Thursday, February 23, 2012

High Anxiety: This Panic Disorder Is Killing Me!

Where was I? What was I doing? I can't recall the details of my whereabouts -- mind or body -- when I found out that I may or may not be mentally ill.

Somewhere I read, or heard, that panic disorder is a mental illness. But there is a lot of contradictory information out there on this, so it's less medical fact than medical theory, and a highly debatable one at that. I've also read that the children of overprotective parents are more likely to develop panic disorder as adults because they aren't as well equipped to deal with fear. That sounds reasonable, but my parents have enough on their plates, so I'm not going to dump this on them. One thing is certain, though: I never feel less sane than when an anxiety attack is coming on, or when I'm waiting for the next one.

If I'm not mentally ill, in those moments, I certainly feel mentally unsteady. I'll never forget my first panic attack. It was in 1997, the night I'd gone to see Cocteau Twins at the Roxy in New York City. It was a great concert, but hardly the standout event of that particular evening. Shortly after I drifted off to sleep, boom! I shot up in bed, wide awake!

My heart was racing, my palms were sweating, my body was vibrating. A sense of complete doom overtook me. This is it, the big one, I thought: I was having a heart attack at age 28. For me, there'd be no more tomorrows, no more "I love you's."

So what do I do? I get on the phone and call my friend Deirdre. I don't know why I thought she'd be awake, but she's one of those people who actually means it when she says to call her if you need her, day or night. She tried to talk me through the ordeal and offered a diagnosis and prognosis, courtesy of her roommate, who was a nurse. "Tell Jeremy that if he were having a heart attack, he wouldn't have time to get on the phone and call all of his friends to tell them," said Nurse Diana. "He'll be fine."

It made sense, but I wasn't convinced that I'd die another day. I phoned my friend Maureen, who lives in San Francisco, three hours behind me, so she wasn't too exhausted to humor me. She stayed on the phone with me until I was too drowsy to hold it up any longer.

The next morning, life was back to normal -- almost. I was terrified of the next time it would happen. And it did. Not too often, maybe a few times a month, but it was always without warning and always when I had just fallen asleep. For nearly a decade, I lived in a precarious mental state with fear bubbling just under the surface right before bed time. I slept with the TV on for several years (I was sure the voices and lack of total darkness would scare off the panic), stopped, and started again after 9/11.

And then on July 3, 2006, the night after I'd gone with Dave and his parents to see Madonna at Madison Square Garden, the biggest one yet arrived. For the first time, that feeling of intense panic, that sense of doom, arrived while I was fully awake and sitting upright.

It was Monday around 6pm, and the TV didn't save me. In fact, I was watching that day's episode of All My Children on SoapNet. I felt a strange twitch go through my body, and then I felt like I was having some kind of out-of-body experience. My heart was racing, my body tingling, and I couldn't stand still. It didn't feel like I was having a heart attack or a stroke, but I was certain I was about to die. This one lasted longer and was more intense than any of the others. (That first hours-long 1997 episode aside, they usually didn't go on longer than 15 to 30 minutes.)

I figured that I should go outside. If I expired, I wanted to do it on 14th Street, in the middle of a huge Manhattan crowd. That way, they'd find my body immediately, not days later, rotting on the living room floor.

I called several close friends. None of them were home. So I walked. Eventually, I ended up in the emergency room at St. Vincent's Hospital on 12th Street and 7th Avenue. I couldn't stand still. The woman at the desk was very understanding, and allowed me to pace the floor while I waited for what seemed like forever because I felt like if I stopped moving, my body would explode. By now, I had reached my friend Zena. She was on her way. After a few hours in the ER, during which I received an EKG, a CT Scan, a magic pill, and a clean bill of health, I felt like the Angel of Death had passed. I went home, hoping that he, or she, wouldn't be back.

I had about two panic-free months, and started to convince myself that I was cured of those scary anxiety episodes. Then, on Sunday, September 10, five days before I moved from NYC to Buenos Aires, I ended up in the ER twice in less than 24 hours. The first time, it was the worst one yet. My extremities went cold. I felt disoriented, body trembling, heart racing, mind literally attacking my body. This time, my best friend Lori, who happened to be shopping near my apartment when the shakes set in, was there to see me through it.

That night, shortly after I fell asleep, it happened again, though not as frighteningly as earlier. It was just like the first time back in 1997. Death never crossed my mind, but it was the first and, to this day, the only time I ever had more than one in a single day.

So off I went to the ER at 3am, where a doctor sat me down and tried to explain what was going on with me. "You are perfectly healthy," she said soothingly, holding my hand. "What you have been having are panic attacks." It was the first time anyone had actually used those words to describe it. "They are a lot more common than people think and perfectly treatable.

She arranged for me to see a psychiatrist the following day. The shrink evaluated me, officially diagnosed me with panic disorder and prescribed me Clonazepam, the same drug I had been given during my July trip to the ER. A few days later, I had an appointment with Dr. Andrilli, my personal physician, who assessed my situation and told me that the medication I had been prescribed, 1mg of Clonazepam, would help me, but I should be very careful as it is highly addictive.

Why me, Lord -- I mean, Dr. Andrilli? He didn't have any answers. He did say that although I was not stressed out on the outside, moving to a different continent is an extremely high-stress situation, and I was probably internalizing a lot of my fear of the unknown. This, too, hopefully, would pass.

It didn't, not entirely. Over the next five and a half years, I had occasional panic episodes, never as intense as the ones that sent me to the ER in New York, though usually much longer in duration than the ones that would interrupt my sleep. Those 1-mg Clonazepam tablets never failed to dull the symptoms -- except for the one time shortly after I moved to Buenos Aires, when they kicked in while I was on a date, and I didn't want to mix a pill with the beer I'd been drinking, so I didn't take one. (Not that I even had any on me: Those panic symptoms normally hit me when I was home alone, so I never left the house prepared for the worst.) I took it not as a preventive measure, but only when I felt doom coming on strong, on those days when the physical sensations attacking my body made me feel like I was pounding on death's door.

Clonazepam continues to be a semi-regular presence in my life, some weeks and months more regularly than others. I'll go a month without it, then pop a 1-mg pill a week for several weeks. I never ended up in the ER again, and as much as I enjoy the mental and physical calming effect of Clonazepam (so this must be why potheads are always stoned, I've often thought), I've never taken the stuff for fun.

I've always figured I have everything under control, but something about being dependent on a pill, even if it's not a dependency, or an addiction, troubles me. I rarely take pain medication, and, with my doctor's blessing and guidance, I managed to wean myself off of my blood-pressure pills before I moved to Melbourne last year. Clonazepam, a sort of magic drug, harmless in small, controlled doses, has been my one concession to pill popping. But I pop with caution.

Celebrities are dying from mixing these prescription designer drugs with alcohol. It's a dangerous game of Russian roulette because overindulging in alcohol, then stopping, leads to withdrawal, whose symptoms can be alleviated with this class of medication, leading to a vicious cycle and a potentially deadly double addiction. I've luckily been able to sidestep all of that, but every so often, I still worry about the fact that I use it at all -- even if it's in tiny doses that never exceed 1 mg.

Though I probably should be just as concerned about the time I spend worrying about the next panic episode, it's the effect on my self-image that vexes me most. I also suffer from migraines, and I've resisted every drug any doctor has ever prescribed to me. Neither Advil nor any other painkiller will do either, even if they worked. I clench my teeth and bear it. I'm an independent guy, and I don't like anyone or anything, not even a harmless-looking white pill, upsetting my do-it-yourself-or-die nature.

That's what I was telling myself this afternoon in the shower when it hit me. My head got heavy, my face started tightening, and that sense of impending doom set in. Whitney Houston's death in the bathtub weighing heavy on my mind, I hung on as tightly as I could, lest I pass out in the shower. I stepped in, stepped out, stepped in, stepped out, trying to remain active because someone who can work out in the shower couldn't possible be dying.

All week I've been having terrible headaches, a malady that's affected me since I was 8 years old, and one, I've been told by doctors, that would have killed me by now if it were going to kill me at all. But as I stood under the water, I considered various fatal scenarios -- death by brain tumor, death by aneurysm. Why was I letting my mind torture me like this? I stepped out of the shower and headed straight for my stash of Clonazepam tucked away in the safe.

One mg later, inner and outer calm once again had been restored. I guess it wasn't a tumor, or an aneurysm, something I tell myself every time my mind works against my body, and the anxiety relief kicks in. I'm not sure where I go from here. I think this week -- a three-1-mg week so far -- has been a particularly stressful one because in a few days, I'll be leaving Melbourne for Bangkok, and I have no idea what to expect this time around.

Maybe my first order of business will be to go to BNH Hospital on Convent Road, just a short walk from where I'll once again be living, for an MRI, or a CT Scan, you know, just to stay on the safe side.

Being told that nothing is growing in my head and nothing is about to explode there might not give me the sense of physical calm that Clonazepam is so good at providing, but it should give me something better: peace of mind that lasts for more than just a few hours.
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