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What are the side effects of GAD medications on health?

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Posted on Sat, 7 May 2016
Question: So we are down to understanding the issue of taking a deep breath. or not able to take a deep breath. I sat and read the copies of the 6 PFT tests I have taken. I first realized after that I took the first, fourth fifth and sixth after a bout of Panic because breathing was problematic. Tests 2 and 3 were follow up requests by dr. As I began, I was reading the tests and noted that the first was normal. the following had mild vent defect but overall unremarkable. The last 3 mentioned Asthma and bronchitis. No bronchitis symptoms but last weeks visit the dr mentioned possible Asthma. The conclusions reached should be simplimatic but I can only assume that in some way this stress and GAD is been going on so long that my body is on overload. Can the bodies release of hormones not only create physical sensations but when happening so often that they take longer to leave the body.

I started this thread talking of the understanding of my breathing issue. I need to relax and hope that the limitation is just after effects or over abundance of panic hormones or heaven forbid, the effects pf anxiety and asthma since anxiety amplifies asthma and asthma has a air trapping component.
I landed a used but great shape foot pedal for my bass today, so I will go sit in front of tv and try it out. just relax. Maybe just maybe, it can take my mind off the issue some and if i do it enough, it will eventually overcome the amount of issue so that I can knock it out.
I need a refresher from you regarding gad and its effects on breathing. All changes it can cause. I have 6 PFTs that are normal except the midflow. I think I will put the testing to rest by requesting a cat scan to look for air pockets. If that arises get another pft. Last one 20 months ago. Not sure what can change in the time frame for a non smoker. One nut on Facebook had to say that XXXXXXX Nemoy quit smoking and 30 years later developed emphysema. 30 years is a long time so change can be slow huh?

I conversed I with a pulminologist on hcm yesterday. And they have me questioning any change to the 25/75 range of mid flows. A detector of air trapping along with the rv range.
doctor
Answered by Dr. Alexander H. Sheppe (3 hours later)
Brief Answer:
Private Consultation

Detailed Answer:
Sorry it took me a while to get to your first question. We can use both these open threads at once to answer more questions more quickly, so no worries!

You ask here about the effects of GAD/panic on PFTs. The answer is that PFTs will generally be normal in people with anxiety/panic. The only exception is if you were doing a PFT on someone experiencing an acute panic attack -- it would show hyperventilation, but no restrictive/obstructive patterns. The sensation of not being able to expand your lungs and not being able to get enough air is 100% a byproduct of anxiety -- it does not correlate to any physical problem in the lungs or the air surrounding the lungs. Your brain perceives a problem that is not there.

Regarding the need for further testing including a CT scan and additional PFTs, you are certainly welcome to do this for peace of mind, but be careful. PFTs in particular are completely safe.

However, I would caution against getting a CT scan. You are a non-smoker and your PFT values do not suggest any meaningful lung disease, so a CT scan is really not indicated, and will expose you to a significant amount of radiation, equivalent to about 100 X-rays.

I don't think you need any more testing at this point (I see the HCM pulmonologist in his most recent message has also said he believes this is anxiety and not lung disease), and I wouldn't want you exposed to radiation -- if you strongly feel the need for additional testing, a PFT would be safer.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (43 hours later)
Ok, Ill skip the office testing. I am gonna try the relaxation testing. I ready a great portion of the data you sent and found that I can relate to a bunch of it.

A link in one of them described "Health Anxiety". I had to look it up and found Hypochondraisis. That i have read over the years and can comprehend it. My adopted son has Cerebral Palsy and he has this uncanny ability to think he is sick and before you know it, he is. I cant do that but I can worry that something is wrong.

Now understand before hand that I am not considering I have it, but I realized that I have gone three years with a breathing sensation that has caused limited inspiration. I was pointed out that emphysema that has the similar symptoms to air trapping keeping air from entering because of air pockets being filled. As my internist dr pointed out last may was that if I had it, the test results would have clearly pointed a decline and that was not the case.

Now to the real subject. The other day i mentioned the data in the prior question above how I took PFTs after a breathing issue and stress. Test number 4 occurred April of 2013, 4 months after my mother died, 2 months after a stressful breakup and a case of anxious nervousness with a new relationship beginning (I have never been comfortable asking women out or being comfortable at the beginning of dating)-(this lady was a catch!-Big time). I knew when the old relationship was reaching its breaking point and it came at the same time as the new one was to start. I had the nervous behaviour of breaking up the old relationship. It has/had the same effect as the divorce it have coming up.3 weeks after I had to deal with an Ice storm that took down trees, branches, power lines, and treacherous driving. At this time, I was dealing with care of moms house, care of my house, and care of an apartment building. Power wires and branches were down at the apartments and moms house. I had branches down in my yard. Dealing with this would be costly and laborious. The apartments and Moms house were two blocks apart so as caretaker of moms I hired out cleanup on branches and repair and used the same to take care of apartments. My house was up to me to get ready. I had to saw the branches,from the trees at breakage point, then cut them up and move them to clean the yard. The city provided a service where if you hauled the branches to the parking, they would pick them up. They put a time deadline to get ready. The panic, stress and anxiety took its toll on me. I went in to a shortness of breath issue when cutting branches and being panicked. Remember this is 2013 and I quit a regular exercise program in 2010.

Then came stress of getting moms house cleaned up and moved out, Taking care of bills at her place, mine, apartments. Then my hot tub develops a tear in the lid, this causes evaporation and means I have to fill more regularly. I try a quick fix but it fails, I order a new lid and it comes in damaged so I order a second one. Then the hot babe girlfriend stops talking to me as we had, come to find out she had dumped me without telling me. Left me wondering for a few weeks before I could dig it out. She said I was to good for her and she was too stressed for a relationship. I think that was a bunch of poo poo, but her brother in law said she once in a while has stress breakdowns. Anyway things settle down a bit for a few months and then when Snow falls and the temp drops, my hot tub XXXXXXX a pipe leak. If it drains too far down, it shuts off the pump and heater. Not good in winter, the pipes freeze and burst. too costly. OH SHIT more stress, I don't have money to replace, how do i fix. get done. What I notice afterwards is that I was having to tote pails of water from house out to the tub to keep it full. Never recall any breathing issues then. Oh, I developed Carpal tunnel (stressful when you cant play a bass guitar) and had surgery in December 2013, Painful but i skipped the pain killers and provided therapy by playing the bass, slowly at first. This helped.then I started painting interior of my house, didnt have too much problem until I panicked when I answered a phone while walking at 3 miles per hour. This triggered the latest run. This was March of 2014, a few weeks will be 2 years.

Now with all this stress over time and some times with out (few), I carry a constant worry of the sensations I have felt thinking that they are health changing.

I Have noticed that the only real complaint/issue/sensation/trigger is one. I do not take in a full breath like i used to. I feel i only can take in 1/3 to 1/2 of a breath. We have never fully discussed what stress does to the breathing when we are over sensitized as you put it. Some of your readings state that chest muscles tighten causing less expansion, some are the fright sensations causing limited-hyperventilation and shallow breathing. I am doing a number of things to distract myself. I am sure I will come up with other triggers or reasons that I am held back, one big one is to get back to my home in South XXXXXXX The support network I have up there is great. I assume that my relaxation has to be greater than my negative thoughts. Can i assume that continually thinking that i cant breathe because I have reached a stopping point will go away over time and therapy??????? Oh I see your web site info talks of CBT in with Hypochondraisis.

I have my ex, my daughter, my grand daugther, my home, friends and family in laws. The space, freedom and support will be helpful. The only downfall is being alone at night in the house. That is a downfall till I overcome the issues.

My ex inlaws love me as a brother. That family has issues that can cause recurring thoughts. My father in law was diagnosed with Copd in late 2001, died in spring 2009. 6 Kids, Oldest boy had lost most of his lungs due to chemicals and exhaust from vehicles, he was a mechanic. Second son is fighting with lungs, never smoked but inhaled chemicals that damaged lungs, Third and fourth sons are heavy smokers and wheeze and have dyspnea, only in early 50's. and one of the two daughters is in the same boat. Only my ex had the smarts to quit smoking after 15 years of smoking, eats healthy and is in great health.

Enough for now too much data on one text
doctor
Answered by Dr. Alexander H. Sheppe (8 hours later)
Brief Answer:
Private Followup

Detailed Answer: XXXXXXX I really think you're showing so much growth here. Let me explain what I mean.

In the above paragraphs, you've really clearly identified several incidents/experiences in your past that tie in to your fear about lung problems. These are really painful experiences. Coping with your mother's illness and eventually her death is just one piece here. Your father in law, with whom you are very close, also has these problems -- as do all of those children! And dealing with other major problems such as the ice storm during which time you were exerting yourself and had a panic attack -- these are all incidents which have trained your brain to say, WOAH! IS SOMETHING WRONG? And go into panic fight-or-flight mode, even when you're not really in danger. It's become a reflex.

The good news, as you identify above, is that by making yourself aware of this reflex your brain has formed, you can use your rational mind to combat it and eventually to overcome it. I'm glad you had time to read through some of those threads I posted. I hope you can see that you are not alone in your experiences. I'm not sure if hypochondriasis is the perfect diagnosis for you -- I think anxiety/panic is more of a factor -- but I think you do have some features of it. Anxiety makes you focus on a bodily sensation, that of not being able to get a full breath, even when we don't need full breaths to operate perfectly normally in life (indeed, in normal people the top part of the lung is almost constantly collapsed -- we just don't need the extra air!).

Looking forward: when do you plan on moving back to South XXXXXXX back to your support network? And back to the stress of the divorce? Do you worry about it? Would it be helpful to think about how you might handle that transition?

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)
This is a short text for review at the moment. I keep talking of a deep breath or failure to take one. Well tonight after work, I took a trip to a Walmart store to get a few items. While coming out of the store, I noticed that my breathing was short, a bit labored if I tried for a deeper breath, and that my breathing was lower lung or stomach area only. No upper chest. It was very uncomfortable. I have forgotten to ever mention that my back is so tense that I could use a major massage Is it safe for me to say that I am so sensitized from all that happened that I am tense and that is helping to add to my difficulties.

I have two options. Believe that I have a lung issue.

Or

Listen to 4 pulminologists. 3 psychiatrists, 2 physicians and one respiratory therapist. They can't be wrong. So I must conclude that there are certain triggers that mess me up and I must get by them. These physical sensations that affect my regular activities then I start to avoid them. I must get a good understanding on when I trigger an event I need to understand what areas of the body and lungs are occurring. Such as is my fright ( that's what I'll call it from now on) causing my brain to trigger an inability to take a breath without fighting it in. Is it tension to my back and ribs causing the body to take shallow breaths. I had a bad accident that pinched the nerves and discs in my back. This was in 1990, the nerves being pinched was so painful that it hurts to breath and I could only get a little air. So is my back as tense pulling on my ribs in the upper chest. In other words am I so tense that my upper chest is unresponsive and also my mental thoughts are triggering difficulty
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Answered by Dr. Alexander H. Sheppe (2 hours later)
Brief Answer:
Private Followup

Detailed Answer:
I do not believe there is anything wrong with the musculature of your chest. Being tense does not meaningfully affect the musculature of your ribcage and does not negatively impact the ability of your lungs to expand. The way anxiety works is more like this:

The fear circuit in the brain is triggered (sometimes by exercise, sometimes by exposure to past trauma, sometimes for unclear reasons) ->

The brain believes it is in serious danger, and begins to active the fight-or-flight system ->

Blood pressure rises, heart rate rises, respiratory rate rises ->

Your mind interprets this as panic and begins to worry there is something seriously wrong ->

Your mind begins to focus on things that might be wrong with the body such as an inability to breathe properly that may kill you ->

You feel like your chest is not expanding enough.

But it is not the case that anxiety makes your chest not expand enough, nor does it make your chest muscles tighten to the point where you are getting less air. You simply FEAR and PERCEIVE that that is the case. In reality, you are getting plenty of air (you're not passing out, are you?).

Does this make sense?

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Alexander H. Sheppe (37 hours later)
Bad time going on right now, I need some discourse regarding my health. Our thread may end before we get through this. If so we will try to continue. May have to use other account to do so.

I have mentioned previously that numerous drs including yourself tell me that I have no lung disease, or Copd, some even say no to Asthma. Correct?

I have high Anxiety, Stress, and Panic. I would love to say its more than anyone but that is debatable and i would lose.

I have Pfts that are unremarkable, with exception that in the first ones there is a comment about "very mild obstruction" What might that refer to exactly.

There is a time gap in the PFTs, 1-3 back in 2001-2002, next 3 are 2013-2014 Tests show little change in percentages for my age and height. Numerical quantitative date are going down. Again age will do that, at least according to my daughter and the data i have found on Internet.

The only fluctuating test is the FEV25/75 or midflow that has started at 100 gone down and up and down and up with the low back in 2013 at 49 and back to 59 then 69 % Not sure how that is today,

I deal with a sensation of breathlessness. Why do it feel it. What inside is triggering it. You have told me before of the chain of events and body reactions that cause it but we have talked enough that i would probably spend a day looking through all threads.

This past weekend I had a jam session with some musicians. The sensations came and went, I was depressed that I could not get rid of it.

Now good news and some that may set me back. Good news is I am going home for the weekend. I am going alone, I am taking some things back up there get to see my family and friends. Bad news, the reason I am going is an old boss died and I am going to his funeral. I have a few options to this. I am thinking the option that is the least stressful. If I go to the Visitation on Friday, I can pay my respects, If I go to the funeral, I will run into a few people that I would like to see but his wife i may not want to see because she will trigger a attack. She has/had Alpha1 trypsin. She had a full lung transplant in 2002. She has lived past her transplant life expectancy and I dont want to see her condition.

So your job today, is to explain as if it was our first time, what my body chemically doing along with mentally doing to manifest a breathing issue. In your opinion, what exactly be it hormone or what ever that is triggering a response to cause the sense of short of breath or lungs that do not take in as much as it once did. I understand your repeated comment that my body is getting the oxygen it needs but sometimes I want to take a deep breath and cant, WHY is that. If I exert my self I get a need for air and my lungs say you can only take in a quarter of what you use to. Why is that, is that from the tensions and stress. Since all of this has been going on for quite a couple of years, I have thoughts as if it is a lung disease. I know it is silly that I need re enforcement by re educating and support with understanding but I need to get around this wall that is blocking my healing before it eats me up and I get so trained to think bad that I may never get over it.

I woke this morning at 3;30 and was doing ok, then my thoughts took over. I realized that thinking that if it was a COPD issue, I am gonna live on Benzo's of some type. I was a basket case and it raised the panic level two levels

Hoping your answers clear the wall.
doctor
Answered by Dr. Alexander H. Sheppe (30 hours later)
Brief Answer:
Private Followup

Detailed Answer:
"So your job today, is to explain as if it was our first time, what my body chemically doing along with mentally doing to manifest a breathing issue."

When the fight or flight response is activated, the brain releases hormones such as epinephrine and norepinephrine to kick the body into high gear. This increases respiratory rate, blood flow to muscles, pupils dilate. When we were cavemen and a tiger was attacking, this was great. Your response now happens in situations that ARE NOT dangerous. You feel an increased need for oxygen, but you don't need more oxygen. You're getting all you need.

"Sometimes I want to take a deep breath and cant, WHY is that."

The problem here is that you want something that you don't need. When a child asks why she can't have a candy bar and is upset because she can't have it, the problem is not the inability to get candy -- the problem is that she is so focused on getting it. You're too focused on your breathing, when in reality there is nothing wrong with your breathing. Your lungs can only expand so much, and beyond that they don't need to expand. This worries you because you are preoccupied with the idea you might have COPD.

Does this make sense? Open up a new thread if this one is finished.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Alexander H. Sheppe (1 hour later)
Thanks, thanks big time. I asked that of you because all those comments were lost in all our threads. I will print this one

My body has been giving me grief lately. Might be because of the new meds along with my preoccupation. Any way I decided to go the route you have been leading even though my body has a few sensations that don't fit the conversations we have had. So I pondered all that has been told to me from pulm Drs to internists to psychs to resp therapist. And I thought of the one thing my daughter said, dad, there's nothing wrong your just getting older. So I had her fill me in on aging and resp issues. And I guess I failed to think that there are small changes that occur as we age and there will be times of dyspnea, and being out of shape then more winded. Then add preoccupation to it and. Boom Sure helped put a new light into lessening the anxiety.

Will start a new thread after this. Not sure how soon. I am going to my other home and I had the Internet shut off while I'm away. I may have to go to a Burger King and use free wi fi. Lol
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Answered by Dr. Alexander H. Sheppe (6 hours later)
Brief Answer:
Private Followup

Detailed Answer:
I think it's great you're talking with your daughter about this. You're right -- as you age, things will slow down a bit, and shortness of breath with exercise is normal, to be expected, and not dangerous. You continue to demonstrate great insight into everything that's going on -- you recognize that even though these feelings and sensations are very real to you, they are also not dangerous, relying on the opinions of several doctors. Your rational mind is clearly a great strength and asset, and you are using it well.

I look forward to hearing from you on a new thread. Even if it takes Wifi from Burger King, I look forward to hearing from you. Good luck dealing with the funeral -- I think in your case it is appropriate to minimize exposure to this person with respiratory failure, as you suggest. Paying your respects in a small but meaningful way while also avoiding your triggers is entirely appropriate.

Don't forget to rate and close this thread!

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Deepak
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What are the side effects of GAD medications on health?

Brief Answer: Private Consultation Detailed Answer: Sorry it took me a while to get to your first question. We can use both these open threads at once to answer more questions more quickly, so no worries! You ask here about the effects of GAD/panic on PFTs. The answer is that PFTs will generally be normal in people with anxiety/panic. The only exception is if you were doing a PFT on someone experiencing an acute panic attack -- it would show hyperventilation, but no restrictive/obstructive patterns. The sensation of not being able to expand your lungs and not being able to get enough air is 100% a byproduct of anxiety -- it does not correlate to any physical problem in the lungs or the air surrounding the lungs. Your brain perceives a problem that is not there. Regarding the need for further testing including a CT scan and additional PFTs, you are certainly welcome to do this for peace of mind, but be careful. PFTs in particular are completely safe. However, I would caution against getting a CT scan. You are a non-smoker and your PFT values do not suggest any meaningful lung disease, so a CT scan is really not indicated, and will expose you to a significant amount of radiation, equivalent to about 100 X-rays. I don't think you need any more testing at this point (I see the HCM pulmonologist in his most recent message has also said he believes this is anxiety and not lung disease), and I wouldn't want you exposed to radiation -- if you strongly feel the need for additional testing, a PFT would be safer. Regards