Mindless Algorithm

A blog for someone who sometimes writes

Anxiety

July 13, 2019

I have generalised anxiety disorder with panic attacks. The main triggers for me are related to social situations and unfamiliar situations. Things like going to parties, travelling etc. This post will be about my experiences of it, how I deal with it, and how I interacted with the UK medical system.

Beginnings

Looking back, I had hints of more than normal anxiety all my life. I always hated to go on holiday, meeting people as a kid made me feel ill and I felt a sense of dread before I went back to school from summer holidays.

However, it really began to get bad a couple of years after I graduated from university. There’s no clear trigger for what caused it, but the first hint that I had a problem was when I went to a job interview in a different country and spent the entire 3 days there extremely anxious and throwing up every meal.

For a while I managed to deal with it. My anxiety presents mostly as physical sensations, particularly feeling nauseous. There are also some psychological symptoms, I tend to ruminate on the source of anxiety. So I dealt with it by avoiding sources of stress where possible, and ducking out of social events to throw up periodically.

Crisis

Things came to a head a couple of years later when I went on a business trip again, and had a few panic attacks while I was there. I also found it very difficult to eat and had digestive issues.

Once I came back, I felt slightly sick for a few days, and then one evening after eating I started to feel a sharp pain in my stomach. This got worse and worse for a while, until I finally threw up. When I threw up it was largely blood. I was alone in the house at the time, so I called an ambulance and a nice paramedic came over. He said it was probably a non-serious issue with my stomach lining, but referred me to A&E anyway. They confirmed a break in my stomach lining, most likely due to too much stomach acid, and prescribed me some medication to reduce the acid levels. I felt ill for a few more days, but then it mostly cleared up. My family and partner told me that it seemed very suspicious that this had happened the week after I had been having panic attacks in a foreign country, and thought I should try to resolve the root anxiety problem.

Aftermath

I went to my GP. She was a young doctor, locuming with that surgery. She was excellent at doing more or less what I wanted, which was a referral to private therapy and a prescription of something to help with panic attacks (which at the time I saw as the main problem). She prescribed 20mg of propanolol to be taken before stressful situations.

At the same time, I was referred to a therapist, who I saw for the next few months. She was not a good therapist, as she had a lot of her own health and mental issues. I got some value out of the first few sessions, but after that it was a waste. I should’ve cut things off sooner but I found it too awkward to do so. I don’t think she was doing a particular school of therapy, just talking to me about feelings. I got some feelings out about my anxiety and other issues, but I think that just made me feel a bit better, it didn’t actually help with my anxiety.

The propanolol also did not help. There might have been some effect/placebo, but I basically didn’t notice it having an effect. I have a theory that my dose was way too low to actually have an effect. I should’ve tested that by just increasing it myself, but was worried about doing that without the doctor’s say so.

Treatment

After a few months of propanolol and no improvement, I went back to the doctors and got a prescription for an SSRI, sertraline (50mg). I had been cautious about going on an SSRI, even though it is the NHS’s first line treatment for anxiety. Mainly I was worried about the side effects (around sex mostly) and didn’t feel I needed it for what I saw as a problem mainly with occasional panic attacks. This doctor was reasonably nice, a tad more prescriptive than the previous one. I was warned that it takes 4/6 weeks for the drug to have a positive effect but that negative side-effects would be worst in the first two weeks.

They were right, the side-effects initially were awful. I had some trouble sleeping in the first few days, I felt like my brain was very foggy during the day and my anxiety went through the roof (though no panic attacks). After 2/3 weeks the worst of these symptoms faded, though some got worse over time (e.g. indigestion).

After 6 weeks I began to see an improvement in my mood day to day. There were a lot of little things that used to make me anxious (for example, going for a team lunch at work) that completely went away. So sertraline helped clear out a horde of tiny anxieties that pervaded a lot of my life. It became clear that the threshold for me to become anxious had increased, which meant that things which could’ve provoked panic attacks before would now just cause nervousness. This effect began to fade into the background of my life before long. In general I just felt more like myself, and not a terrified animal.

It’s been about a year since I went on these meds and I think it’s one of the best decisions I’ve made. The side effects are tolerable for me, and I no longer feel crippled by anxiety. The quality of my relationships has vastly improved, and I feel happier in myself.

Advice:

  • Research anxiety - Scott Alexander’s post and the NHS treatment guidelines are a good place to start.
  • Some doctors seem to be happy for you to take the lead with your treatment. If you sound intelligent and do some research, they will generally do what you want. In my experience, these are more junior doctors.
  • Other doctors are not like this, and will be more prescriptive with what your treatment should be. This isn’t necessarily a bad thing, especially if this is your first time seeing someone, and you haven’t done the obvious treatments yet.
  • Therapy, meditation, exercise and self-help books were useless for me.
  • Medication was the most useful, the SSRI in particular.
  • You should consider doing what most commonly fixes anxiety for other people in your rough position, before assuming you are special and will require special treatment.