The sad and incomprehensible state of palpitations - seems to be no treatment

[panicface]

Palpitations are just so weird. They come and go like storms must have before there were weather forecasters. You just wake up and get wet, some days are sunny, and every once in a while you're house is blown away.

I'm a traveler, I'm usually cool the first week, week 2 I'm on daily Xanax (0.25 4x a day) and by week 4 I'm in full blown panic mode (constant palps, paranoia, crying jags etc).

This trip I prepped in advance, got a RX for 10mg daily Lexapro, my 0.25 stopped working so I moved to 0.50 4x a day and MAN - what a beautiful trip! I spent 28 days going through Japan, Korea, Taiwan etc. Not a single palp, or fear. Even went up two huge towers. Of course still tired very easy, feet hurt, and got worn out after 7,500 steps per day.

I felt SO GOOD, I stopped being militant about taking my xanax.. 6am, 12pm, 6pm, 12am.. Those can be hard to maintain when hungover..

Then... (drum-roll), 2 days before returning - I drank a beer at a microbrewery, instantly it felt like my throat was tight, and I couldn't swallow... The symptoms went away in a few hours, assumed I was allergic to some chemical in brewing process and thought nothing more of it - till the palps started... That night had them once every 10 min or so.

The next day every 1 to 2 min palp. After 48hr of hell - I uppped my Xanax dosage to 1mg 4x a day, and I feel like i'm at a zombie party, sluggish, sleepy, not myself - but the palps have almost vanished.

1. Do I stay on this regiment for a week, then taper back to 0.50? Or am I stuck on the 1mg pills now?

I have a 90 day trip coming up in November - most of it booked, and I just don't feel like I can do it.. My brain is willing but my mental illness is not.... Would upping my Lexapro to 20mg help?

Any advice?

Palps are just so strange, coming out of no-where, ruining your life for a week or a month, then disappearing for months.

[Fishmanpa]

Any advice?

What stood out to me was the amount of benzo usage. That's a lot TBH. Add to that drinking and being hungover is a slippery slope. I would think your body's dependence on them, then stopping had a lot to do with it. I would speak with your doctor and see what they recommend.

Positive thoughts

[panicface]

What stood out to me was the amount of benzo usage. That's a lot TBH.

Well, I agree.
I was on 0.25 (4x a day) for 8 months, and it worked great.

Then it stopped working entirely, and left me with nearly constant palps, and extreme paranoia - I ended flying to another country to have a doctor look at a mole on my back I was convinced was cancer, even once told it was fine - I got biopsy... (it was fine).

Finally a doctor at that hospital suggested I needed to up my dose of Xanax to 0.50 (4x a day). So I did it and life returned to 100% normal. He also prescribed me Lexapro and said maybe in 6 months we would start to taper off the Xanax.

Yet here I am - just 3 months later and the 0.50 is doing nothing when I take it. Palps every minute to two minutes and feelings of anxiety and dread. When I tried 0.75 nothing.. When I moved to 1mg - peace again.......

I don't want to be on 4mg a day.

My current strategy is to take 1mg 4x a day for the next 10 days until my body recovers from what was a hard trip... Then back it down to 0.50 and see if I can maintain, then slowly taper to 0.25 and then see if I can get off it in 6 months.

In my country there is no medical help - the last psychiatrist I met with (3 months ago) wanted to talk about taking god into my heart and that would solve everything. And she's the premier anxiety resource.... so... (shrug)...

[ankietyjoe]

Regular benzo use is not good. Regular drinking is not good. Regular benzo use whilst drinking is not only not good, it's dangerous. Combined with an assumed unhealthy lifestyle (travelling a lot, poor diet?) is a recipe for extreme stress.

I'm not surprised you suffer with anxiety symptoms.

A Doctor suggesting you take MORE Xanax is one of the reasons I'm glad I never have to rely on the American healthcare system. Absurd.

[panicface]

Regular benzo use is not good. Regular drinking is not good. Regular benzo use whilst drinking is not only not good, it's dangerous. Combined with an assumed unhealthy lifestyle (travelling a lot, poor diet?) is a recipe for extreme stress.

I'm not surprised you suffer with anxiety symptoms.

A Doctor suggesting you take MORE Xanax is one of the reasons I'm glad I never have to rely on the American healthcare system. Absurd.

I'll try not to be defensive.

I've had panic disorder since I was a child. Not until I reached early 20's did I finally get medicated. Prior to that I would just flip out twice a day and wander the streets, or go to sleep fully-dressed - as I was in a constant state of waiting for death. After each attack I was flooded with relief. But also dread of it returning. The next day it did. Not a fun way to grow up.

I don't have bad feelings about drugs, because when I was first given Xanax it allowed me to preemptively stave off a panic attack, like before a flight, or a stressful event. I could finally carry around a pill in my pocket that was there in case of emergency.

Up until 2019 I only took Benzo's for short times (1 day) or after a long trip I'd take them for 2 days to let my body relax and 'reset'.. It worked.

I don't know if you have palpitations, but when you're having a palp every min or two for days on end it can turn you into a mess quickly.

In 2019 I started taking long trips (3+ months) through many countries, I found the longer the trips went on the more I lost it. Agoraphobia got worse, paranoia got worse with each stop - esp if distant islands etc. I'd get more fatigued, need more sleep and become more fragile.

In March before going to Somalia and Africa I got the bright idea to start taking a low dose of Xanax 0.25 (4x a day) a week prior to my trip. I assumed this would prevent the horrible anxiety that always started the week prior - and that by staying on a low dose throughout the trip I could cut the panic offf at it's knees. Panic attacks are mental - not physical - right? I also wasn't drinking - maybe two beers a week. This was my dumb decision - not a doctors.

I came back from Africa in May and tried to come off the 0.25 - and had really bad reactions - even though I did it over a 5 week period. Paranoia, palpitations etc. HORRIBLE withdrawal. I couldn't work, or function.. My (non-American doctor because I'm not part of the USA medical system - I'm in Asia) - advised to go back to 0.25.. I did, but it no longer worked - he then suggested I move to 0.50 - and that worked perfectly.

I just got back from another month trip and thus this thread was started... I was having hundreds of palps a day and the 0.5 wasn't working.... Yes I was also drinking on this trip... Not a ton - about 3 cocktails a night, 3 nights a week- and when I drank I would skip my midnight Xanax and just take my 6am I wasn't drinking ON Xanax. However i got lazy with my 6hr routine, and started taking my pills at all hours... I think this screwed with my system.

Anyway - I've decided to stick to 0.5my 4x a day and not move to 1mg - and for the last 24hr things have settled back down. I decided to stay in this hotel for an extra 3 days and basically just keep the room dark, watch netflix and eat salads and healthy food. It seems to be working.

Plan is to reduce back to 0.25 again - if I can over the next 60 days - and then see if I can get off of it entirely. The Lexapro might help? Maybe you're omnipotent and have the magic bullet and wouldn't mind sharing it with me. What drug prevents panic disorder? And what wonders does your system of medicine suggest for anxiety?

Thanks.

[ankietyjoe]

What treatment have you ever tried that isn't medication?

Also, panic isn't just mental, panic is a system wide physical and mental condition.

What was it in your childhood that started the cycle of anxiety? How did you panic disorder manifest itself as a child. Anxiety isn't a normal state to be in, and it's not an inevitable part of life.

Oh, and the UK medical profession are medication friendly too, just not with Xanax, it's pretty hard to get. It's also really hard to come off, which I think is what you've experienced.

In any case, I would imagine it's worth investigating other ways of dealing with your anxiety other than the pill/panic cycle that you're in now.

[panicface]

What treatment have you ever tried that isn't medication?

Also, panic isn't just mental, panic is a system wide physical and mental condition.

What was it in your childhood that started the cycle of anxiety? How did you panic disorder manifest itself as a child. Anxiety isn't a normal state to be in, and it's not an inevitable part of life.

Oh, and the UK medical profession are medication friendly too, just not with Xanax, it's pretty hard to get. It's also really hard to come off, which I think is what you've experienced.

In any case, I would imagine it's worth investigating other ways of dealing with your anxiety other than the pill/panic cycle that you're in now.

For years we were told panic and other issues were a simple (or complex) issue with chemicals in the brain. Now they're saying a lot of other things - gut, environment etc.

I had a very supportive father - I've done it all as a child - from biofeedback sessions, the proper psychiatrists, and then some really bad therapists to boot. I've done cog. behavior therapy etc. My first panic attack was maybe 3 or 4yo - I had to wear a red swimsuit at a party and they weren't mine. I flipped out. As a child they came at random, usually when I was just sitting around watching TV, or sitting in school. I'd get a sudden rush of adrenaline and feel either I was gong to go crazy or drop dead - it would last 20 - 40 min. As a teen I'd get them twice a day. As an adult again - almost always out of the clear blue sky.

I was in 9/11 - no panic attack, I was in a car crash - no panic attack, other bad things - no panic attack.. They come 90% of the time while laying in bed watching TV, bicycling, sitting in the bath, doing housework, etc. I have a good life, almost no stress, and have never had any trauma. My goal now is visiting all 338 countries and territories - and I do see that continued stressors combine to create breakdowns..

My point being - I can't talk it out, because there's nothing to talk about. I can and have taken biofeedback and control my breathing, look up, stay in the moment, clench my hands, splash cold water on my face, cough, and do all the other dozen of things they suggest. I meditate and do yoga and keep in shape.

I can watch a panic attack happen in real time on my Apple watch. My HR will be in the low 60's and then within 2 min it's at 120, and then 140's... I've had all the tests you could want - hyperparathyroidism, thyroid, immune, etc.. Spent more than 10k out of my pocket on all of it.

I subscribe to it being some kind of chemical imbalance - because it started so young and it's so random. But hey... what do I know... I'm almost 50yo now - so thankfully don't have too many more years to deal with it. But the pound of flesh it takes sure does seem heavier the older I get.

[ankietyjoe]

It's difficult to know what to say here.

I do disagree with you about it being a chemical imbalance, but that's only based on my experiences and the research I did to overcome my anxiety (I'm also nearly 50).

What I do believe is that because your panic attacks started at such a young age, it's a more ingrained reaction than mine ever became. My attacks were bad, life changing, life halting and I fell into a deep depression, but that wasn't until I was in my 30s. I saw the stress that led to them, and as an adult it was easier for me (over the period of a decade) to learn how to cope and eventually beat the actual panic attack.

What I'm hearing from you is that you are (understandably) trying to avoid the experience of panic, and the symptoms that go along with it. Anything that relates to anxiety is either being avoided or treated, the problem being it's a moving target that is paradoxically being fuelled by your avoidance.

'The dread of it returning' is something I remember haunting me for years.

What I eventually discovered is that once you don't pay any heed to the panic, or the accompanying symptoms, it becomes less of a problem over time. However, it took me about 18 months to fully let it go. That was 18 months of allowing and accepting the symptoms every day, and literally talking myself down -

"This will pass, this is just anxiety"

"This is just a symptom, it's not dangerous"

That kind of thing.

As long as you try and run from it, it will keep following you.

[panicface]

It's difficult to know what to say here.

"This will pass, this is just anxiety"

"This is just a symptom, it's not dangerous"

That kind of thing.

As long as you try and run from it, it will keep following you.

So, totally agree with this. My own mantra is
"This is uncomfortable but not unsafe"

When I get into a panic attack I literally turn into a baby. I mean I forget if I've had panic attack symptoms before, that I got through them, etc. Before I had a close friend who would talk me down - yes, you've had these same symptoms before and they went away etc.

Now I keep a spreadsheet that I can read during a panic attack that lists the symptoms, and that they ended. It helps - a little.

As a right brain person I think one of my biggest problems is that i'm always searching for an underlying cause.... what caused this last panic attack, how can i avoid another one, what was the trigger. mine come out of the blue, when i seemingly have no stressors mostly. was it something i ate, drank, was it something unhealthy i did or didn't do, etc. because panic attacks always seem to come back slightly differently and because i'm aging - i'm always on the fence on if the symptoms are mental, or if there is something physically wrong that needs to be addressed. At 50 - heart, stroke, and other issues are real potentials.

Lately I've just started trying to accept that it comes when it wants and focusing through the day on being in the moment. when I try to ONLY exist in the moment i do notice and underlying thread of part of my brain always trying to live in the future - what will happen if... or this... or this.... occurs. it's a negative thing. never positive.

so maybe there is a way to rewire our thinking to slowly move away from panic attacks? you evidentially have.

again, my plan is to just rest for a week and then try to wean myself off xanax over the next 60 days - but stay on Lexapro.. it's killing my sex life, but i feel it's helping with depression, or maybe just placebo.

appreciate your previous responses. i copied out your mantras as well.

[ankietyjoe]

Your mantras can be your own, mine were just examples. They key is self reassurance without reaching for a crutch or searching for a reason.

Speaking of reasons and self analysis (I'm a right brain person), I used to be as well. I was bound by science, and had a measured IQ of 171 in 2007, therefore a fVcking genius and more than capable of 'working this out'.....right?

Nope.

Anxiety is a paradox. The thing you're scared of is the system in your body that's working overdrive to keep you safe. It's your subconscious telling you to run from something that doesn't exist, and therefore becomes self perpetuating. You have the evidence here that you are trying to run from something that you're carrying throughout your life. You cannot escape that, ever.

The acceptance and almost befriending your anxiety is the flip side of the paradox, you allow it to consume you....and it goes away. Eventually.

Yes, you can definitely rewire your brain, and yes I have. I would not claim to be 100% anxiety free, but one thing I don't have any more is panic attacks. My anxiety is down 95%...if I had to put a number on it.

Things I absolutely know contribute to anxiety are stressors, in any form.

Work, relationships, diet, lack of exercise, body clock changes (that's you right), illness, alcohol, smoking, drugs, too MUCH exercise. Anything that causes your physiology to adapt is stress. Stress in itself isn't bad as it allows your body to adapt and strengthen, but that's only true if your body has the resources to do so. People in our situation are often running on empty, sometimes for years.

Your language tells me you have absolutely accepted that your anxiety is hard wired, your solution is set and it's just a waiting game for death. My language is challenging that because I don't believe it to be the case, despite my Doctors leaning more towards your way of thinking.

Meditation was my magic bullet, but that was only once I realised what meditation actually was, and also after practicing it for months, not days. You have practiced being the way you are now for 40 years, so it's going to take a little while to reprogramme your entire ethos of living.