I’ve had several anxiety/panic attacks in the last month or so. I don’t know if they were anxiety or panic, but most have included a sense of abject terror. So I’ll call them panic attacks.

This is highly unusual for me.

Sure, I have anxiety, and I feel it at some point almost every day. But panic attacks? Those are not the same thing.

About 17 years ago, when I lived in California, I had a panic attack problem. Sometimes, they were sparked by a deep conversation; other times, I couldn’t identify a trigger. They almost always included hyperventilating. It really sucked.

I signed up for a panic disorders group through Kaiser Permanente and learned different ways of coping. Apparently, it helped, because even though they didn’t go away immediately, they did go away.

SO WHAT’S GOING ON?

After having an attack during TMS last week, I was able to talk to my pdoc for a few minutes (after calming down in an unoccupied room for half an hour). His immediate thought was that it was because of the TMS.

Color me surprised!

The first couple rounds of TMS I did actually helped my anxiety for a few months, and now he’s telling me it’s because of the TMS?

He went on to explain some technical stuff about the brain that I can’t even begin to explain here. Also, that was my 47^th session; previously, I’d had 30, 30, and 13 sessions. So, 47 was kind of pushing it. There’s not a ton of research on TMS out there anyway, and much less for so many sessions.

And then there was the fact that a couple weeks after I’d started the treatments, my insurance company decided to un-approve my treatment – so I had to go without for a week (it’s a daily treatment). Turns out that came at a bad time for my brain, and I did feel quite depressed that week. It took me a couple weeks to come back up.

So, there were a couple of technical biological reasons involved.

PERIMENOPAUSE, ANYONE?

The monkey wrench in all this is my hormones. I’ve been going through perimenopause for about four years now, and sometimes my emotions are out of whack.

I won’t go into a lot of details, but at the beginning, my emotions were all over the place every two weeks (while I was ovulating and when I was on my period). I cried a lot, I felt a lot of anxiety, I was an unpredictable mixed bag of feelings.

That lasted a while. Then there were the backaches, the cramps, the bloated feeling, etc.

At any rate, there’s a ton going on inside my body. Naturally, I wondered if that had anything to do with the panic attacks. Dr. Nelson concurred that it certainly doesn’t help, and it may well be involved, but he believes the main culprit was the TMS itself.

It’s not just me they increased the sessions for, either; their protocol changed for everyone. Since they started giving people more sessions, usually daily for a couple weeks, then every other day for the rest of it, he’s noticed a definite uptick in some people’s anxiety and/or panic.

So I’m now done with TMS (this time around.) He said the attacks should all but disappear, very quickly.

Good. They suck.

SURPRISE!

The thing about panic attacks (for me, anyway) is that I have no clue they’re about to hit. Sometimes, when it’s just anxiety, I can feel it bubbling up. It might be mild or moderate, hit a plateau, and then subside.

But with panic, it’s different. I don’t know it’s coming, there’s no warning, and there is almost always no identifiable trigger. Just *BOOM*! And once I realize it’s there, I – well, I panic, so it only gets worse until I can do some deep or paced breathing and probably take a Xanax.

I do know that, once I’ve reached “the point of no return”, I’m too far gone to be able to use my DBT skills. So I usually have to take a Xanax first. Then I’m able to calm down enough to use my skills thoughtfully and get through it.

I should note something here:

**We take precautions at my house. As a recovering alcoholic and pillhead, I obviously have to be very careful around drugs like Xanax. My wife keeps a close eye on my (prescribed) supply and sets them out for me in pill boxes.

As an addict, my brain tries to come up with ways to sneak some or get my grubby little hands on more, but the bottle is locked in a lock box (at my request), and I have no idea where the key is. We try to be proactive, because you just can’t trust a drug addict around drugs, no matter what they tell you or how much you’d like to give them the benefit of the doubt.**

When I feel panicky, I get that same sensation in my chest that I get when I’m really depressed – it feels like there’s a hole where my heart should be. It’s really hard to understand and probably hard to grasp this concept unless you’ve experienced it, but it’s there and it’s real. It makes me feel the need to double-over or curl up in the fetal position. A nice, solid hug helps in that moment, too.

EXTERNAL TRIGGERS

I feel depressed less than half the time now that I’ve done the TMS and have upped my therapy. I also feel anxious less than half the time. Perhaps most important, most of the time, I’m able to use my skills to stay on an even keel and prevent them from getting worse.

Most of the time. I’m not perfect. 😉

These are vast improvements and continue to give me the hope of more peace, joy, and serenity.

Unfortunately, there are a few situations/circumstances/expectations that cause me anxiety regardless of where I’m at in my treatment. I’ll list them here:

1. Making phone calls/answering the phone. This is a biggie and has been getting worse.
2. Leaving the house, even just to run errands.
3. The news.
4. Conversations/TV shows around death, especially when graphic or with details (thanks, Sharon).
5. Conversations/TV shows around sick or dying animals. Those are the worst.
6. Coming to a stop when driving. I’ve been seriously rear-ended a few times, for a total of six rear-enders over the last twelve years. I keep my eyes glued to the rear-view mirror when I’m at a stop, but I always feel anxious that the person behind me won’t stop in time.

I’m sure there are more, but thankfully, it’s not a huge list. All I know is that any of these things can put me in a bad mood (from fear and frustration) and make me anxious, so I often avoid them.

That’s a bad idea, by the way. The key to getting over anxiety-inducing situations is to slowly get used to being in them, in a controlled manner, hopefully with the help of a professional.

Yeah, no thanks! Not right now, anyway.

When all else fails, sometimes it’s best just to leave a situation. I know someone who has a fascination with death (of all kinds) and she talks about it fairly consistently. She has a knack for inserting it into the most benign of conversations.

Depending on the circumstances, I may either ask her to change the subject (“Can we talk about something happy instead?”), I leave the situation (i.e., walk out of the room), put in my fantastic LG Tone Ultra HBS-800 bluetooth stereo headset earbuds, or jump in and change the subject.

I’m depressed, anxious, and sensitive enough – I don’t need the people around me to manufacture it for me, too!

Anxiety can be a tough nut to crack. When I’m going through a bad attack, I sometimes think, “Man, this is worse than depression!” But then, when I’m stuck in the rut of depression, I’m like, “No, this is the worst. It might last forever!”

Bottom line? They both suck. Don’t let anyone tell you that one is better to have or easier to get through than the other, and don’t let them get away with saying that you’re “lucky” you have one and not the other; they don’t know what you’re going through. Besides, anxiety and depression often go together (read more here).

NEXT STEPS

For now, what I’m doing seems to be helping. I haven’t had a panic attack in a week! I have an appointment with Dr. Nelson in five days, where we’ll take a look at things and see how it’s going.

In the meantime, because of all the little changes going on right now (medication change, starting light therapy, done with TMS…), I’m keeping a daily diary of my emotions and other symptoms of depression and anxiety, such as sleep, appetite, suicidal thoughts/thoughts of self-harm, energy level, irritability, and more. This helps me see how different things affect my mental health.

IN A NUTSHELL

1. Panic attacks are scary as hell.
2. Too much TMS can cause panic and anxiety attacks.
3. Hormones can play a role in panic and anxiety, too.
4. Perimenopause sucks!
5. For me, panic comes on suddenly, with little or no warning.
6. Prescription drugs are not the final answer, but they can help if it gets to be too much.
7. Panic attacks can be caused by specific triggers, which are different for everyone. (or for no apparent reason).
8. You need to be your own best advocate for your physical and mental health.
9. Panic attacks and depression BOTH suck – don’t let anyone tell you otherwise.
10. They don’t last forever, and you will get through it. I promise.

As always, thanks for reading. I welcome comments, questions, suggestions, complaints, and challenges. Contact me at Laura (at) DepressionWarrior (dot) com for a more personal (and confidential) response.

Keep on Keepin’ it Real, folks!