me start by saying I do not at all think you're nuts. When people experience bad things, they don't want to experience them again. This is natural. You watched your mother die from a terrible disease and you are intensely worried this may be happening to you. This is a natural and very human response.

Sometimes the brain takes things out of proportion. You can even know your response is out of proportion, but that doesn't mean it doesn't feel very real. When you're worried about climbing the stairs or answering the phone or door or raising your voice at your dog, this is a very real feeling. Anxiety can make you feel like you can't breathe, this is a fact. But it is also a fact from reviewing your PFTs that you do not have COPD like your mother. Your lungs are working fine. And you have to keep telling yourself this.

You're right. This is one hell of a challenge. If Lexapro 20mg daily (total) has not been helping you, perhaps it is time to try a different medication. Zoloft, Prozac, Paxil all come to mind. Sometimes one antidepressant does not work, but often a different one will. How long have you been taking the Lexapro? With medication and ongoing therapy, the vast majority of my patients will see these panic attacks and anxiety improve tremendously.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Alexander H. Sheppe 1 hour later
Thanks, first I was just adding a bit of stupid humor on the NUTS bit. Outside this issue, I have a warped sense of humor so it was strangely fitting but not actual.

Any way, The psychiatrist that prescribed the Lexapro first prescribed me effexor back in 2002, I took it for a couple years and the side effects of 24/7 yawning and sleepiness were enough that i ceased after the first onset of anxiety subsided. i was off of it for 6-7 years until the Psychiatrist thought i should go back on medication. That is when i started Lexapro at 10 mg a day after 6-8 months he increased it to 20 in a day. If i am correct, I think both are made from same pharmaceutical companies. He likes that co i think. so i have been on Lexapro since 2012

BTW, thanks for taking time to thoroughly reading my texts, not to say you wouldnt but its comforting to see that you pick apart the key parts of my questions to supply me with things i need to know or have overlooked in my view

I must also say that I do not like to be heavily medicated and do not think anti depressants cause that unless very high dosage but I do wish to move to something else that might work better. If I haven't made it clear, I have moved 9 months ago 300 miles away from my home town. I have had to change over all my doctors, This means I will have to find a new prescribing doctor
doctor
Answered by Dr. Alexander H. Sheppe 5 minutes later
Brief Answer:
Follow-up

Detailed Answer:
It is unfortunate that e-medicine has not evolved to the point of prescribing across state lines, but I'm sure you will find someone who can prescribe something effective for you. There are many antidepressants, which as you note are not heavily sedating, and one almost certainly will work for you. It sounds like Lexapro is not getting the job done, so I would think about switching.

I appreciate your humor. It's a good quality to have.

And it's my pleasure to read what you send and help you think through it. It's my job and I enjoy it. I hope to talk with you again soon, for any other questions you have or for ongoing therapy.

tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Raju A.T
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