Nick Johnstone 

Blue Notes

The panic attacks have returned. The solution? A thousand sit-ups a week and a big slice of cheesecake, writes Nick Johnstone.
  
  


Lately, I've been having panic attacks again. Only one or two a week. Nothing dramatic. But enough to have me worried. The first one struck while I was doing the food shopping (fluorescent lighting is a proven trigger). As my limbs went all rubbery and I broke into a cold sweat, and the heap of avocados I was picking through turned very abstract, very surreal, my first thought was: how is this possible? I take medication to make sure this doesn't happen.

As long as I've been on Efexor XL, an antidepressant designed to alleviate symptoms of depression, ease anxiety and stifle panic attacks, I've been blissfully attack-free. Until that afternoon in the supermarket. So what's going on? The obvious explanation is the dose I'm taking. Over the past months, I've been slowly, incrementally weaned, by my GP, from 150mg a day, down to 112.5mg, before settling at 75mg. At first, this felt insufficient. My brain felt hungry, as if it had been put on a crash diet. But then, things levelled out and I felt brighter and the worst of the side-effects cleared away. I lost a stone (like most antidepressants, Efexor XL makes you puff up); the excessive sweating stopped (at 150mg, even a short walk left me dripping with sweat); and the jittery, too-much-coffee feeling vanished, too (when I first started taking Efexor XL, it rather alarmingly reminded me of youthful experiments with speed).

But then recently, there it was again, that sense of my brain being starved. Aside from the panic attacks, other predictable symptoms have also popped up: I've been craving sugary foods, in particular New York cheesecake. My sweet-toothed wife, nine months pregnant and currently resembling a beautiful spacehopper, is only too happy to grab a spoon and join me, but we're both aware that it means I'm too stressed, feeling overwhelmed, trying to pep up my mood with a sugar bomb.

Then there's the upping of my exercise regimen. Alongside my usual weekly diet of yoga and pilates, I recently announced a new additional challenge: 1,000 sit-ups a week. My wife is now indifferent to the sight of me huffing and puffing on the floor, ranting about burning off adrenalin. The sit-ups, invaluably, get me high. At the moment, I need that. If we weren't up to our eyeballs in all the usual stresses of life, topped off with the exhilarating, overwhelming, nerve-jangling experience of a first pregnancy coming to fruition, I'd consider going back on a higher dose. But I know this rocky patch is reactive, circumstantial.

Scary midwife appointments, sleepless nights, sudden dashes to the hospital. Will our baby be OK? Will my wife be OK? It's typical stuff. But I have a low-stress threshold. So for now, I'm sticking it out with my patented self-help methodology, which will be referred to from now on as Beating Depression, Anxiety And Panic Attacks With New York Cheesecake And A Ridiculous Number Of Sit-Ups.

Although I know deep down that I'm coping OK, there's the nagging doubt that the panic attacks have nothing to do with the current stresses of my life, that maybe they're a sign that I'm heading for trouble again, that my brain isn't making - artificially or naturally - enough serotonin, that it's chomping too swiftly through what little serotonin there is, then spending the rest of the day licking an empty plate. This inevitably sets up a pattern of self-monitoring. Am I feeling better today? Why did I forget to have lunch? Did that camomile tea relax me? Did I overreact?

From experience, I've learned that too much monitoring only makes you more anxious, which in turn creates a perfect, jangly breeding ground for panic attacks. And once you have one panic attack, you quite logically start worrying about when the next one will strike. And then you have a vicious cycle. Eventually, you wave the white flag. Give me the drugs - NOW! You have to find that delicate balance between being healthily self-aware and unhealthily self-indulgent.

You have to learn to sit out the turbulence. Instead of letting every little crisis lead to the same predictable thought: "I'm not doing well, let the medication do the dirty work," you have to take a deep breath, bend with the stress, adjust your coping strategies. Tell yourself that this too will pass. I like that expression. It's one of the few useful things I picked up at Alcoholics Anonymous. It's true. These little crises do pass.

www.nickjohnstone.com

 

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