Panic disorder wasn’t even on my radar when I wrote my blog entitled The evolution of my Mental Health this past May. When I wrote it, I was in a very healthy place – spiritually, physically, and mentally. In fact, I (thought I) was the healthiest I’ve ever been in my entire adult life: enjoying retirement, exercising, eating right, reveling in the wonder of my three grandchildren. Nature was my new love and I was on an exciting spiritual journey, exploring a myriad of perspectives, beliefs, and teachings. Metaphysics was my new passion and I was fascinated by and explored many aspects of it. I was – quite literally – high on life. I was doing great… until I wasn’t.
Struggling with Mental Illness
The higher you climb, the harder you fall.AMERICAN PROVERB
I have battled depression and generalized anxiety for two decades – which is when I was actually diagnosed. In truth, I suffered from (undiagnosed) panic disorder as early as age ten – that being my first cognisant recollection of having a panic attack, which you can read about here. I say cognisant because I’m almost sure the first panic attack I suffered was at a much earlier age – as early as age 3 or 4 – but it is a vague memory. Regardless, panic disorder followed me (infrequently) into my adolescence and beyond. Again, it was undiagnosed. I didn’t really know what these weird and scary episodes were.
There was no internet back then… no Google from which to glean instant information. All we had were our doctors and even then, given the symptoms associated with panic disorder, in those days, they tested for signs of stroke and heart issues, and they took blood and urine and such, all of which yielded nothing. Having finally been diagnosed with depression and generalized anxiety in 2001, and treated with medication and rudimentary psychotherapy, the panic disorder component of my mental illness melted away, becoming a backstory to the depression aspect which took center stage. Generalized anxiety was still a gnawing, fluctuating struggle throughout but it was relatively well managed.
After 20 years working with the same company, in varying high-stress roles, I retired in 2019 when I was 55. Having worked since I was 13 years old, being retired was a bit of an adjustment. Certainly one of the positive adjustments was to that of my mental health. Without the high-stress job, my depression and generalized anxiety were almost non-existent. My journey into spirituality and metaphysics was exciting and fascinating. I was meditating daily, really getting in touch with aspects of life and the afterlife that I had never known about or believed. I was enjoying life in a way I hadn’t experienced before. So much so that I began to wonder if maybe – just maybe – my mental illness had retired as well. Maybe it was time to go off my medication and go it alone.
At this point, I was managing my mental illness with a combination of an SSRI called Cipralex (10mg daily) and medical cannabis (THC vaped once daily). In October 2020, I began the titration of my Cipralex from 10mg down to 5mg a day. There were no issues, no changes to my mental illness. I had expected that during the dark winter months I would suffer a depression dip (as I have in years past) but this never happened. I was feeling great. Better than great. Encouraged, in February 2021, I took my last 5mg Cipralex. All was well. In June 2021, I took my last vape of medical cannabis. When my husband asked me why I was going off my medications, I said, “I need to know if meditation-Liana can replace medication-Liana.”
How foolish I was. You see, with depression and generalized anxiety being in the forefront for so long, undoubtedly exacerbated by my career, I had completely forgotten about (blocked out?) how it all began – a terrified little girl suffering from panic disorder.
Ignoring the Signs
Facts do not cease to exist because they are ignored.Aldous Huxley
The signs were there, I just didn’t recognize them for what they were – precursors to a devastating fall. Over the months since October 2020, I actually had a few episodes of heightened anxiety. I put these off as my body and psyche reacting to revelations I’d been having about myself as part of my spiritual journey. Self-therapy, as it were. I would have a revelation, confront it, examine it, talk about it. Experiencing real forgiveness, of others, of myself. These revelation events would be followed by a few hours of elevated anxiety. I got through these bouts easily. I welcomed them as I was really processing a lot of psychological baggage and I considered these episodes to be my body’s way of detoxifying – for lack of a better word. This happened 4 or 5 times between February and the months that followed.
During this time, I also started experiencing heart palpitations. I put that off to caffeine. My right eye began to twitch. I put that off to eye-strain from doing too much crochet. Then, I got pins-and-needles in the small of my back. I put that off to strain from exercise. (Louder than usual) ringing and rushing sounds in my ears. I put this off to my ever-finicky tinnitus. My body would often buzz and my hands would feel as though they were floating. I put these off to the energies I believed I was experiencing from awakening my spirituality.
Around mid-July I put my sweet dog, who’d been with me for 13 years, to rest. I can honestly say that I believe I processed the grief associated with the loss of my dog quite thoroughly. She was old and sick and I believe I did the right thing by her.
None of the precursor symptoms I listed above, nor the grief I experienced for my dog, concerned me. I was so far into metaphysics and spirituality that I considered some of what I was feeling (body buzzing and floating hands) exciting. I wasn’t scared – at all! Not consciously, that is.
Panic Disorder Hits Hard
The calm before the storm.Sailors’ idiom
Funny thing about our sympathetic nervous system, the primal system gifted to us by nature that detects and alerts us to danger and readies us for fight-or-flight by pumping adrenaline into our bodies… when this chemistry is dysfunctional – and it goes unheeded and untreated – all hell breaks loose.
In early August 2021, I had what I now call my mini panic storm. I had waves upon waves of panic; rapid heartbeat and breathing, nausea and dry-heaving, dilated pupils, tingling all over my body, tinnitus was off-the-charts, crying, feelings of disassociation, fear of insanity. It had started on a Friday night and lasted on and off for about 36 hours. By Sunday morning, the storm had passed. I felt weird and winded and openly wondered – what the actual F just happened??
The next day, Monday, I went to my daughter’s and played with my adorable, giggly grandson. That Wednesday, I signed a self-publishing book deal for a children’s book I’d written. I was so excited. I was back in the game! Sure, all the ignored/explainable precursor symptoms were still there but I’d survived the storm – what I thought was the worst of what the universe could throw at me – and I was invincible.
One week later, to the day, the big panic storm hit. Only this time, I was stuck in fight-or-flight mode for 3 full days, sometimes shocking me out of a dead sleep. Why?? I had no idea. All the symptoms I’d had the week before, I had again, only magnified tenfold. I started disassociating from myself and my husband. My limbs felt detached from my body. I thought I was going crazy. No matter what I did, I couldn’t get off the hamster wheel from hell! That’s the thing about panic disorder – you get stuck in a cycle of fight-or-flight where each wave triggers another… and then another… and then another.
Getting Medical Advice for Acute Panic Disorder
By Monday morning, desperate for relief, I resumed my Cipralex at 5mg even though I knew it would take time – weeks! – before taking effect. I called my doctor’s office and was connected with a nurse practitioner who, upon hearing my plight, agreed with my resumption of the Cipralex at 5mg and prescribed .5mg Lorazepam, a fast-acting (dissolved under the tongue) medication (benzodiazepine) that would help me calm down. I was warned to take it only when in extreme distress as it was habit-forming.
The nurse practitioner also prescribed Gravol for nausea and suggested that I might take it instead of the Lorazepam because Gravol often causes drowsiness which may be enough to calm extreme panic. The nurse practitioner reiterated that Lorazepam can be habit-forming and warned that I shouldn’t take the 2 (Gravol and Lorazepam) together, that I should space them apart by at least 4 hours. I wasn’t in a state of mind to ask why. Lastly, the nurse practitioner said that since I had been on Cipralex before, I could increase the dosage from 5mg to 10mg “in a couple of days”.
The Lorazepam worked, to a degree, which I’ll come back to later. Within about 2 hours, aided by the Lorazepam and exhausted from more than 3 days of adrenaline rushes, I fell into a fitful sleep. I was off the hamster wheel, still in an acute state, but the terror had subsided.
I heeded the nurse practitioner’s warning and took Gravol rather than Lorazepam when I felt as though a heightened state was coming on. Tuesday passed. On Wednesday, it being “a couple of days” since I’d taken 5mg of Cipralex, I increased to 10mgs. I also took a Gravol as, by this point, my appetite was non-existent and I was very weak. Within an hour the extreme panic returned with some added terrifying symptoms. I told my husband that something was very wrong and to take me to the hospital. He worked to calm me and together, we called our local crisis line.
What is Serotonin Syndrome?
After describing what was happening and what I’d taken (Cipralex + Gravol), the amazing lady at the crisis center suggested that the Gravol was likely a red herring but that it sounded like I was suffering from serotonin syndrome, the symptoms of which include agitation, restlessness, confusion, rapid heart rate, and more. As for me, I felt like a caged animal, pacing, circling, wringing my hands, breathing fast and shallow. These symptoms activated my fight-or-flight and I was back on the hamster wheel only this time, I was spinning out of control. The crisis center lady suggested we call Telehealth Ontario (a phone-in medical service in Ontario, Canada) for advice on the 2 medications and my symptoms.
My husband and I thought that perhaps there was a drug interaction between Gravol and Cipralex, and, given I was back in an extreme state, I badly wanted to take a Lorazepam. I couldn’t as it had only been an hour since taking the Gravol. We called my doctor’s office again, who said a nurse practitioner would call me back, and Telehealth, which had us on hold and offered to return our call should we wish to leave a message. We did. I called my pharmacist to ask about interactions between Cipralex and Gravol. He said he couldn’t find any.
At this point, my panic – coupled with the symptoms from the serotonin syndrome – was so bad all I could think of was taking a Lorazepam to find relief. It still hadn’t been 4 hours since I’d taken the Gravol, and because I didn’t know why I had been warned about this 4-hour window, I waited – in a state of heightened panic – for a call back from either Telehealth or my doctor’s office.
When my doctor’s office called back, less than 45 minutes later, it was a different nurse practitioner. I again explained what was happening and what I’d taken and asked if I could take a Lorazepam despite it being less than 4 hours since taking the Gravol. She confirmed that she didn’t think Gravol played any part in my current state but that increasing the Cipralex dosage from 5mg to 10mg so quickly (after “a couple of days”) had, indeed, caused serotonin syndrome. She said I could take the Lorazepam despite taking Gravol and explained that, because both cause drowsiness, caution should be exercised if taken together. Lastly, she said I should go back to 5mg of Cipralex and stay at 5mg for another 7 days.
It took several hours for the serotonin syndrome symptoms to subside, aided in part by the Lorazepam I had taken. I leveled off later that afternoon, again, fried and exhausted from the ordeal.
Several days passed. Anxiety ebbed and flowed. The most disturbing times occurred when symptoms would wake me up. I would be in full fight-or-flight mode even before reaching consciousness. Obviously, my brain chemistry was seriously F’d. I took my 5mg Cipralex daily and took Gravol for nausea and occasionally when I felt mounting anxiety. I did take 1 Lorazepam during this time, preemptively, when I knew that Gravol just wasn’t going to cut it.
Remember earlier when I said that Lorazepam helped – to a degree? Well, every time up until this point when I had taken a Lorazepam, I was already in a heightened state of panic. This time, I wasn’t. I was on my way there but I hadn’t reached that state. What I noticed was that within about fifteen minutes of the pill dissolving under my tongue, both sides of my chest above my breasts tightened and tingled, and my heart started to race. Whether these odd sensations were brought on by the Lorazepam or the anxiety these sensations induced, Lorazepam seemed to worsen the situation before making it better. Still, I couldn’t be sure as again, the panic was on the rise. Within about 2 hours I had calmed.
The following Wednesday, as recommended by the nurse practitioner, I again, nervously, increased the Cipralex from 5mg to 10mg. Blessedly, there were no adverse effects this time.
Recovery Cannot be Rushed
During this time, my husband and I (mostly my husband) were packing to go away for 2 weeks to a cottage we rent annually at this time of year, a place we absolutely love – peaceful, beautiful, tucked into a forest, and surrounded by water. Despite my worry and stress about leaving the safety of my home, what better place to recover from acute panic disorder than in a place of tranquility? That, and, I didn’t want to disappoint my husband, or my kids and grandkids who would visit while we were there.
I was making progress – slow, but progress nonetheless. The first couple of days at the cottage I did okay. I used all the coping tools in my toolkit and hadn’t yet taken another Lorazepam, despite several bouts of increased anxiety. Lorazepam is habit-forming, remember? A fact I fixated on. It had been 10 days since increasing my Cipralex to 10mg and given the erratic anxiety fluctuations, I called my doctor’s office to ask if I should now increase from 10mg to 15mg. They said yes.
Within an hour, I was – once again – in the grips of serotonin syndrome. I won’t repeat what I experienced. Suffice to say, it was horrible and this time, it lasted several hours longer than the previous time. I called my doctor’s office and explained what was happening (serotonin syndrome) and asked – “Do I skip a dose at 15mg? Go back to 10mg? To 5mg?” They advised me not to skip a dose and to go back to 10mg and stay there.
At this time it’s important to point out that, despite having called my doctor’s office several times for care and advice, I had not yet spoken to my actual GP. I spoke with two separate nurse practitioners on several different occasions and this last time, to a resident at their clinic. I finally spoke with my own doctor 2 days later. She confirmed that going back on Cipralex was the right course of action. She confirmed that serotonin syndrome was what I had experienced and said that we would NOT be going up to 15mg again. I was to stay at 10mg. If necessary, she would add a different medication to the Cipralex reiterating that SSRIs can take up to 6 weeks (at this point it had only been 2 weeks) to become fully effective.
As for the Gravol? My doctor said I was to stop taking Gravol altogether. Why? Because there is a known link between Gravol and Cipralex to heart arrhythmia! Are you F’ing kidding me??? I told her that it was their nurse practitioner who had advised me to take Gravol in lieu of Lorazepam! “Regardless,” she said, “no Gravol.” As for nausea, I was limited to ginger tea. For breakthrough anxiety, she stated Lorazepam was the solution. When I explained the side effects I was having from the Lorazepam (tight/tingling chest, pounding heart, heightened anxiety) she said she had never heard of this reaction and left it at that.
That same evening, I kept thinking about the Lorazepam. Had I imagined the sensations I had felt? With my fight-or-flight on overdrive, it was possible. Was it just anxiety about feeling something odd in my body? I needed to know once and for all. Since I was feeling pretty level that day, I decided to take a Lorazepam around 8pm. BAM! Just as I had experienced before. Within 15 minutes the side effects began and my anxiety went up. I was able to breathe through the effects as I knew they would last for only a couple of hours, at worst. Within 45 minutes the tightness/tingling and increased heart rate subsided. Within another 60 minutes, I calmed down and was very drowsy. I slept okay through the night having to breathe through only a couple of anxiety waves after waking to go to the bathroom.
Late the next afternoon, my daughter, son-in-law, and granddaughter arrived. I was fatigued and shaky but ever so glad to receive them. They were to stay for 4 days. We spent some time on the dock, went for a walk, then enjoyed a lovely dinner together. I played with my granddaughter and helped with her care where I could. By around 9pm, we said our goodnights. It had been a good day. My husband and I settled into bed and I read my book – as I do most nights – to get me good and sleepy.
My husband turned off his light first and was sleeping within a few short minutes. Sometime later, I turned off my light, rolled over, and closed my eyes.
Panic Disorder Makes You Lose Control
With eyes closed for less than a few minutes, my heart began to race, pounding loud and hard. I breathed, as slow as I could. Tinnitus blasted my eardrums. Counting. Slowwww inhale through the nose, slowwww exhale through the mouth.
I did this over and over and over – to no avail. I tried everything. Relax, don’t fight it. Let it pass through you. I worked my way through the multiplication tables – twice. Recounted dialogue from movies and TV shows. Sang songs in my head. All while breathing. I did this for 4 hours as wave after wave of panic hit me over and over. None of it worked. I was exhausted, thought that I was having a heart attack, and was sure I was dying! I wanted to die. Please take me home. And I knew I couldn’t take a Lorazepam because of the side effects. I didn’t think it was possible but my panic level was higher than it had ever been. If I took a Lorazepam it would go even higher!
Frightened out of my mind, and body, in tears, I finally woke my husband. I told him I felt like I was having a heart attack and that I needed him to take me to the hospital. It was 2am. We were in cottage country. The closest hospital was 45 minutes away. As he had done many times before, my husband helped calm me – a bit. He suggested I watch movies to distract myself, which I did on our portable Blu-Ray player.
A few times I fell asleep only to be woken up by another wave of flight-or-flight crashing down on me. By 6am, when my husband woke up from his own fitful sleep, I was distraught in a way I had never been before… crying, no – sobbing – in a way I had never done before. The sound coming from me was foreign to my own ears. I was outside myself. Disassociated. Terrified.
My husband went and told my daughter and her husband. They helped me to the car. I cannot stress enough how awful I felt at this point – not just because I was so panicked – but because my beautiful daughter had to see me in that state! My heart broke in those moments. I broke. Into a million pieces.
“I’m so sorry you have to see me this way,” I sobbed.
My daughter reassured me. Loved me. Supported me. As she always has. Still – I just wanted to collapse and disappear. I hated myself.
The amazingly compassionate ER doc, when he came to see me, said they were going to run some tests and asked if I wanted something to calm me down. I said yes, but not Lorazepam, explaining why.
“No problem,” he said.
They took my blood, urine, and a chest x-ray, and ran a quick test on my heart. Then, a lovely nurse came in and offered me two little orange pills to help calm me.
“Not Lorazepam,” I hiccupped between sobs.
“No,” she said, “Clonazepam.”
Within about 30-45 minutes, and having felt no odd side effects/sensations as with the Lorazepam, I was asleep. I woke a couple of hours later to the sound of the nice ER doc telling my husband that all the tests had come back normal. Of course. It’s only panic disorder, after all. I was discharged with a prescription for Clonazepam, .5mg a day when needed for extreme anxiety. With the aid of my husband, I stumbled to the car as 2 Clonazepam (1mg) packs a punch.
As a sidebar, I have since looked up side effects from taking Lorazepam and the ones I had were listed; chest tightness and fast or irregular heartbeat. To be fair, similar side effects can be felt when taking Clonazepam. I’m not sure why I experienced side effects with one and not the other except to say that obviously, my body metabolizes them differently.
Back at the cottage and for the rest of the afternoon, I slept on and off on the couch, waking every now and then to the sounds of movement around me, with ripples of anxiety hitting me as soon as I became conscious. The movement I heard was that of my daughter and husband packing the cottage. He was taking me home.
I lasted 1 week at the cottage. 6 days, really, given we arrived on a Saturday afternoon and left the following Saturday morning. I had ruined everyone’s vacation, was useless in terms of packing up to leave, couldn’t share the burden of driving us home, was too weak to haul everything into the house, and couldn’t be relied upon to put any of it away. I carried a mantle of guilt and self-recrimination the likes of which I had never carried before. All self-imposed, of course, as nobody – not one single person – said a single word to me that wasn’t loving and supportive. I am so blessed in that regard.
Recovery Ebbs and Flows
Sometimes my anxiety hits toxic levels. Many times, I don’t know whether what I’m experiencing is an anxiety, panic, or heart attack. It’s like my heart is pounding so intensely that it’s about to burst through my chest.― K.J. Redelinghuys, Unfiltered: Grappling with Mental Illness
Being home was a relief though. It took a few days but I started to slowly progress, though tenuous at best. I found a new therapist and discussed next steps with my doctor. I was still being woken up by anxiety, my heart was still palpitating, and I was teetering on a very precarious tightrope whereby any little thing – even benign heartburn – could set me off.
My doctor ordered special tests to check my adrenal glands (fight-or-flight chemical production/secretion), my heart (ECG, Holter monitor, and heart ultrasound), and several others. So far, most of these have come back normal. I should be glad of that, right? I am. At the same time, I wanted there to be something that could explain why all this happened, seemingly so suddenly, in the first place. It seems ridiculous but a tumor on my adrenal gland, called a (neuro)endocrine tumor, could explain the fury with which my sympathetic nervous system has attacked me!
Or course, it hasn’t really attacked me. In fact, our sympathetic nervous system is there to protect us. Just because mine senses life-threatening danger, when I have simple heartburn, doesn’t mean I shouldn’t thank it for doing its duty. <sarcasm>
After being home from the cottage for a week or so, I started to level off. The 10mg of Cipralex seemed to be reaching its apex. I visited with each of my 3 siblings and my 91-year-old dad, all of whom have been incredibly supportive. I visited with my daughters, their husbands, and my grandbabies. Each day I was getting a little bit better. I had only had to take one Clonazepam post-hospital. Otherwise, I was managing the daily waves of anxiety well with breathing and therapy. I had an appointment with my doctor and we were staying the course.
Self-Medicate With Caution
I’ve written before how medical cannabis helped me with mental illness in the past. You can read about this in my The evolution of my Mental Health; 2 decades in the making blog or by reading any of my blogs on the subject. I saw no reason why medical cannabis, CBD specifically, couldn’t help with the daily anxiety waves with which I was contending, as it had done for me in the past with my generalized anxiety. I knew enough not to take THC as it can cause and/or exacerbate anxiety.
Though I’m relatively well-versed in cannabis use, I scheduled a call with a cannabis educator at my medical cannabis clinic and spoke at length about my ordeal. We discussed CBD specific to its use in the treatment of anxiety. I had been on 50mg CBD a day in years past but knew that starting low-and-slow was best. I asked the educator what kind of side effects might be felt if the dose was too high to start. She said that mild headaches were the most common for the first few days, and maybe some diarrhea. Pretty benign.
I ordered 10mg CBD gel caps from my favorite provider. On day 1, remembering to space taking CBD and Cipralex—which I take in the evening—by several hours as CBD can sometimes lessen the efficacy of SSRIs, I took a gel cap in the morning.
As CBD impedes the body’s system that metabolizes certain SSRIs, this could interfere with how these medications are metabolized if/when taken with CBD oil or other products, making them potentially less effective.CBD oil and SSRIs (Antidepressants) – https://resolvecbd.ca/
That afternoon I got a mild headache, as I knew might happen. That evening, I had a couple of mild waves of anxiety. I slept okay that night and when I woke up the next morning, the headache was gone. The next morning – day 2 – I took another gel cap. I got another headache. It was worse than the day before. Okay. To be expected. I started feeling more anxiety but used the coping tools in my toolbox. Slept okay but when I woke up, the headache was still there. Day 3, I took another gel cap, determined to push through the first few days of the headache side effect, trusting that the CBD would help with anxiety, as it had in the past.
That afternoon, the waves of anxiety started to mount, quickly. As with the Lorazepam, whether it was the CBD itself that induced and heightened my anxiety or my sympathetic nervous system detecting danger from the headaches I had, I was back on the dreaded hamster wheel! I stopped taking the CBD on day 4, and for the next 2 days, dealt with waves of heightening anxiety that reached a peak on the 3rd day post-CBD when I was reaching a state of panic. I took a Clonazepam that night, slept deeply for about 6 hours, awakened mid-sleep by panic – again! The next morning, after much insistence by my husband, I took another Clonazepam – 2 within 24 hours.
My doctor’s assistant took pity on me when I called their office and begged to see my doctor – in person – that day. My doctor – never a fan of cannabis as a treatment for anything – reluctantly stated that while cannabis can be potentially helpful for some symptoms of mental illness, that CBD has been known to exacerbate panic. In this case, I couldn’t argue. There I was in her office, in tears, afraid of everything, desperate for answers. She made me promise not to take any medical cannabis – which I did – and scheduled me for a few more tests given these attacks sometimes wake me from a dead sleep. She prescribed Seroquel, an antipsychotic medication (quetiapine) that in low doses (half 25mg a day) can help with panic disorder, and help me sleep.
Leveling Off from Acute Panic Disorder
There is hope, even when your brain tells you there isn’t.John Green, Turtles All the Way Down
The first night I took Seroquel, I slept almost straight through until morning. Happily, that continues to be the case since I began taking Seroquel. I am – once again – leveling off. Yesterday, when my sister asked me how I was doing, I said, “I feel almost like myself.” I don’t exactly know what that means given I feel utterly rudderless and am doing my best not to live in a state of waiting-for-the-other-shoe-to-drop.
The more often you have panic, the more you anticipate panic. It’s part of the disorder. For me, these post-menopausal panic episodes weren’t just occasional one-and-done events, as they had been in the first half of my life. These were multiple attacks in an hour, several hours in a row. Right now, I’m just trying to survive hour-by-hour, day-by-day. Therapy is helping me deal with anxiety by teaching me new coping skills using treatment strategies such as Brainspotting, EMDR, etc., and with the trauma, I have suffered as a result of this ordeal. While I’ve suffered traumas in the past (who hasn’t?), for me, nothing compares to, nor could have prepared me for, the trauma of surviving acute panic disorder that lay dormant for twenty years.
Mental Health resources
- Mental Health Platform
- Mood Disorders Society of Canada
- Canada Suicide Prevention Service
- The National Institute of Mental Health (NIMH)
- US Suicide Prevention Lifeline
- US National Alliance of Mental Illness (NAMI)
- Wikipedia List of Suicide Prevention Crisis Lines
- World Health Organization (WHO)
Feature image courtesy of Pexels.com, SHVETS production.