I have a medical condition which will be tough to treat, and it means the end of radio (for now)

[Dan Druff]

Psychiatrist seems reasonable. Namely for finding medication that works for you. I assume you're not really interested in random hippy therapy that's also prescribed for GAD treatment.

With psychiatrist you need to find one that's tolerable, you don't need perfect and you can't bail instantly after the first failed drug experiment. There's a huge amount of trial and error involved in finding what works.

SSRIs are usually the first thing that's tried out. Mostly because lack of abuse potential and being generally well tolerated without too many serious side-effects (excluding mild suicide). They all do roughly the same, so the idea is to just find one that has tolerable side-effects.

SNRIs come after that. Less sexual dysfunction if that's a concern. There are also drugs that can be used to specifically combat that while taking SSRIs/SNRIs. Class of drugs called Azapirones that can also be used on their own for GAD.

If none of that works, you might be prescribed Pregabalin or Seroquel. Possibly some other drugs from their relative families are also used, but those are the most common ones. Both of them work almost instantly. They aren't first line choices because Seroquel causes heavy drowsiness and Pregabalin has a huge abuse potential.

Regarding finding how any drug is "reviewed" by the general public it's good to remember that people love to tell negative shit for anything they have to take therapeutically and love to hype whatever they choose to take recreationally.

Thing with GAD is that even though you cure whatever triggered it, it is now in your arsenal of reasonable coping mechanisms. So it's likely a bad idea to just focus on LPR and assume GAD goes away with it. It's not really how it works.

Yes, I'm afraid you're right with that last line. I wish I understood why, at certain times, the GAD fades to almost zero (without medication), and then comes roaring back for no apparent reason. Maybe unrelated stimuli are making my serotonin levels occasionally go up, and that covers the problem. Interestingly, after being completely off caffeine for weeks, a single 100mg dose of caffeine also wiped off the anxiety (for the night), but it returned the next day, and another caffeine pill didn't help. I suspect that my body was so happy to have the caffeine again that there was some kind of serotonin spike that first night, but nothing which would continue with continued use.

Definitely wouldn't want anything with heavy drowsiness, and as I said before, I really want to avoid sexual side effects. My anxiety spiked through the roof on Day 1 of Lexapro once I noticed my dick couldn't get hard no matter what. Couldn't rationally explain why that bothered me so much, given that I knew it was coming and might be temporary, but it sent me into an 8-hour super-high-level anxiety which was hard to break from. I think if I was already far along the slow, age-related road to impotence, this wouldn't have bothered me as much, but I pretty much went from 100 to 0 as far as that was concerned, and it was like I lost a part of myself.

Part of the reason it's tougher to get on long-term meds is because I've been able to manage the anxiety enough to where it might be at a preferable level over the side effects of the controlling medication. I haven't had a panic attack in several weeks, and I'm also not getting the soul-crushing, high-level anxiety where I can't do anything but pace around and feel super agitated (that was common in late August and early September).

Now when I feel the anxiety rising, I can usually put the brakes on it to the extent where it doesn't progress beyond medium-high.

Your explanation about the side effects sounds correct.

I saw the dentist today, just to discuss everything. I suggested to him that I pop a Xanax an hour beforehand, then take an Uber down there, then we start with the "easy" work and go from there. He agreed that's a good plan, so I have an appointment to get a "simple" cavity fixed on Wednesday. I'm not going to back out of that one unless something unexpected happens (like getting sick).

[LegalizeMeth]

Druff sounds to me like a younger version of this guy

[gimmick]

I think the most common methods to deal with anxiety without drugs are exercise to release endorphins and some form of breathing exercises to generally calm you down. With physical exercise you're trying induce a "runners high" where your brain rewards you by naturally releasing endorphins. It's preferable to do it outside or in a form of some kinda game. Anything that elevates your heart rate and simultaneously keeps your mind focused. That allows you to dump some excess noradrenaline and dopamine as an added bonus.

I have no idea about breathing exercises or anything that relates to that and what's needed with GAD specifically. The least hippy form of meditation is breathing normally and solely focus on counting your breaths, either lying down or sitting.

Oh and one long term solution is to not stress as much about things. Some people can never do it and those that can, do it in small steps fairly slowly. It's a stupid thing to say to people with anxiety to just chill, but for some it's doable years down the road. Usually just eliminating stressful situations is more realistic.

I've never had GAD, but i've had most drugs that are used to treat it. I think i had 4-5 different SSRIs/SNRIs. I used all of them till my tolerance grew so high i would've had to go over the recommended maximum dose to get the desired effect. Just quit one and move on to the next one. Only one i remember that had any memorable withdrawal effects was Venlafaxin. I got mild electric shocks at random intervals for 3 days. I mostly got giddy about it once i found out what was causing it and knew it wouldn't last too long.

Seroquel i tried for a week or so and found it mostly useless. It just made me too drowsy to do almost anything. Pregabalin and assortment of Benzos i've only had recreationally. I had to quit Benzos because i kept forgetting when i had already taken them. It's not really a problem at proper therapeutic doses. With pregabalin i just ran out and didn't bother to get more.

Pregabalin is likely a better choice for long term use than Xanax. It's biggest problem is that therapeutic doses are really close to recreational. Most of the side-effects are dose dependent and finding the effective smallest dose that works is a bit tricky. Xanax is more forgiving in every one those aspects.

[MumblesBadly]

Druff, I’m going to go out on a limb and say that you have probably been misdiagnosed as having *general* anxiety disorder. You’ve only exhibited the severe anxiety with the onset of the LPR. Until that experience, you weren’t exhibiting the day-to-day anxiety that GAD as a diagnosis is intended to cover. I know a few people who have GAD and their anxiety was almost continuous despite no material issues that would cause them to be anxious. And for those folks, SSRIs *might* be useful, but more recent research now questions the merit of that protocol.

Reporting Bias in Clinical Trials Investigating the Efficacy of Second-Generation Antidepressants in the Treatment of Anxiety Disorders: A Report of 2 Meta-analyses.
https://www.ncbi.nlm.nih.gov/m/pubmed/25806940/

In any event, assuming that suffering from LPR triggered you developing anxiety, and given your highly analytical personality, my guy tells me that you should seriously seek out a good therapist with a good track record in cognitive behavioral therapy. I say this because I don’t believe that a general anti-anxiety drug regimen, or at least not by itself, will help you get over the trauma you most likely experienced from suffering as badly as you have expressed.

Seriously. Not being to get to sleep night after night because of the choking feeling for the time period you experienced put you through hell in shocking and unexpected way that almost surely rivals any extraordinary life-and-death experience. Meaning, you most likely have a form of post-traumatic stress disorder from the experience. Merely taking some pills to try to calm you down will you struggle through healing from the LPR isn’t likely to help you do the therapeutic work to address PTSD. And if anyone here jokes or laughs at this suggestion, they can go fuck off. Because they almost surely hadn’t experienced what you did. Very few people do.

Well, that’s my two cents. Hoping you lick this thing sooner rather than later whatever approach you take.

[gimmick]

With that 4 day period where you were least anxious it could be outside stimuli, physical activity, nutrition,some short term physical change or something else.

Something i thought about was that since you changed your diet and generally ate less because of LPR it could be a diet thing. Normally the most important chemicals involved in keeping anxiety at reasonable levels are GABA and Serotonin. They are mostly synthesized in the gut and usually common diets have all the required parts for synthesis. Everything that's needed comes from so many sources that it's hard to have deficiency. Why i didn't think about it before.

GABA slows down other brain juices and Serotonin controls it's release. Benzos force the release of GABA and Pregabalin is a synthetic form of GABA (it doesn't bind to GABA receptors but it similarly slows down). Since Xanax still worked it's less likely it's a direct GABA issue, but it could be a serotonin deficiency issue. I guess it's also possible you're producing so little GABA that your body has decided to save it for a rainy day.

Gut bacteria, any damage in that area or diet likely could all have an effect.

https://www.integrativepsychiatry.net/natural_gaba.html

Start from there, just ignore the ads at the bottom of the page.

Another working theory is that during those 4 days you directed noradrenalin and dopamine to some activity. Poker might have been something that took care of it for so long that you got used to it and you don't yet have an alternative for it.

Physical activity should also release Serotonin to the brain, but that requires there's enough to go around.

[Pooh]

Psychiatrist seems reasonable. Namely for finding medication that works for you. I assume you're not really interested in random hippy therapy that's also prescribed for GAD treatment.

With psychiatrist you need to find one that's tolerable, you don't need perfect and you can't bail instantly after the first failed drug experiment. There's a huge amount of trial and error involved in finding what works.

SSRIs are usually the first thing that's tried out. Mostly because lack of abuse potential and being generally well tolerated without too many serious side-effects (excluding mild suicide). They all do roughly the same, so the idea is to just find one that has tolerable side-effects.

SNRIs come after that. Less sexual dysfunction if that's a concern. There are also drugs that can be used to specifically combat that while taking SSRIs/SNRIs. Class of drugs called Azapirones that can also be used on their own for GAD.

If none of that works, you might be prescribed Pregabalin or Seroquel. Possibly some other drugs from their relative families are also used, but those are the most common ones. Both of them work almost instantly. They aren't first line choices because Seroquel causes heavy drowsiness and Pregabalin has a huge abuse potential.

Regarding finding how any drug is "reviewed" by the general public it's good to remember that people love to tell negative shit for anything they have to take therapeutically and love to hype whatever they choose to take recreationally.

Thing with GAD is that even though you cure whatever triggered it, it is now in your arsenal of reasonable coping mechanisms. So it's likely a bad idea to just focus on LPR and assume GAD goes away with it. It's not really how it works.

Yes, I'm afraid you're right with that last line. I wish I understood why, at certain times, the GAD fades to almost zero (without medication), and then comes roaring back for no apparent reason. Maybe unrelated stimuli are making my serotonin levels occasionally go up, and that covers the problem. Interestingly, after being completely off caffeine for weeks, a single 100mg dose of caffeine also wiped off the anxiety (for the night), but it returned the next day, and another caffeine pill didn't help. I suspect that my body was so happy to have the caffeine again that there was some kind of serotonin spike that first night, but nothing which would continue with continued use.

Definitely wouldn't want anything with heavy drowsiness, and as I said before, I really want to avoid sexual side effects. My anxiety spiked through the roof on Day 1 of Lexapro once I noticed my dick couldn't get hard no matter what. Couldn't rationally explain why that bothered me so much, given that I knew it was coming and might be temporary, but it sent me into an 8-hour super-high-level anxiety which was hard to break from. I think if I was already far along the slow, age-related road to impotence, this wouldn't have bothered me as much, but I pretty much went from 100 to 0 as far as that was concerned, and it was like I lost a part of myself.

Part of the reason it's tougher to get on long-term meds is because I've been able to manage the anxiety enough to where it might be at a preferable level over the side effects of the controlling medication. I haven't had a panic attack in several weeks, and I'm also not getting the soul-crushing, high-level anxiety where I can't do anything but pace around and feel super agitated (that was common in late August and early September).

Now when I feel the anxiety rising, I can usually put the brakes on it to the extent where it doesn't progress beyond medium-high.

Your explanation about the side effects sounds correct.

I saw the dentist today, just to discuss everything. I suggested to him that I pop a Xanax an hour beforehand, then take an Uber down there, then we start with the "easy" work and go from there. He agreed that's a good plan, so I have an appointment to get a "simple" cavity fixed on Wednesday. I'm not going to back out of that one unless something unexpected happens (like getting sick).

Almost sounds as if you're to the point of barely being able to leave your house some days. CBT isn't a bad choice however fully committing to a SSRI for six months could be the way to go as well. You just need to go in knowing there will be some side effects. All drugs have side effects. You need to commit knowing this and also knowing side effects will subside in a few weeks. In your case, I'd say it's worth it at this point. Just commit to six months and I can assure you that when you go off the drug your body will return to normal. Not saying your anxiety will be gone but you won't be impotent I can tell you that much and I was on the thing for five years. Like gimmick said you may need to try a few to see which one you can tolerate. I was lucky, the first one I tried I quit after two days (Celexa) but Lexapro was easy for me with very minimal side effects. I can't say for certain whether they work or not however I never had a panic attack while on a SSRI. I decided to go off early this year and while I still have a bunch of anxiety at times it has never gone past that. And if I felt a panic attack coming on my body pretty much shut it the fuck down and I returned back to normal.

Since this hasn't subsided much for you in over two months you need something that will retrain your brain to act normal again. If you are having agoraphobia issues at all then CBT if just GAD then suck it up and take a SSRI. Or at a minimum try buspirone. And don't read any reviews for Cripes sake I can't stress that enough.

[Pooh]

My biggest problem taking SSRI was that I was unable to fall asleep. The first night I took Celexa I slept for 45 minutes total so you can imagine the state I was in the following day given I was having panic attacks, my anxiety level was through the roof and I still had to run my little business so I had to interact with people face to face. Not fun. The Lexapro I took in the morning instead of night and it helped with the insomnia. Some complain of being in a zombie state or without any feelings. This is also 100% false. I can't stress that enough either. And you will still have anxiety, it will just be more manageable. You'll be a hell of a lot closer to your old self than you will a zombie for sure. Possibly sweating more was a side effect however I live in Florida and I work outside so that one is debatable for me. Couldn't really say one way or the other. Suicide you don't have to worry about, that one's only for young people.

But if you try it you need to fully commit. No saying you tried but there were a few things you didn't like in the first two days so you quit. That's cry baby horseshit stuff. The Celexa gave me flu like symptoms and got me to the point where I could barely even stand so it was a no go. The other one had side effects that were almost non existent. My only regret was when I came off them I didn't get any brain zaps. I would've like to have experienced those. I think the biggest negative about weening off was the unknown of how I would react without knowing I had the pill in me once anxiety came back. Whether anxiety would cause a full blown panic attack. And let's be honest, it's the fear of the panic attack that is the problem. That's the uncontrollable feeling nobody wants and only those who've actually had one knows what others are going through. So mumbles can copy and past from google but if he's never had one himself then he can fuck off and die trying to give armchair quarterback advice like some clown.

[Dan Druff]

First off, I would like to thank everyone who has responded with advice here. It is very much appreciated.

I don't have agoraphobia, nor any kind of social anxiety. I don't have issues leaving the house or interacting with others. The anxiety I have is more generalized, and sometimes shows up without any apparent trigger or reason. At times it also exists because I think about my existing health issues. So I'd say it's half brought on by health concerns, and half brought on due to my brain being screwed up somewhat by the quick onset of the LPR in mid-August.

I went to see the Dodgers on Thursday night. I felt zero anxiety while there. The only negative feeling came from the inability to use my voice that much (the crowd was yelling and screaming, and I felt hoarse from just some talking to my friend there), but even that didn't bring on anxiety. I felt normal.

I took a hike on Saturday evening, starting about an hour before sundown. I didn't know how that would go, as I've felt fatigue recently, and in fact sometimes felt winded after going up and down stairs. I also woke up on Saturday feeling awful, both physically and mentally. I realized that some of it was lethargy, so I took a caffeine pill about 2 hours after waking, and it removed most of the fatigue. Then I went on the hike. It was about 1.2 miles, but the first 40% was up a steep hill, far more difficult than my house's staircase. I had no problem. I did it just as easily as I did before all of this started. I was not even particularly winded at the top.

After the hike was over, I noticed something. I felt good. No anxiety, or if there was, it was very minimal. It stayed this way for a few hours, before eventually returning. So the theory of exercise helping with anxiety was true, at least in that case. I didn't even expect this, so it wasn't a matter of a placebo-type effect. My only concern was getting through the hike normally.

I've decided to exercise more often, though I'd like it to be in the presence of another adult, just in case anything happens. Men over 40 who don't exercise a lot are susceptible to heart attacks during exercise (especially tall men), and while it's not likely, the consequences of it are dire enough to where I want someone else present if it happens. (Many hiking deaths occur due to heart attacks when the person is alone and nobody is there to help.)

However, I realize that this is only a temporary fix, as the effects wear off after a few hours.

Mumbles is possibly right that this is a PTSD issue, but it's also possibly not. Looking back, I saw some early signs of GAD building prior to mid-August, but they were not debilitating because they were minor. Regardless of what this is, it's highly likely that the inability to breathe when lying down for 5 consecutive days is what caused the psychiatric issues. Whether this is reversible is in question. It's possible that this is a temporary condition which I will eventually get over (or can force out through CBT), or if it's going to be with me forever.

There have been some improvements since this all showed up in mid-August:

- In August, I was having panic attacks. I haven't had a panic attack in about a month.

- In August, I was having a lot of "heavy anxiety" days, where anxiety would just show up for seemingly no reason, and it would press down on me like my brain was in a vice. I felt super stressed, jittery, restless, and upset, yet I didn't have any particular thoughts on my mind causing it. These weren't panic attacks, but it was a super-heavy level of anxiety right below the level of panic attacks. Usually these would last 1-3 hours and then subside, and I could sometimes bring them down by distracting myself with something relaxing or brain-intensive (though it was hard to concentrate on anything). However, the absolute worst incident was the day after I took Lexapro. I had a heavy anxiety incident at 2pm, and I couldn't get rid of it, no matter what I did. I probably should have taken Xanax, but for whatever reason, I didn't. It last until 10pm, at which point it abruptly broke, and oddly I actually felt fairly good. I attributed this to the Lexapro leaving my system enough to where my brain felt a change, and it had a sense of relief. Anyway, in the past month, I have not had that level of anxiety. When I feel it coming on, I can talk myself down to a medium anxiety level.

- In August, I could not get in bed without repeated choking episodes. The Biotene Dry Mouth rinse did something for my throat to where this sensation was not less, but it was still there -- just not as frequent or noticeable. However, since late September, the choking has been much less. This could be the result of a few things. I could have gotten enough used to the LPR to where my brain doesn't conclude choking from the full throat feeling as easily. The cold I caught from Benjamin may have altered something (that's when the choking greatly reduced). The medication I've taken to thin mucus (it's OTC and I decided to do this on my own) might be helping. Anyway, that's not happening as much.

- In August, I had depression. I didn't realize it. I thought it was just anxiety. But then someone suggested to me that it might be depression, and I took a little written depression test at the psychiatrist's office. I came up with a score indicating mid-level depression. I couldn't get joy in anything anymore. Nothing made me happy, nothing made me laugh, nothing made me excited in a good way. I wasn't a robot, as I had plenty of negative emotion, but nothing positive. Also I had a really odd sensation of my mind warping past memories to all be negative. Basically any thought of the past was stressful and unpleasant, even of good things. Most of this has since vanished. I can now get enjoyment from things, and I can laugh again. I do still have some of that weird sensation with thinking about the past, but whatever. I just try not to think about the past as much. I will say that I was never suicidal at any point. It does not seem that I'm susceptible to that.

So we're less than 2 months in, and yet I've seen improvement over the beginning, when it was pretty damn bad and super-debilitating.

Now I'm at more of a different point, where I'm facing the frustration that the LPR and anxiety may never go away, but at the same time, none of the symptoms are intense enough to where I want to go down the rabbit hole of dangerous or addictive medication and side effects.

I do have enough anxiety to where it's difficult to do a lot of things, including travel. Going to the Dodgers game is one thing, but staying in a hotel, flying on a plane, and other stuff like that is something I can't do right now.

[BCR]

I think you’ll eventually get over them. Not saying you won’t have an occasional episode, but it will be months or years apart. Everyone I know who suffered for even more prolonged periods of totally debilitating anxiety, often months before even doing half what you’re doing, got over them in an every day sense. They just suck so bad that you need to clear a lot of mental hurdles even after they’re mostly gone before you can just get on with it.

[Dan Druff]

I also just weighed myself and am down to 211 pounds -- and that's after eating a fair amount this afternoon. Had I weighed myself upon waking, it was probably under 210.

This now puts my weight loss at 30 pounds, though I had stabilized for a few weeks before starting to lose weight again recently.

I really want this to stop. It's probably anxiety-related, and maybe my body is still adjusting to eating less than I used to, but I don't like it. I want control over the weight loss. Here I feel my body is just dropping weight arbitrarily, and at some point that will be an issue.

There's also the outside concern that the weight loss is a result of a yet-to-be-diagnosed serious disease, but I keep telling myself that I was slowly GAINING for the entire year until mid-August, and then abruptly started losing weight rapidly when all of this started. So that wouldn't make sense for weight loss related to a super-serious disease.

I think the remaining anxiety (which has been higher recently compared to the prior few weeks, though not at August levels) is burning off weight again.

Long term health-wise, I'm probably best off dropping to 185-190, but I would want control over that happening. If I fall below that, I'll start to become concerned, both because I will look too skinny AND I'll start approaching levels where I'm underweight, which can actually be more damaging than being overweight. I'm guessing that 160 is probably where that would start, though I won't let it get there if I can. I'll start taking weight-gain supplements if necessary.

Strange that I'd never guess two months ago that being underweight would ever be my concern again. When I was a teenager, I used to have such a high metabolism that I would lose weight unless I consistently consumed a high amount of calories. This continued until about age 19.

[BCR]

I understand the concern regarding the weight loss being related to something more serious. I think that’s 100% what’s bothering you rather than any desire to control the weight loss for any other reason. You’re not dropping to 170 or anything from stress or LPR. I mean, unless the LPR got so bad you couldn’t swallow, in which case you’ll know exactly why you are losing and that will be a bigger concern than the weight loss.I highly doubt that ever happens. You’re just burning from anxiety like you said.

[Dan Druff]

I think I might have had heartburn for the first two times in my life, in the past week. Was after eating.

Felt like a pain in my chest, but nowhere else. Did not feel any kind of acid or burning sensation though, nor was there any sour taste in my mouth.

This is interesting.

If it is heartburn, it might be indicative that reflux really is causing this LPR, and it may be treatable. Hmmm...

[chinamaniac]

I've decided to exercise more often, though I'd like it to be in the presence of another adult, just in case anything happens. Men over 40 who don't exercise a lot are susceptible to heart attacks during exercise (especially tall men), and while it's not likely, the consequences of it are dire enough to where I want someone else present if it happens. (Many hiking deaths occur due to heart attacks when the person is alone and nobody is there to help.)

Get a gym membership. There are plenty of people around or you can hire a trainer.

[big dick]

especially men 40+ who on occasion stay up for 3 days snorting a couple 8 balls and drinking 90 or so beers

[chinamaniac]

especially men 40+ who on occasion stay up for 3 days snorting a couple 8 balls and drinking 90 or so beers

That will give heart attacks too

[Dan Druff]

Would rather do hiking than a gym. The gym scene doesn't appeal to me.

I've always liked nature and hiking. There is a great feeling getting out into the open air, and hiking into scenic landscapes or toward great views of the city below.




Plus on Saturday I ended up at a cell tower.

[Gookieheimowitz]

Druff: I said this before and I wasn't being a smart ass . Everything you post over the years about your health comes off as hypochondriac.

Advice : If you live your life worrying constantly about what's going to kill you . You aren't LIVING!


Seriously. You won't hike or work out alone because a statistic says men over 40 die of heart attacks while alone hiking or working out? Next up you will be saying you can't shit anymore unless you notify someone you are shitting because men over 40 die on the shitter.


Seriously Druff start living

[GrenadaRoger]

sorry, wishing you a complete and pain free recovery.


given the show is suspended, how about un-sticking the post concerning Radio Schedule thru Mid-August?

[Sloppy Joe]

I think I might have had heartburn for the first two times in my life, in the past week. Was after eating.

Felt like a pain in my chest, but nowhere else. Did not feel any kind of acid or burning sensation though, nor was there any sour taste in my mouth.

This is interesting.

If it is heartburn, it might be indicative that reflux really is causing this LPR, and it may be treatable. Hmmm...

This could also just be a manifestation of anxiety. When mine used to really flare up I would get what felt like a weight on my chest. Went to the doc about it; when the anxiety subsided it went away.

[Pooh]

I think I might have had heartburn for the first two times in my life, in the past week. Was after eating.

Felt like a pain in my chest, but nowhere else. Did not feel any kind of acid or burning sensation though, nor was there any sour taste in my mouth.

This is interesting.

If it is heartburn, it might be indicative that reflux really is causing this LPR, and it may be treatable. Hmmm...

This could also just be a manifestation of anxiety. When mine used to really flare up I would get what felt like a weight on my chest. Went to the doc about it; when the anxiety subsided it went away.

100%. The pain is anxiety. Heartburn isn't a pain, it's a burn in the chest and it's uncomfortable but there is no pain associated with heartburn. Regarding Druff's massive weight loss I'm very sure it's from a deeper underlying issue probably quite serious in nature. I wouldn't rule out cancer honestly.