When I got to the office, I had a good talk with my psychiatrist. We discussed new medication options to get my anxiety in check. She suggested I go on very small dose of a beta-blocker, propranolol, which is a heart medication that stops the fight-or-flight response in people with anxiety disorders. The therapeutic dose for people with high blood pressure is 40-90 mg, and I was prescribed only 10 mg. I was given the option to modify my dose as I saw fit. It made a lot of sense, and I was enthusiastic about trying it. I left with the prescription, and high hopes. We picked up the pills at the pharmacy, and I took one in the car on the way home.
Ten minutes later, I had the worst panic attack I've had in at least two years. Chills, sweats, nausea, rapid heartbeat, feeling of impending death and/or doom, the whole nine yards. It lasted for more than an hour and took four times my usual dose of klonopin to bring me down.
I still found the fortitude to do what I needed to do even during the ebb and flow of the ordeal. I called the 24-hour advice nurse hotline provided by my insurance, and explained what was going on. I asked if I might be having a paradoxical reaction to the medication. The RN I spoke with did not really know, but suggested that I call a pharmacist and ask, so I did. The pharmacist did her best, but was little help, because she didn't have enough information.
I called and left a message for my prescribing psychiatrist, explaining what had happened. Then I collapsed. Well, not literally. I just sort of shut down. So tired. These things take so much out of me. I cried, I trembled, I felt lost. Matt was a great help, and so were my gods. I'm better, now, but I am incredibly frustrated. Right now I feel calm, with my brain back at normal operating capacity, and I am wondering exactly what went wrong.
It does not make any damn sense that propranolol should cause or exacerbate panic symptoms. This medication is used to slow and regulate the heartbeat, and interfere with the hormones that contribute to the fight-or-flight response. Was this a coincidence? Was I secretly terrified of an adverse reaction, and thus caused one to occur? Was it just bad timing? Was it the fact that I took it with a frozen mocha? (Some forums suggested that stimulants can mess with the effects, but I haven't yet found any legitimate studies that link normal consumption of caffeine with problems with propranolol.)
According to Wikipedia, peak plasma levels occur between 1 and 3 hours after ingestion, and bioavailability is increased if it is taken with food. So perhaps the reaction ten minutes after I took the pill was not connected after all. At the one-hour mark, I was still in the throes of panic, but by the three-hour mark, approximately one hour ago, I was more-or-less symptom free. (Granted, it took 2 mg of clonazepam to get there.)
Was there was some other trigger I was not consciously aware of? Even if I am hopeful that a new medication will help, I am often initially fearful of side-effects. Maybe I just psyched myself out. I'm laying off any more research for now. I am willing to explore any and all explanations, but I am not going to take another dose, and lay off the research until I talk to both my psychiatrist and my therapist.
Now that I'm done bitching about medication, I want to talk about panic attacks: what they are, and how I experience them. Conventional wisdom claims that a panic attack rarely lasts for more than 7 to 10 minutes, because the body can't keep dumping adrenaline at that rate indefinitely. This is sometimes true for me, but not in cases like this. It's not just "the jitters." It's not just vague mental agitation. It has nothing to do with fear of a specific thing or situation.
The ones I call "Grand Mal Panic Attacks" are like being attacked by everything around me in addition to my own thoughts. It begins with a tingling, icy chill that starts from the top of my head and pours down my body. It's like being pelted by tiny, electrified hailstones. Suddenly, my reality is warped into a waking nightmare. Everything feels threatening. Sounds are to bright, and light is too loud.
When the chill reaches my heart, it starts to pound. When it gets down to the base of my spine, I feel off-balance, nauseated and afraid to move. The most insidious part of this entire process is that it usually happens in the absence of any obvious triggers. I am attacked without warning. My mind begins to race, with all of the worst-case scenarios coming to the forefront. I am going to pass out. I am going to vomit and shit my pants at the same time. I am going to die.
Spiritually, it feels as if something is forcibly trying to pull my soul from my body. (I described it this way to my former psychiatrist, and she immediately recommended lithium and anti-psychotics.) And these suckers don't just go away after ten minutes. No, they ebb and flow. I find some relief, through steady breathing or guided thoughts, but the sensations return a few minutes later, sometimes stronger than before. Even when I take benzodiazepines, they seem to take much longer to work than they normally would, and I have to take more than I would for a simple anxiety episode. Typically, GMPAs last for an hour or more. When I finally come out of it, I am always extremely relieved, but also completely exhausted.
Is this part of my PTSD? What is hidden in the depths of my memory that might be causing this? What triggers am I not aware of? Is it entirely chemical? Is it because the doctors fucked with my hormones and screwed me over with my antidepressants when I was younger? Does it matter? Not really. I'm not interested in taking a scalpel and probe to the bits of my past I can't remember. I just want it to stop. If I could slice off a limb and be assured that I would never experience this kind of crippling terror ever again, I would do it without hesitation, and I mean that sincerely.
Let's switch gears, and talk about grateful. Matt was incredibly supportive and patient and kind throughout the entire ordeal. He knows, by now, that when I cry, it means it's almost over. It means I'm breaking through. He holds me, soothes me, brings me water and cold compresses, and doesn't question my requests. I am so goddamned lucky. I love him so much.
This time, I also appealed to my gods for help, but that is an entry better-suited to my spiritual journal. Hail Loki! Hail Odin! (I'll write that tomorrow.)
(Art by chrissiecoolI am grateful that I did not freak out when Matt couldn't give me a ride to the doctor, and I got there on my own, even though I didn't know the bus route. I am grateful that I managed to enjoy the bus ride from there to my favourite coffee house and have a tasty drink before all Hel broke loose. I am grateful for my cat, who did a wonderful job being too damn cute not to lift my mood.
So I guess that's about it for now. Isn't that enough?
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