[partlycloudy]

I've been getting medical and psychological treatment for bipolar2, anxiety and panic attacks for over a year. Up until the last spate of hurricanes, I was progressing well and feeling like I might well return to a more normal way of life. I had major trouble with anxiety when I went on a short trip to England, and it's been downhill from there. With each storm that approached and missed where I live, I've become more and more anxious.

My depression has crept back. My anxiety waxes and wanes over the course of a day, and my panic attacks last for hours. I see a p-doc (I'm on effexor, wellbutrin, ambien and xanax), a therapist , and have been getting EMDR treatment which had been working great on my anxiety and panic.

Now I feel like I am almost back to where I started. My T told me that everyone has setbacks, and hinted that I was recovering almost too rapidly, if that makes sense. I see my p-doc next week, and I have not changed any dosages of meds on my own because I'm a wuss, I'm pretty sensitive to side effects, and would like to keep them to a minimum. I take no more than 1mg of xanax a day, and am paranoid about addiction, as I am a non-drinking alcoholic.

So - what do I do with a setback like this? Does it get better on its own (it feels like it's been getting worse over the last 3 weeks), or am I likely to have to make a med change?

Anyone have any insights as to how I can deal with this?
thanks all,
pc

[Genevieve]

First of all, with all the external stressors going on for you, it's not surprising that you'd be feeling anxiety and even panic. C'mon, Woman! People without your diagnoses are probably experiencing panic attacks in your neck of the woods right now!

Anxiety is a natural response, part of the fear spectrum. Fear is what keeps animals alive, that's why it survived evolutionary pressures. Anxiety itself is a natural response to certain situations, which everybody experiences at one time or another. It only becomes a disorder if it's experienced in inappropriate situations or to an extreme degree. Experiencing anxiety after three hurricanes is not especially inappropriate, but you're sensitized to it by both your psychological history and your physical history. Psychologically, you're more sensitive to it because it might mean that you're having a relapse. Physically, you're more sensitive to stressors, because your body figures that, if you want to over-express the physical response to anxiety, it had better accommodate you. Your body is "trained" to produce a stronger response to anxiety than someone who hasn't experienced anxiety disorders.

All of that adds up to a very worried partlycloudy, doesn't it?

Then there's the therapy, which you've been making such progress in, so rapidly. If you ask a therapist about this, you'll probably hear that there's a lot of two steps forward three steps back at certain times for certain people. I think, based only on my own experience, it's because it can be so frightening to realize that you're getting so much better -- you're stepping into unknown territory, after all, so falling back into the more familiar landscape feels safer. It doesn't mean that your progress wasn't real -- it means that that progress was so real that it scared you. And that means that you'll get back to where you were, just as soon as you're comfortable with getting there. It'll be easier this time, too. (<<That's a bet, not a promise.)

When you see your pdoc, you might ask about something to settle your adrenaline response, rather than changing the other meds. If you're hypersensitive to stimuli, then blocking that adrenaline can do more to help your body reset than anything else. Just a thought. Also, if the other meds were working, then it's probably just a little tweaking, not a big change, that will help now.

Also, you mentioned elsewhere dropping the HRT? That's probably also involved. You might want to have your thyroid levels checked again, as well as having a basic blood chemistry test done. It could very well be that you're experiencing psychological manifestations of a physical change.

I hope this helps. And I hope it gets better soon.

[partlycloudy]

Wow! What a thoughtful response. I didn't realize that the hormones could play such a large role. All along my thryoid has been tested and been fine, but other women in my family have had problems with hyper and hypo conditions. It was the migraines that were maddening - and frightening.

I think I'll be asking my p-doc many questions next week. I truly appreciate your input - one of the great things about this place.

pc

[lenjan]

PC, I am *well* familiar with the forward and backward motion of progress. My pdoc's best soapbox speech (after, "if you had bronchitis you wouldn't think twice about medicating it -- this is a disease too") is "Progress is never a straight line, and if you look back over your history, you're actually doing quite well compared to where you started from." I laughingly call him Pollyanna because even if there are 14 pitch-black rainclouds overhead, he'll find the one beam of sunlight! :-) -- but I've come to learn that he does have a point.

I'm a self-injurer, and after several overwhelming stresses around Mother's Day (my mother was my abuser, and I gave a child up for adoption, both guaranteeing that Mother's Day will suck for me forevermore) I cut for the first time in a year. I was FURIOUS with myself. My pdoc and my T just shrugged and said that it was normal to revert to old coping patterns that had worked before in times of stress.

It sounds to me like you're doing very well! Hang in there.

Candy

[partlycloudy]

Thank you all for your thoughtful replies. I am getting checked out for thyroid function, lliver, and hormone levels. I know that my whole body is involved, and my whole body should be treated.
pc