Here goes - Citalopram the sequel

[happycamper]

Mark, you said originally you suffered from HA...?
I was just wondering if it was secondary to having pain and if you feel you've recovered from it...? If so, do you feel it was largely due to CBT rather than meds...?

I'm waiting for CBT and hopeful it will help with the awful HA relapses I keep getting, which are always related to having some sort of pain, which then rules my brain often for days...no fun at all

[oldtime]

CBT does help with health anxiety, although the NHS group programme does not mention it. I saw a Psychologist privately for a few sessions. The trouble is I had a tendancy to catastrophise things so that a sore throat is throat cancer, chest tightness heart problems, stomach pains are stomach cancer or even other non-serious like diverticulitis. So I kept thinking I had no end of medical conditions. A typical symptom is checking heart rate, looking at back of throat in mirror, poking at stomach looking for problems.

CBT teaches you to write down what you feeling, what you fear it might be. Then to challenge that belief with a list of things it is more likely to be caused by. Eg. trapped wind, harmless ectopic beats, acid reflux, or aches from sitting at a desk all day. Eventually you can quickly recognise catastrophizing thoughts and replace them with more rational ones.

I still get brief feelings of health anxiety, typically at night when I am half asleep. By countering them with more rational thoughts I am able to stop them from going on too long. I think my sub-conscious mind still has health anxiety to some extent, but by continuing to apply CBT I think it will slowly be re-trained.

I don't think there is any other way to correct health anxiety. The AD drugs reduce obsessive thoughts, and make you feel more positive, so they help -- especially with obsessive thoughts but they are not a cure. CBT is a cure in the long term.

[happycamper]

Thanks for that. I'm sure you are right. I've read various self help books which incorporate the CBT approach...but applying what I've read seems to be very difficult and when the anxiety hits the irrational thinking overtakes everything. So, it would seem much more work is required.
Well done to you anyway!

[oldtime]

My doctor gave some good advice:
You will not feel normal whilst you are like this.
You will keep asking for reassurance, and medical tests.
Reasurance will give you short term relief then you will start worying again.
Everyone has lots of aches and pains all of the time but they are not aware of them, their brain filters them out. A health anxiety sufferer will dwell on and notice all the pains and feelings in their body.
There is no guarantee in health, you may have cancer or an undiagnosed heart problem, but all I can tell you is on the balance of evidence you are healthy and your problems are all anxiety related.

[kestral]

did you get any reassurance from what your gp said or was you more stressed?

[oldtime]

By this time I felt terrible, I had been completely irrational suffering from severe sleep deprivation. I had read a lot of self help material and was coming to a similar conclusion myself. What my doctor said did not make me feel better but it changed my attitude, his words had a lot of impact and I started to trust him. On subsequent visits to see my doctor I always started with saying I'm going to tell you what I'm feeling but following CBT techniques don't offer me any reassurance. I stopped asking for medical tests, they lead to more anxiety and re-enforce the sub-conscious belief that something is wrong.

It is working a year later, I feel mostly normal, last saw a doctor 8 months ago, and don't dwell too much on my health. I still struggle with chronic pain and I do still have a sub-conscious anxiety that is easily triggered, thankfully episodes are now short lived. I think the sub-conscious brain will take a very long time to recover. I do not feel that I can handle a major crisis yet but I can deal with day to day life with some confidence.

[kestral]

did you ever have a fast pulse rate or dont you check steve. mine is between 80-100 at the moment and that is making me stressed, i had a bad panic attack yesterday and im feeling crud.

[oldtime]

Pulse checking was a big thing for me, I would check my pulse 10 times a day. When my health anxiety started I had a high blood pressure reading: 150/110. This freaked me out, I am a fitness fanatic and have always had low blood pressure and a low pulse rate. During the first year of my anxiety my resting pulse rate was around 80. My pre-anxiety resting pulse rate was around 55, and I saw a low pulse rate as confirmation of my fitness. 80 is not really high, a healthy range is 60-80.

I now know that its the checking and worrying that fuels the anxiety cycle. If you can stop doing it you will break the cycle. Try restricting your pulse checking to once an hour, then 3 times a day, twice a day, once a day etc. Also try deliberately increasing your pulse rate by running up and down the stairs for example. Get used to the feeling of a racing heart and you will start to loose the fear.

[kestral]

at the moment mark, my feeling the fast heart rate is freaking me out and stopping me from doing anything, at the slightest movement it seems to go over a 100pbm and slowly comes back to about 85pbm when i rest, and that is still a big worry for me.

[oldtime]

At one point I could not walk more than 100 yards from my house, I would get palpitations and panic. When I first went back to the gym I would get palpitations if I did anything more than light exercise.

I guess that you have discussed your heart rate with a doctor. If he diagnoses anxiety then you must trust him, and try to learn to break your behaviour.

I saw a cardiologist she told me that my heart could beat at 180 / minute for a month non stop and it would not fail.

Anxiety releases cortisol and adrenaline, this increases your heart rate, and number of palpitations. Checking your heart rate and fearing a fast heart releases more adrenaline and cortisol.

Try to reduce your checking, slowly day by day and allow your heart to do what it is designed to do (beat faster when you are anxious / feel in danger).

Eventually your anxiety will decrease and your heart rate will return to lower levels. But it takes time, months or re-learning how to react to the messages from your body.

I had help from Mirtazapine and Citalopram, the Mirtazapine apparently lowers cortisol levels. But it is the CBT techniques of correcting un-helpful behaviours and re-placing them with more rational behaviour that is the real cure.