Hey guys,
I just discovered this place, and would like some help clearing up some confusion regarding my rather difficult to treat anxiety.
Anxiety/Medical history:
Childhood
Developed claustrophobia as a child, avoided playing (american) football in the playground or being trapped in tight environments. They would cause me to feel trapped and at a loss for breath.
Palpitations while playing football/soccer would freak me out, physical examinations and EKG were normal.
Perennial allergies to various aeroallergens, progressively got worse throughout the years.
Adolescence
Went on a summer vacation to India, became terribly ill and was hospitalized for fainting and falling down the stairs from vomiting and diarrhea.
Returned home, gastric symptoms lingered. Became fearful and hypersensitive to the smallest inclinations of physical ailments.
When nausea would hit during class, would become fearful of vomiting and being humiliated and escape to the washroom, if the feeling didn't dissipate would go home.
Adulthood
Anxiety dissipated early-on after high school, good balance of school, work and social life.
Entering university was unable to study or pay attention in class, completely disinterested, would skip entire semesters and only showed up for finals. I guess agoraphobic behavior started to kick in around here.
Occasional minor panic attacks, when nausea would kick in at bars, restaurants, etc.
Despite never studying or attending class got my bachelor's of engineering.
Post-graduation
Here is where severe symptoms commence
Immediately after graduating start noticing whenever, I am out in public I would get hit with nausea and suffer from a panic attack. In under a few weeks I was house-bound. Even at home I would suffer these attacks.
Went to the hospital to get my blood checked, took me days to gather the necessary courage to do so.
After the nurse took my blood, I almost fainted and was sent to the ER, where the doctor ordered abdominal x-rays, abdominal ultrasound more blood works and urine work. After being cleared, she suspected I might have an ulcer and prescribed me Pantoprazole (a proton-pump inhibitor) as well as Fluconazole (an antifungal) for yeast overgrowth.
Despite completing the course of medications, I did not feel any better and would still suffer from panic attacks.
After a month, went back to the ER, where I met with a gastroenterologist who did a gastroscopy and biopsy on me and everything came back normal.
I was seen by a psychiatrist for a psychiatric evaluation. He diagnosed me with Generalized Anxiety Disorder and Hypochondria/Illness Anxiety.
First SSRI trial
Escitalopram 20 mg for 5 weeks. No improvement. Side-effects: complete loss of libido and headaches.
First SNRI trial
Venlafaxine XR, up titration bi-weekly until 150 mg. Medication stopped, due to increased anxiety, terrible night sweats and nightmares.
Therapy 1
While tapering off Venlafaxine XR, started weekly sessions of therapy. Despite being very friendly therapist was very incompetent, spent half of the session talking about herself and the other half quoting self-help books. She recommended I distance myself from my friends, and since then I haven't had any friends. Went through 12 sessions. Was introduced to the concept of exposure therapy, not much cognitive work done here. The exposure allowed me to get used to having panic attacks in public, but was exhausting. By the end, I was scared of having panic attacks at the gym, library, shopping mall, etc.
Second SSRI trial
Once successfully tapered off Venlafaxine XR, met with another psychiatrist who put me on Sertraline. Up-tapered until 100 mg. Thinks were looking good, but found out my dad might have cancer and suffered a relapse back into agoraphobia.
Had basically given up, until my father was cleared of cancer. Then went to see another psychiatrist, who I would stay with until this very day.
The psychiatrist couldn't diagnose me anything, told me I definitely have anxiety, but I could have other cormorbidities including Bipolar II, Major Depression Disorder.
He increased my Sertraline dosage to 150 mg. At this point, I started experiencing insomnia. Only sleeping 5 hours a night. So he added Seroquel 25 mg to aid sleep, which caused nasty hangovers. No improvement was seen in terms of the anxiety.
Sertraline was increased to 175 mg, I suffered very high anxiety and complete insomnia. Sertraline was tapered down to 100 mg. I was given Lorazepam 1 mg to take as needed, only took these a few times as all they did was make me sleep. From this point I developed ringing in my ears, tinnitus, which seems to be aggravated by high anxiety levels.
Augmentation with Seroquel XR
Psychiatrist added Seroquel XR to Sertraline 100 mg, seeing if there could be a hidden Bipolar under the anxiety. Up-titrated until 300 mg. This essentially turned me into a zombie. I was drowsy and stoned from wake to sleep. Panic attacks certainly decreased, but functionality was non-existent.
Augmentation with Olanzapine
Was taken off Seroquel XR and put on Olanzapine 7.5 mg combined with Sertraline 100 mg. The same effect as the Seroquel XR had.
Cognitive Behavioral Therapy 2
This therapist was more competent than a last one and had a lot more experience. She introduced me to Mindfulness, which I was skeptical of at first, but it did seem to alleviate some of the anxiety caused by overwhelming thoughts. Only saw her a few times, as she was very expensive $160/h.
Augmentation with Pregabalin and Trazadone
Pregabalin was introduced and up-titrated along side Sertraline until a dose of Pregabalin 150 mg, three times a day, and Sertraline 200 mg was reached. Since insomnia seems to kick in with high doses of Sertraline he added Trazadone 50 mg, which I hated as it accentuated my already crippling nausea.
Augmentation with Pregabalin and Clonazepam
Psychiatrist convinced me to try a long-acting benzodiazepine at this point, reluctantly accepted. At this point, was on; Sertraline 200 mg, Pregablin 150 mg x3, Clonazepam 0.5 mg AM and 1 mg PM. Largest reduction of anxiety by psychopharmacology occurred here, panic attacks were almost non-existent. But once again energy levels were non-existent, would require a lot of day-time napping and thus be impractical. Not Seroquel/Olanzapine zombie-mode, just tired.
First TCA trial
Sertraline was replaced with Imipramine. Up-titrated until reaching Imipramine 200 mg combined with Pregabalin 150 x2 (reduced due to drowsiness) and Clonazepam 0.5 mg AM and 1 mg PM. This medication caused severe constipation, even laxatives didn't work. It also caused severe drowsiness, required even more day-time napping then the previous combination. This medication did not impact any of my anxiety, the panic attacks had come back.
Augmentation with Clonidine
Clonidine 0.025 mg x3 was added to Imipramine 200 mg, Pregabalin 150 mg x2 and Clonazepam 0.5 mg AM and 1 mg PM. No change in anxiety.
Withdrawal from Imipramine, Pregabalin, Clonidine and Clonazepam
Brutal withdrawal, should've done one at a time and slower. But didn't want to waste time.
First stimulant trial
Saw therapist number 2 again, she recommended we try to see if there would be any ADHD causing some anxiety. Psychiatrist was skeptical, but took her advice and put me on Methylphenidate, up-titrated until reaching 15 mg x2. Anxiety was multiplied and the medication was stopped. For some reason the increased anxiety didn't come back to normal after stopping the medication.
Sertraline and Mirtazipine
Psychiatrist met with a pharmacologist who recommended to try this combination. Sertraline was up-titrated 50 mg/week, when 100 mg was reached Mirtazapine was added and up-titrated 15 mg/week. After reaching Sertraline 100 mg and Mirtazapine 15 mg, I had started to develop an exaggerated startle response/hyperarousal. Didn't make much of it and kept with the program. When the final dose of Sertraline 200 mg and Mirtazapine 30 mg was reached, I had started to show some serious adverse effects; hyperarousal, tongue/jaw spasms, restlessness and the highest anxiety I've ever experienced. Feared Serotonin Syndrome and went to the ER. All blood, urine work came back normal. Didn't have a fever. The psychiatrist was unfortunately a resident?, very young, he said maybe it was a mild form of Serotonin Syndrome and told me to stop Mirtazapine cold turkey and continue with Sertraline 200 mg. Reluctant to take his word, I contacted my psychiatrist, who agreed that it would be best to withdraw Sertraline by going down to 100 mg for a few days then stopping it, as Serotonin Syndrome is extremely hard to diagnose at its early stages.
Here is where I stand today. Surprisingly feel better now than I felt since the Sertraline, Pregabalin and Clonazepam combination. But I feel utterly confused at the moment. Even my psychiatrist and therapist are unsure with what to do. My psychiatrist has referred me to an Anxiety clinic in my city, where there is a specialist in anxiety disorders. But the appointment with the specialist might take months.
Regarding my current health/habits, they're relatively poor. I've always been incredibly underweight, BMI 16-18, with a very poor appetite, usually 2-3 meals a day. Not many veggies or much water. I don't exercise anymore either. Sleep is good, always more than 8 hours, seems to have solved itself somehow. Panic attacks are more easier to control as well, don't come out of the blue anymore. Allergies are really bad, urticaria lasts all year, while rhinoconjugivitis only happens in the spring/fall. I'm also reluctant to take Cetirizine or other second-generation anti-histamines, psychiatrist told me it's fine while the ER doctor told me it affects psychiatric conditions..
I'm sorry for writing this long history, but I would appreciate it if anyone had any recommendations (with sources if possible) to make.
Thank you for your time.