[jawngee]

Great article.

I suffer from PTSD, GAD and mild depression. Having been involved in a fairly violent street gang in high school, I had seen a lot of violence and just plain f*cked up stuff. People getting shot in front of me, a lot of situations that forced me to confront my own mortality, etc.

It really didn't hit me until about 10 years ago. I was getting off the F train at 23rd street and had an overwhelming feeling I was going to pass out, which I then interpreted as my imminent death. It was frightening because it was so out of the blue and so intense. Who wants to pass out on a subway platform? Or worse, die on a subway platform?

For the next two years I tried to find a medical reason behind that first massive panic attack, but never found one despite spending several tens of thousands of dollars on medical bills. I finally had to accept that I had these certain mental conditions.

I used to reign it in through a variety of meds; anti-depressants, klonopin, ativan, xanax. I went to a cognitive behavioral therapist to figure out how to change my thinking and learn to control it.

These days I don't take any meds and though I still have massive panic attacks now and again, they mostly don't phase me as they're so common place now and you sort of grow to accept that these things aren't going away and it's your lot in life.

The most damning aspects of anxiety disorder aren't the panic attacks, by the way. It's all the passive shit that comes with it. Hyper-vigilance and derealization have to be the worst. Hyper-vigilance means that you are so focused on your physical well being that the slightest pain, discomfort, etc. gets misinterpreted as a major medical calamity. A cough becomes lung cancer, a mild pain in your armpit becomes non-hodgkin's lymphoma, etc. With derealization, you'll have entire spans of time where nothing seems real to you at all, familiar things become unfamiliar, etc. If you've read anything by Camus, you'll have some understanding what derealization is all about. It's pretty scary shit.

But despite all of that, I have what I consider a fairly successful career. I believe that is partially due to the CBT therapy, and part to my stubbornness to not be a victim.

I do think depression and anxiety are endemic to this current generation of technologists (late 20's and up). This new generation, seems more balanced though, so maybe it's a generational thing? Not sure.

One controversial thing that has helped me, as well as hurt me, is marijuana. Most times it helps me to get out of my head, specifically on days when the anxiety is thickest. On the flip side, sometimes imbuing too much brings the anxiety like nothing else. But most times, it's been more helpful than harmful.

[maxawaytoolong]

I developed most of the symptoms of GAD last summer after having a panic attack where I ended up in the hospital. It was weird because I'm in my early 30s and have never had any anxiety symptoms before. I guess I was probably mildly depressed, but no prior history of panic attacks or other GAD symptoms. I believe the panic attack was brought on because I got food poisoning during a time period with a lot of uncertain work-related stress.

I find the hyper vigilance the most obnoxious thing about this. The other things I can't stand are various weird chest tensions and growling stomach issues, which are related to the hyper-vigilance thing. I'd probably not even notice them usually, but now they freak me out.

I've not tried any drugs but have used the "Linden Method" which was suggested by a friend. It was relatively useful but there's not much too it. Mostly: get an engrossing hobby like photography and learn some deep breathing exercises.

Other things that have helped:

- exercise, specifically outdoor exercise like running or surfing

- more social time with friends

- avoiding caffeine... this is a bummer since I really like coffee.

- one glass of wine seems to help, but drinking to excess makes it worse the next day

- regular sleep schedule seems to help

- spending less time using computer-mediated communication helps

- avoiding certain foods seems to help. I think indigestion triggers the hyper-vigilance response.

Out of all of these things, exercise seems to be helping the most. Thanks YC for the previous suggestions. I kind of knew that exercise would be the most beneficial, but it took some external prompting to actually get started running again.

I am interested in CBT. How do you go about getting into it? Just ask my primary care physician?

[dkarl]

"I am interested in CBT. How do you go about getting into it? Just ask my primary care physician?"

I wouldn't recommend it. Doctors have a wide range of attitudes towards therapists. A friend of mine who is a GP is scared to enter therapy because he's scared that other doctors in his area might find out and lose respect for him. So, evidently, your doctor might help you locate a therapist or might just decide you're a loser, or both. Or he might try to steer you toward a particular form of therapy that you don't want.

There are online services that list therapists in your area. I think (don't recall exactly) this is the one I used:

http://therapists.psychologytoday.com/rms/

The profiles include therapists' training, preferred approaches, and pictures. Highly analytical people should really make sure they get a therapist with a PhD. Therapists without PhDs tend to be more empathy-based, less analytical, and more likely to ignore the content of what you're saying. A PhD will at least listen to your complicated ramblings, try to understand them, and glean information about you and your problems from them. She will be able to understand your questions and complaints. That doesn't mean she'll buy into your own framing of your problems and engage with you using your own terminology, but she will recognize that what she's hearing is important to understanding your inner world. A PhD is also more likely to be smart enough to provide a critical perspective on your beliefs and to explain and defend her own ideas.

[gcheong]

Your primary care physician can probably refer you to someone. It would be a good place to start. "Feeling Good" (Burns) is a good source of CBT information and exercises. I would also recommend "Managing Your Mind" (Butler and Hope). Another approach called "Acceptance and Commitment Therapy" has showed some promise in research. The book "Get Out of Your Mind and Into Your Life" (Hayes) was written by the person who developed ACT. Another good workbook on the subject is "The Mindfulness and Acceptance Workbook for Anxiety" (Forsyth and Eifert).

[Prikrutil]

It sounds like you have already read some of these books and find them useful to find possible "bugs" in your mind making you anxious. If so, maybe you'll find my comment a bit naive.

What I've decided is that the only way to find out all the "bugs" to annihilate is by ignoring all the easy to get suggestions made by other peoples (who are smart enough to do that without any assistance). It's important that you should find out where the roots of your problems actually are and how to get rid of them by yourself. I beleive that no one knows about you more than you do.

Why don't I consider such books as a good point to start from? In fact, I'm a bit afraid of such books... They look like ones about patterns: they don't always turn you into a good programmer, but there is a chance that after reading you won't be able to think in terms other than you have already read about (that is actually what I'm afraid of).

Anyways, I'm going to take a look at books you've mentioned (with care :). Thanks!

[jawngee]

I found mine on adaa.org.

[gabrielroth]

I'm not sure why you gave up on prescribed psychotropics under medical supervision but you're still self-medicating with mariajuana. Is the latter more effective? Having a (capable, attentive) doctor monitoring your treatment can be a big advantage, and it's worth putting some effort into finding such a person.

[jawngee]

A variety of reasons. First and foremost, the side effects were typically worse than the benefits. For example, I was on Effexor XR for a year. The side effects from that included a lovely bubble sensation in your brain, sort of a cranial pressure that literally feels like your brain is growing too large for the skull it's contained in. The worst side effect, though, hits when you forget to take it. You get these things called "brain shivers" where moving your eyeballs causes an electric shock sensation in your brain. The more days you miss, the worse this gets, to the point that you are unable to get out of your bed because the slightest movement of your head results in a mildly painful shock.

Zoloft, on the other hand, is much more mild, but didn't really put a dent in it.

The benzo's were helpful, but are highly addictive. I still carry Klonopin around with me for those times when it's real thick, but I only use it as a last resort.

The most beneficial thing, for anyone suffering from anxiety, is CBT therapy as it teaches you a set of tools for navigating the anxiety and minimizing the impact of panic attacks. To me, that's far more sustainable than being a guinea pig for Pfizer. With CBT, you learn how to tackle it head on and come out on top. It takes some time, but it's doable.

For anxiety, in general, I see the AD's being used until you get to a point with CBT that you can handle it without. The long term impact of AD's are still unknowns, and their efficacy is constantly challenged. If you can get control without that dependancy, the better off you'll be. That's just my opinion though.

As for the marijuana, it took some trial and error to discover what worked there. In the last six months or so, I smoke significantly less than I used to, in fact I haven't smoked probably in the last three months, save a few times at parties or hanging with friends and playing Killzone 2. It has it's own set of problems though, but in contrast to all the other medications I've been on, it's been the most effective with the least side effects.

[ibsulon]

I can speak for myself. Wellbutrin made me paranoid, and Lexapro and Effexor had less serious but still life-altering side effects. Neither were worth the minor improvement in mood. (Further, they just make me incredibly apathetic.)

I'm glad that anti-depressants work for others, but I'm not willing to spend years going from side effect to side effect just to find the right drug which will probably stop working after a while.

[time_management]

Lexapro had no side effects for me, except for mild, short-duration panic episodes when I was going to sleep, mostly during the first week. (If you have anxiety, the first week of an SSRI is known to suck.) The first three nights I had to take Klonopin (clonazepam) and by the end of the second week there were no side effects.

[bprater]

First, it's dangerous to give up psychotropics without a doctor's plan of attack. People that commit suicide and who take them are often found to be going cold-turkey when the incident occurs.

Second, I've found that when I've lived where pot is legal, that it has a similar effect for me. When I was really tightly wound at the end of the day, it helped me relax, shift my perspective and I could usually fall asleep in minutes.