Handling hypochondria without SSRIs

[vsp]

Long story short: I am a hypochondriac, particularly when it comes to chest pain. I have accepted that as being part of me for two decades, and freely admit it. Dealing with it is generally manageable, but it's been a bastard over the last six or seven months, and knowing that it's there doesn't necessarily make it easy to resolve.

My father had a series of heart attacks in 1996 that should've killed him; the hospital nurses were told to keep him comfortable because he'd be dead in the morning. (Thankfully, he survived, and he leads a very productive life today.) HIS father died of a heart attack in the early 1980s. HIS father died of a heart attack right around when I was born in 1970. That contributes significantly to my paranoia about all things chest-pain related.

Of course, I'm not a thirty-year smoker like my father was. His father had cancer (something I didn't know about until twenty years after he died), and also had an extreme aversion to taking his blood pressure medication (and took none at all on the weekend that he died, which went a long way towards the attack that killed him). HIS father was old and basically on his deathbed already in the hospital when his attack claimed him.

I'm only 34, do not smoke, drink or do drugs at all (yes, I'm boring), and am far from a classic cardiac-risk case. My cholesterol was borderline high (around 200) when last checked a few years ago, but is not at the medication stage, and I have cut out tons of nasty stuff from my diet over the last decade or so. I'm much more cognizant about fat, cholesterol and sodium than I used to be (cooking for and dining out with a heart patient tends to cause that). I could stand to lose another 10-15 pounds (I'm 5'11", 175), but I'm far from tubby and have lost about 10-15 from my heaviest point. I need to exercise more, but apart from that I'm generally healthy; I've never had a serious illness, never stayed in a hospital, and have never even broken a bone.

That said... if something's hurting and I know why, I can almost always cope with it. If I'm sick, I deal. If I can logically associate chest pain with my acid reflux, I'm used to it and can treat it accordingly. If I'm tired and not getting enough sleep, I'm prone to headaches and all-over pain, often in my left shoulder or arm. They've been happening for 20 years, I'm used to them, I know they're not a sign of bubonic plague and thus I can adapt to them.

If something's hurting and I _don't_ know why, The Fear can sometimes take over. Knowing that discomfort in my chest isn't heart-related doesn't always do the job when it keeps on hurting. Flareups are usually years apart, but they can be spectacular; I've been in the ER twice for anxiety-related incidents, and walked into my primary doctor's once and said "I'm having a panic attack." I was correct in that, but recognizing it for what it was didn't mean I could turn it off like a light switch. Even a twinge or two at a bad time can trigger a bad adrenaline rush and that familiar tight-chest feeling.

At any rate, I've been having problems with it recently; I had a flareup in November-December that I beat without medication, and over the last couple of weeks it's been creeping up again. It ruined my day at the beach yesterday, as I was sitting on a bench on Rehoboth Avenue half-hyperventilating and wondering why my pulse rate wouldn't go down. It's exhausting to deal with when it's active.

Complicating things is the fact that I _really_ don't want to go on medication for this, as I'm highly suspicious of most of the major SSRIs that are remedies for anxiety and depressive disorders. My secondary doctor wanted me to try Paxil CR in December, and I shot that down after reading about the immense problems many people have when they miss doses or try to stop taking it, even with doctor-monitored tapering schemes. My primary wanted me to try Effexor XR recently, and one look at _its_ withdrawal-horror stories made me shoot THAT notion down. He mentioned Zoloft as an alternative, which I did take briefly years ago after the "I'm having a panic attack" incident, but only for a month or two, and I stopped taking it (with my doc's approval) due to the side effects (zombie-like emotions, dampened sex drive).

The pills do not cure the disorder themselves, nor should they be expected to; they simply help relieve some of the symptoms when they work properly. SSRIs without accompanying therapy to work out the root causes of the anxiety are a time bomb waiting to happen, IMHO. Likewise, it won't do for me to be anxious _about_ an anti-anxiety medication; if I'm convinced that taking it (or stopping taking it) will cause an anxiety relapse, well, that's sort of a self-fulfilling prophecy right there.

I pulled myself out of the funk in December mostly through forcing myself to confront the irrationality. I'm trying to do that again, but I'm open to suggestions as to some good ways to take it on non-chemically and/or distract myself.

(Professional therapy is an option, though I tried some CBT around December-January the last time this was a problem. The doc basically kicked me out after four visits, saying that I seemed to have a handle on the problem and that I wasn't bad enough off for full-fledged CBT. I'd also need to see how my health insurance plan covers such things.

My home life with my wife is great, I have no major worries looming over my head (no cash crisis, no impending doom, invaders from Neptune are still at least a light-year away), and I'm not seeing any major stressors apart from health anxiety messing with my mind right now.)

Thoughts? Meditation has been suggested, but I'm not sure where to even begin looking into that.

[Undertoad]

Ironically, if you start taking the Paxil, you won't be suspicious of it any longer for the very same reasons you're hypochondriac.

I know exactly where you are because when I was panicky, I had a touch of the hypochondrical too. Panic comes from the same place. And my dad died at 38 of lung cancer, and at age 36-37 I was unreasonably panicky and thought that might be why.

What kind of implications does it have on your everyday life. If it really gets in the way, and regularly, and it causes you a large amount of anxiety, then it's something you need to address. If you're using this as an excuse to not do things, for example, that's a big impact on your life. If you can get by every day with just a little worry, not such a big deal.

It won't do for me to be anxious _about_ an anti-anxiety medication; if I'm convinced that taking it (or stopping taking it) will cause an anxiety relapse, well, that's sort of a self-fulfilling prophecy right there.

You won't have those sorts of thoughts while on the medication. The self-fulfilling prophesy is that taking the med stops you from being unreasonably anxious about it.

Think about it from one perspective. You are concerned about a minor symptom of what might happen if you don't manage it correctly. But in the meantime, you are affected much more seriously by your condition - to the point where you at least feel it's serious enough for therapy.

Well, I've been on the non-CR version for about 4-5 years now, and I forget a dose all the time, big effing deal. My dosage is "sub-therapeutic" - less than what's generally considered the amount needed, and I'm absolutely certain that it does me a benefit. I was pretty med-phobic before going on it, but you know what - being on it means I'm not med-phobic any longer. Anxious about handling it: no, without thinking about it, it's damned easy to do, easy as having the morning coffee.

And I know it makes a difference for what you talk about. I get the same little aches and pains I always got -- last night my (obviously temporary) back pain seemed to migrate to the side, and I had a little concern: what if this is really a kidney going bad and masquerading as back pain? And that concern was fleeting, because I had no interest in lingering on it, unlike what might have been before. And this morning my back is better, and I haven't wasted any energy on it.

Don't listen to Tom Cruise on the matter, he's an ass.

[Trilby]

great insight, UT. SSRI's will stop all the useless ruminating. And quite right about occasionally missing a dose. Most SSRI's have such long half-lives that missing one dose here or there really makes very little difference once your levels are up.

[vsp]

Originally Posted by Brianna

Most SSRI's have such long half-lives that missing one dose here or there really makes very little difference once your levels are up.

Prozac, yes. From what I've read, Paxil and Effexor have distinctly shorter half-lives than other SSRIs, which is one reason why both are notorious for being very very hard to quit.

Originally Posted by Undertoad

What kind of implications does it have on your everyday life. If it really gets in the way, and regularly, and it causes you a large amount of anxiety, then it's something you need to address. If you're using this as an excuse to not do things, for example, that's a big impact on your life. If you can get by every day with just a little worry, not such a big deal.

This is not a new development; I've been living with it for 20+ years. Key phrase: "living with it." If 10 is a full-on spastic freakout and 1 is perfectly calm and healthy, I've spent most of those 20 years at 1 or 2.

Even in recent months, it's not a curl-up-in-a-ball-in-the-corner-of-my-room thing. I'm more keyed up on some days than others, but I still go to work, play on the computer, do things with my wife and lead a pretty normal existence. The "anxiety attack" on Saturday afternoon was a typical spike; it wasn't pleasant and it cut my day short, but I was still okay enough to walk around and drive home. If I'd had a hotel room nearby, a nap might've fixed it well enough to enjoy the evening, but in this case I didn't have that.

The last few months have had more spikes than more typical times.

You won't have those sorts of thoughts while on the medication. The self-fulfilling prophesy is that taking the med stops you from being unreasonably anxious about it.

But what about when I stop taking it?

An SSRI isn't exactly a Halls cough drop. It's a drug that tweaks brain chemistry, can affect the emotions and libido to varying degrees, and to which I'd be committing myself for a minimum of months at a time. That alone is a pretty hefty commitment, particularly knowing that a low dose of Zoloft _did_ zombify me when I took it briefly years ago; Paxil or Effexor may be better in that respect, or I could well be signing up for half a year or more of feeling like a department-store mannequin.

In the short term, yeah, I want the recent yips to calm down. In the long term, I don't feel comfortable with the notion of taking one of these meds indefinitely; it's like taking Advil every day for headaches. Working out what causes the headaches is better than masking the symptoms and eliminates the need for the masking agent.

It's not that I'm pounding my manly chest and yelling "I'm too TOUGH to use a crutch." Hey, sometimes we _need_ crutches, we're human. But I also want to be able to put the crutch _down_ without staring a couple of weeks of hell-ride in the face.

And, yes, Tom Cruise is an ass.

[Undertoad]

20 years says your problem is a chronic one, and not just something that crops up when you are experiencing a lot of stress or something.

OK. The REAL problem is that docs don't really have the time and/or the complete understanding of how this works, which means that you have to become more actively involved in pursuing your own mental health.

Everyone's brain chemistry is different and responds differently to different SSRIs. When my life was crappy I was panicking a lot, went on 20mg and after a while it worked but I felt a little zombified. I had the sexual side effects, which was actually OK because my wife then was a frigid bitch who didn't appear to like me.

But finally it occurred to me to go down to 15mg. No doctor told me to do that, I just figured I should give that a try. Voila, all the side effects went away and I still had no panic.

In fact, not only did the side-effects go away but I was actually multi-orgasmic for about a month. What a waste for that to happen while I was still married Still I didn't get much done that month

After a while of working well at 15, I went to 10mg, and three months later, some panic resumed. Back to 15mg and that was the right level for me.

These days I have a better life, and have reduced to 10mg and it seems like the right level in many ways.

The next question is how far you are willing to go to address it, and how much money you are willing to spend. Along these lines, a doc prescribing you Paxil CR is just reacting to your worry about missing a dose. Paxil CR was invented because the patent protection on regular old Paxil has expired. That means you can get Paroxetine instead, the generic, and in fact Pennsylvania pharmacies will do that exchange by default. They won't exchange Paxil CR. The half-life of Paxil/Paroxetine in your body is 23 hours, and you know, you could do the math on that to figure out what missing a dosage means. The psychological "half-life" is much longer, which is why it takes two months for the full dosage to affect panic.

Furthermore, I "game" the system by buying larger tabs and breaking it up into the size I need. I have a pill guillotine. I have my doc's confidence as a smart person who is actively involved in my own health.

One last note, I am utterly frank about this sort of thing, even though it may open me up to people thinking differently about me and criticizing me and such. It's because I feel it's important to be frank and honest about this. Because almost nobody is frank and honest about these things, and that prevents us from understanding them.

[Trilby]

I appreciate that, UT. Also, right on the prozac half-life, vsp. I've been on prozac since it came out. Every time I go off it I freak out. Taking prozac doesn't turn me into a zombie, it just takes away the thought that maybe an axe to the head would be a good idea. I'm on 60mg qd now but I've been on 80mg qd before. I feel great on it. I was on prozac AND effexor XR (150 mg!!!!) and flipped out. Too much SSRI in my brain. Was terrifying. Anyway I've no compunction about taking prozac for the "rest of my life"--who knows how long I've got anyway? It's ridiculous to think BP meds or cholesterol meds ("meds for life") are less harmful than an SSRI. If you need it, you need it.

[vsp]

One too many flareups for my comfort. I am now a new member of the Zoloft generation.

I am either taking a proactive, doctor-encouraged step towards a healthier mental state or I am making one helluva mistake. Time will tell on this.

[Clodfobble]

It's a brave choice, one way or another. Keep us updated.

[vsp]

Cool! Now that I'm medicated, I can see the fnords.

[Trilby]

(not afraid to show ignorance)--what's a fnord?

[Happy Monkey]

All will be revealed. Or at least hinted at. Or maybe just hiddenfnord in an amusing story sprinkled with hardcore sex scenes.

[melidasaur]

I'm having a depression screening in a few weeks... it runs in the family and I just want to be aware of any potential problems I may have down the road and address any current problems that I have now. Anxiety will probably be my downfall... and with all of the discussion of various pills, I wanted to know if anyone had any awful experiences - ie weight gain, lethargy, etc. that would make me want to avoid certain medications. I want to try to deal with any issues that I have without medication, but I am human and not afraid to pop a pill if it will help.

I probably should have started a new thread, but hey - this is sort of on topic.

[vsp]

Week 4 of Zoloft, time to review where I'm at.

Emotionally, 50mg of Zoloft daily has helped stabilize things. Physically, not necessarily so much. I still have the aches and pains and little bits of nerve weirdness, I'm still getting lightheaded too easily, I'm still "running out of gas" earlier than I used to... but I'm not obsessing over it the way that I had been obsessing. I feel more relaxed and a bit less depressive, though finding the motivation to do things is still sometimes difficult.

My eyes had been bothering me quite a bit (eyestrain issues, focusing issues, sensitivity to bright light, dizziness, all of the above particularly when I'm tired) dating back to before the Zoloft started, and a trip to the eye doctor landed me a new and weaker prescription. Seems to be helping a bit. I also got photochromatic lenses, and after three days of wearing them I don't know how I ever lived without them.

Bedroom side effects, no big problems. Performance and interest seem to be about the same as when I'm tired, and I've been tired quite a bit over the last nine months, so I'm comfortable with this so far.

Other side effects, no big problems. My first day on 50mg had me a little woozy and prone to bathroom runs, but after that I seemed to adjust fairly smoothly.

So all in all, it is making daily life easier, but isn't a cure-all wonder drug, not that I expected it or anything else to be one. I still have physical issues and still have emotional concerns about them, but I'm not as twitchy about them as I was. I have a four-week follow-up on Monday with my primary doc, and it'll be interesting to see what he dictates.

One thing I desperately need to do, but find it hard to do: get more sleep. 6-7 hours a night catches up to you after a while.

[melidasaur]

I started Lexapro today... I'm really concerned with the "bedroom" side effects, but hopefully it won't be as bad as I think it will be.

[vsp]

If it makes you feel any better, the Lexapro rundown on <a href="http://www.crazymeds.org/lexapro.html">CrazyMeds</a> says that its effect on the libido is often less than that of other SSRIs. Your mileage may vary.