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<title>Zk | 2013-09-20-recent-anxiety</title>
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<h1>Zk | 2013-09-20-recent-anxiety</h1>
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<p>type: post
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title: Recent Anxiety
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slug: recent-anxiety
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date: 2013-09-20</p>
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<hr />
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<p>I think that it’d be helpful for me to have some outlet for expressing more
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personal things in my life, and the last few weeks have really hammered that
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home, so I’m starting up a new section here, which won’t show up on its own,
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just as a place for me to dump some of this stuff.</p>
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<p>I’ve been dealing with generalized anxiety disorder for…well, forever, but
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it’s really become obvious in my adult life. Since I started college, the
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anxiety has really come to the forefront, and since I left college, it has all
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but taken over. I am always - <em>always</em> - anxious, and it affects every aspect
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of my day, and in a variety of ways.</p>
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<p>Not all of the ways are bad, of course; I consider myself reasonably happy,
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hardly living in some sort of stressful hell. Anxiety informs a lot of
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positive things in my life. I work hard, and do well at work, primarily because
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my motivations have their basis in anxiety. It has gotten me where I am today,
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in a way. The depth of my communication with my partners is also driven in part
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by anxiety, and I enjoy how close I am to both of them by virtue of sussing out
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details that make our relationships work. I think my dogs are happy, healthy,
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and safe, since I fuss over them so much, making sure they get what they need
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and stay out of harm’s way (no, Zephyr, a snake is not a toy, and no, Falcon,
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you may not play in traffic).</p>
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<p>The feelings of inadequacy and the fear of failure (on my part or others’) that
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go along with anxiety drive me to succeed in a lot of aspects of life, to be
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sure, but that generally is restricted to those things with concrete outcomes,
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and when things are less immediate, less under my control, the anxiety redoubles
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itself and builds insidiously until I’m completely overcome in panic.</p>
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<p>I think the word ‘insidious’ is particularly fitting in this case, as it
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describes the way in which anxiety builds slowly enough as to be almost
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unnoticeable until it’s hard to remember where it even started. In fact, once I
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started seeing a doctor for, I thought, depression and suicidal rumination, it
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took a few sessions of work to get me to understand how much of me feeling awful
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was due to anxiety rather than simply a mood disorder, that it was the anxiety
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affecting my mood, in all likelihood, and not vice versa.</p>
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<p>My work with my doctor led to prescription of a few anxiolytic drugs: clonazepam
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and lorazepam, both benzodiazepines. Clonazepam was a slow and mild
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anti-anxiety medication meant to be taken every day until a level built up in my
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system, helping to knock down the overall level of anxiety, whereas lorazepam
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was a very strong, but relatively short-lived, anxiolytic to be used in
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instances of ‘breakthrough panic’, or panic attacks. Along with medication, I
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kept seeing my doctor on a regular basis for some cognitive-behavioral therapy
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and more traditional talk therapy.</p>
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<p>After my suicide attempt, I stopped the clonazepam: the drug did knock down
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overall anxiety, but it also masked the beginnings of panic attacks, and when I
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was panicking, I often found that I wound up in a state of derealization, as
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though the things around me and in my life were not real. The attempt itself
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was during one of those moments, where I had drifted into this liminal state
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detached from reality, and the logical means of escaping this terrible feeling
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of anxiety was to escape everything all at once.</p>
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<p>Without clonazepam, I increased my efforts with my psychiatrist and worked out
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several mechanisms to help me out with anxiety. These primarily focused on
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heading off rises in anxiety which could turn into outright panic attacks. The
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general idea for the course of therapy was to increase my ability to deal with
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the anxiety as it came up. This was done by identifying what a panic-state felt
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like (tunnel vision, increased heart rate, ‘freezing up’, and so on) and think
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about how I felt and what I was thinking immediately before that before letting
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the attack take its course. When I started feeling and thinking those things
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next time, I’d know that I was right before a panic attack and could try to
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distract myself or go for a walk or something. At the same time, I could think
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about how I was feeling and what I was thinking immediately before that. By
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repeating the process, I’d know the signs of the very beginnings of a rise in
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anxiety, heading off even elevated levels, not just outright panic attacks.</p>
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<p>This worked fairly well for me for quite a while (and still does, but more on
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that in a bit). Over time, I got better at controlling my anxiety and the ways
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it affected me. Sometimes I’d lose and fall back into panic, but not nearly as
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often as before.</p>
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<p>A few times, however, the anxiety shifted in its course. For example, when I
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left my old job at a health insurance company to start working at Canonical, the
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stressors in my life shifted, and so the somatic symptoms of my anxiety shifted
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in step. Rather than high levels of acid reflux (I’ll never be free of it, but
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it got worse with panic), I developed a motor tic in my neck, causing me to jerk
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my head to the side every few seconds when relaxed, or a few times a second when
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panicking. Shifts like this caused consternation at first until my doctor and I
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worked it out as sweeping changes in my life reflected in my anxiety, and they
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even act as additional sigils that I can rely on, signalling an increase in
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anxiety or a pending panic attack.</p>
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<p>With that history in mind, fast-forward about eight months to mid-July of this
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year. Life had settled down in several ways for me - I was getting used to the
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job, I’d gotten another dog and she was relaxing into her new home, James and I
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were comfortable living together - and changed in several others - Russ and I
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had grown into our relationship, I was exploring being more open in my
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exploration of sex and gender, and I was getting more involved in the furry
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community through my projects. At this point, however, I was well on my way
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into an insidious change in the tenor of my anxiety.</p>
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<p>As July started to taper into August, I was finding myself with a few months
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with no free weekends. Not that I was doing something onerous like work, I had
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a convention at which I was speaking, a visit from Russ, a roommate moving in,
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some travel, and so on. Over time, I found myself more and more anxious with
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none of the signs that I had trained myself to notice. Additionally, as August
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wore on, I noticed two new symptoms come to the fore: derealization and auditory
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aberrations.</p>
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<p>These latter two were very concerning to me. The derealization took the form of
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paranoid delusions, at first, and it was only recently that I sorted that out.
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The topics were standard fare: James or Russ had already left me and were hiding
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the fact from me, or the people around me had sinister intentions, or weren’t
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really ‘real’ at all, being instead automata acting mechanically. The auditory
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aberrations (which I called hallucinations until corrected by my doctor), took
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the form of an additional ‘inner voice’ such as you hear when reading, except
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not my own. Sometimes male, sometimes female, it would speak ‘aloud’ what I was
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thinking in the third person or, more often, instruct me to kill myself,
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sometimes down to specifics, listing the steps required to hang or shoot myself
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in the calm voice of an announcer at a train station stating the next arriving
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train. At first I felt crazy, but then that settled into merely being annoyed
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or frightened. If I got upset at hearing these voices, their tones would get
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harsher or mocking.</p>
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<p>Much of this culminated during a work-sprint in London and the week after. It
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was then that I started to worry most and think about heading to the psych
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clinic in town to get this checked out. While these were all signs of
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schizophrenia or the like, the onset was late in life and too sudden for that.
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London was particularly hard on me being so far away from my partners and dogs
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and home, as well as due to the heights involved in both the office building I
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was working at and the bridges over the Thames. This is when the paranoia and
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derealization set in strongly, particularly in relation to my relationships: not
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being able to interact much with those closest to me and watching their
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interactions with others after the fact bred a jealousy not at all tied to
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reality, where I wasn’t just worried that I would be replaced, but believed that
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I already had, and that this was being hidden from my for sinister reasons.</p>
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<p>London was not all bad, as I did have a friend in town who has been a grounding
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force in my life since I’ve known him. Additionally, the city was amazing, and
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unlike our previous international sprint to Copenhagen, I felt more comfortable
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getting out and away from the context of work. It was about Thursday of the
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sprint when the tic, gone the last three months or so, returned, and I started
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to get an inkling that these “paranoid delusions and auditory hallucinations”
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were less symptoms of me going crazy, and more symptoms of the same old crazy:
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signs of anxiety.</p>
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<p>The week I got back was up and down to an extreme. One day, I’d be happy to
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work and, on my days off, walk around, but the next I would be nearly
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incapacitated by anxiety, held in quasi-catatonia by the fear that I would act
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out what I was being instructed to do. During these times, I could not interact
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with other people. I was in some liminal state, betwixt and between sanity and
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insanity, apart from the world, muddled and confused. When I would talk to even
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my partners, I felt like I was talking to masks or machines, and I did not get
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out of the house much.</p>
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<p>This was, of course, made worse by the flooding of the Eastern Slope in
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Colorado. I already have an intense fear of disaster (a house fire and close
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brushes with tornadoes will do that), but having our neighborhood threatened as
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we were stranded by the rising river had my anxiety riding at a constant high.
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The inner voices picked up on this and started instructing me to jump in the
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river, of course.</p>
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<p>The solution became evident when I tried taking the lorazepam I had left over
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from my previous prescription. Taking half a pill - 0.25mg - would stop
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everything and calm me down within half an hour and last for three or four
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hours, or until I fell asleep.</p>
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<p>I won’t recap the next few days, nor the entirety of the appointment with my
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doctor last night, but I will say the outcome.</p>
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<p>The aberrations, what I called auditory hallucinations, are a relatively common
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symptom of very high levels of anxiety. It’s a process called ‘expansion’,
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whereby what might have been a thought about abstract concepts such as death
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expands back out of the realm of thinking abstractly and into the realm of
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language. Suicidal rumination (that is, thinking about suicide over and over
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without any intention to actually carry through with it - not ideation) has been
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a feature of panic for me since high school at least, and in this case, it
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expanded back into the realm of inner speech.</p>
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<p>The derealization, what I had described as paranoid delusions, are an even more
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common symptom of panic. It is the sensation of things around you losing their
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reality and permanence, of reality itself feeling like something totally
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separate, and is indicative of the adrenal ‘fight or flight’ response, where
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things that might once have been people now become things to escape or destroy.
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I have experienced it before, but never so pervasive - it used to be that things
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took on sort of a cartoonish or movie-like quality, seeming scripted or
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mechanical, but this extended even to emotions and social interaction. The
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strongest instance previously had been with the suicide attempt, but that was
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accompanied by depersonalization, where I felt as though I were not a real
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person, but simply a set of actions tied to a sack of meat. This occurred later
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on in March, and again in May, in a similar ‘delusional’ fashion, with various
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forms of self-harm that felt as though the act would cause a rush of relief, a
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bringing to sharper clarity, or even a release of pressure (literally).</p>
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<p>Lacking that this time, the surreal aspect of interacting within the context of
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my relationships felt especially sinister.</p>
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<p>The end result is, as I had discussed with both partners as well as my doctor,
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an attempt to wrangle this under control with the goal to keep it under control,
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living with flexible enough coping mechanisms that I can deal with changes to
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symptoms or tenor in the future. I live with a lot of anxiety, and I don’t
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think I will ever not, but I can adapt and, like I have in the past, use it to
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my advantage: furthering my career and skills, deepening my relationships, and
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exploring the world around me.</p>
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<p>To that end, I’m taking up to 0.5mg lorazepam per day in 0.125mg doses, as well
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as 5mg fluoxetine per day (a quarter dose of Prozac, basically). If all goes
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well, I can stop the lorazepam in a few weeks and keep it, as before, for
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breakthrough anxiety. Finally, I also received a recommendation for a local
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therapist to see more regularly than I’m able to see my current psychiatrist,
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who lives several cities away.</p>
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<p>I’m incredibly thankful and feel, for lack of a better word, blessed for the
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people in my life not only putting up with me, but helping me through this. My
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partners and my roommate must be tired of me ticcing like a madman at the best
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of times, and a total mess at the worst. Surrounding myself with them, my dogs,
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and any hapless friends that happen to be nearby has kept me going, and will
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keep me going in the future.</p>
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<p>At the lowest points in all this, the one thought that stuck with me is that I
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have to believe that there’s a way forward, rather than simply unceasing terror
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or death at my own hands. No immediate solution, of course, but a path I could
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take. I’m pretty confident that I’m heading in the right direction.</p>
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