
Surviving Anxiety - gabrielhn
http://www.theatlantic.com/magazine/archive/2014/01/surviving_anxiety/355741/?single_page=true
======
jawngee
I can relate to this. I took klonopin for 10+ years, just recently weaned
myself off of it (six months and counting).

My first panic attack happened about two weeks after 9/11 on the F train. Top
3 most terrifying moments of my life.

I did CBT, talk therapy, all kinds of anti-depressant medications (the worst
being Effexor XR, that shit should be illegal) until finding klonopin to be
the most effective. Marijuana was helpful too, though it had its moments of
making things worse, but for the most part A+++ rating, would smoke again.

My anxiety manifested itself in some pretty severe panic attacks, extreme
hypochondria and some pretty intense derealization. I miss the derealization
though, but it took awhile for me to appreciate it instead of fearing it. The
hypochondria I don't miss at all. The panic attacks still happen from time to
time (mostly when the lights in the room suddenly change) but I'm so used to
them now they don't really phase me. And I'm so practiced at having them,
nobody standing around me is ever aware that I'm having a sudden bout of
tachycardia and growing concerns that my heart is about to explode in my
chest.

I noticed the klonopin was making me kind of a zombie, putting a mega-kabosh
on the creative output, so I decided to taper my way to freedom. The first two
weeks without it were pretty painful, but now it's relatively smooth sailing.

I'm not sure what happened that I got to this point now. I did move to a
foreign country (Vietnam) so I'm sure the slower pace has had something to do
with it, despite how much I've grown to dislike living here.

As for what caused it, all of my therapists think I have PTSD from my high
school days (I was in a pretty violent anti-racist skinhead group back in the
day), but I personally think it has to do with all the MDMA I chewed in the
post-skinhead rave days. I guess I'll never know.

~~~
cbd1984
It would be great if there were better ways to get the active ingredients in
marijuana into people without hoping the plant has them in the right ratios,
doesn't have the chemicals that cause bad side-effects, and doesn't need to be
smoked (which hurts the lungs) or eaten in a fatty solution (which causes
weight gain, which hurts everything else).

~~~
TheSisb2
From what I've heard "vaporizing" allows you better control consumption
without any (minimal) smoke. Probably the safest and healthiest method to
consume a desired amount.

~~~
cbd1984
That doesn't solve the problem of getting a known dose with minimal bad
chemicals.

~~~
killface
Known dose, sure. A lot of medical shops are posting independent lab
measurements of all of the independent cannabinoids (most importantly: thc,
cbd, cbn, cbg). So if you had a mg-accurate scale, and a bit of math, and
assuming 100% uptake in a vaporizer, that's nearly a solved problem. With
vaporizing the dried flowers, there is literally nothing else in there -- it's
not an extract or anything where there could be latent glycols or butane or
whatever.

So really, the problem _is_ solved :) It's just that the threshold and
effective doses for cannabis mean that mg-specific dosing really isn't that
useful.

------
someone903209
Weed (because it has no real downsides to me personally) and once-a-year DXM
(for depersonalisation) were mildly effective, but the clincher has been
learning about buddhism / the tao. I'm not talking about any kind of spiritual
practice, but moreso a change in perspective that simply isn't expressed by
anyone around me. Doing the unambiguously right thing in the best way in any
circumstance with no effort or conscious thought is powerful. I started with
the question "How do I talk to people correctly?" and found "right speech" and
went from there. Nearly two years later I can say it's been transformational
at lowering the anxiety that I once had. Automatic negative thoughts happen
infrequently instead of constantly. Though, this is not setting me up to be
rich and with lots of worldly possessions or friends, but I'm alright with
that.

edit: disappointing that all of the replies are about the first word in this
post, but I kind of asked for it. Talk about whatever you want to talk about.

~~~
throwaway1
> (because it has no real downsides)

Ohhh boy. On this throwaway to say otherwise. I'm sorry if this post is a bit
incoherent because I'm horribly tired, still getting past the nuts insomnia
phase of quitting.

I've smoked a lot of weed. Started smoking in high school, heavily when I was
19 until a couple weeks ago (I'm 26 now). About an ounce a month over that
time, sometimes two ounces. First it was for insomnia, then it was supposedly
for my digestive health (actually, quitting gives you gas and loose stool),
then for anxiety, sometimes for aches and pains (which were made worse because
of poor posture -- it is a muscle relaxant, after all). At the end it was for
my paranoia, so to speak -- I was convinced I had cancer setting into my guts
and that it was the weed that was keeping it in remission. They did some
experiment where this worked with rats, right?

Right now it seems like there are no side effects. Trust me, there will be.
Your memory will turn to shit and you won't be able to follow a conversation.
You will try to remember a number and forget it moments later. You'll be slow
to recall your own zip code. This doesn't just happen when you're high, it'll
happen the day after smoking also. Basically, if you're feeling "all right,"
you'll have these effects too.

You'll become dull. You'll sit around with peers and have nothing to talk
about, just a stupid smile. Now, you'll feel totally at peace, but you're a
basically a human blob, incapable of really interesting thought.

Your thoughts themselves will become lazy, less rigorous. You'll think you're
being "chill" when you quit a debate, but really, your mind is just working
_much_ slower.

You'll edit code pointlessly, shuffling stuff around.

It's not all bad -- the ability to come up with really funny insights doesn't
go away, so you can make people laugh. But there's no depth to anything you
do.

Heavy smoking makes you shiftless too, and easy to abuse. It let me stay in an
abusive marriage for a few years, fun (I sort of knew this but was too
embarrassed to leave this woman I'd just married, so I smoked more to keep my
sanity). Only when I tried to slow down smoking for a little while did I
realize how bad things had gotten. Whether or not you believe it's happening,
people _will_ try to take advantage of you, if you're worth taking advantage
of.

Keep in mind I'm not talking about "smoking every now and then when I feel
bad," I'm talking about daily use: A smoke in the bathroom before you shower
for work and constant smoking every night. Lunch break smoke if you're a real
go-getter. Maybe smoking on your commute. Always making sure you have a good
bit of bud or hash oil before you go on a trip anywhere (I remember smoking in
a company's garage in SF after a tech meetup, and also regularly taking smoke
breaks in my employer's garage in a less tolerant state).

In this industry, people will let you get away with it if you're any good,
because the fact is that a half-baked person who can still write decent,
reliable code is 10x as valuable as an regular guy with no
skill/aptitude/motivation. And as you might have noticed, most people don't
take to this stuff all that well, which is why (compared to other working
schlubs) we get paid pretty well.

Also, YMMV, but it completely robbed me of my sex life when sober because I'd
orgasm so fast.

It took several years of heavy, daily smoking for these serious symptoms to
fully manifest into what seemed an indomitable form, probably when I was
24-25. I know for sure that heavy daily smoking of high-grade buds in
California took it to the next level.

I had to stop smoking. I realized how stupid I'd become, even if I was raking
in the dollars (not doing consultant BS either, senior developer stuff at a
good tech company and respected by my peers).

Holy crap, I'd forgotten how smart I was. Suddenly I could remember
everything. Issue numbers. My train number. Dates, times, places. I could
remember things (addresses and stuff) I learned when stoned, knowledge I
didn't know was in my head. Weird!

Now I can't imagine smoking again, except rarely with friends. Having my brain
back is so wonderful. Feel free to ask my questions, though I probably covered
the uninteresting life of a stoner programmer pretty well here.

~~~
catchaway1
I have a question for you actually. I have noticed things very similar to what
you talk about after a few years of regular smoking. I started at 19 and I'm
21 now (edit, 22, forgot my own age). I used to evangelize marijuana since it
has no overt medical side effects, but I think I'm coming to realize what you
are talking about -- it kinda does make you stupid, like my Mom warned me
about years ago. And not just when you're high, either.

I try to mitigate the negative effects by alternating -- a month of daily
smoking, then a month off. If I have any in the house, I can't help myself, so
I moderate the quantities I buy.

But, I have started to have episodes around things like locked doors. Did I
lock the door -- or even close it? It's like I can't trust my previous
decision and I have to go check again. Sometimes I will check a door five
times in an hour. It's basically neurotic. If I don't check, I feel very
nervous. I think this might be related to marijuana since it seems to fall
into the category of absentminded behavior. It's like I am not present in
reality enough to have faith in my past decisions.

I definitely don't feel stupid, but I do feel unfocused -- you could say my
thoughts are accurate but not very precise. Or put in other terms, I feel like
my of my intellectual powers are locked up because it feels to difficult to
think about hard things.

Anyway, I was wondering how long you feel like it took you to "get smart
again", as it were. Should a month be long enough to return to a baseline
state of mind? Or should I try a multiple month T break to see if it has a big
impact? (If it did, I would quit).

~~~
priorstoner
Here's another anecdote, for what it's worth:

I started smoking at age 21, when I graduated college a year early, and smoked
nonstop after graduation until age 23.

At that point, my life basically fell apart, and it was definitely related to
being high 24/7.

So I quit cold turkey. By age 25, I had started my own web business that was
very successful. SaaS business, recurring revenue, amazing growth, etc. I was
driving a fancy car, living in Palo Alto, and was on track to being a
millionaire by my late 20's, almost guaranteed, just based on the growth of
the business. I was so financially secure that I even got married and had a
kid very young.

Of course, running the business (plus starting a business at the same time)
was stressful. There were customers, partners, employees, etc., to deal with.
And a toddler, and new wife.

I had very little support or mentors. None of my family or friends were
entrepreneurs and I had no connections.

Eventually, I started getting migraine headaches on a regular basis. Around
age 27. I convinced myself that smoking marijuana again was a logical thing to
do, despite the fact that it had literally destroyed my life after college,
and I had to rebuild my life back up again already.

I was smoking large quantities of high grade stuff. I had a lot of money from
my business, so I went all out. Oils, kiefs, fancy bongs, the whole deal.

Being high all day, I started making terrible decisions and being really
reckless with my business.

Long story short: within 12 months I went from a highly profitable, debt-free,
lifestyle business that allowed me to effortlessly live in the heart of
Silicon Valley (out of choice -- I could have lived anywhere I wanted to), to
having a nervous breakdown, bankrupting my business, and ending up $250,000 in
debt.

Today, I am 34. I am still paying off the debt from that mistake. I have no
business, and work a "shitty" (meaning, comfortable six figures, but no real
ownership) job as a software engineer. I am regularly depressed when I think
about what I lost, and how foolish I was to lose it.

This is an extreme case, and of course only an anecdote. But it's pretty black
and white: smoking a lot of marijuana all the time made me dumb and caused me
to make really bad decisions.

As for weaning off of marijuana and its resultant impact on the sharpness of
mind:

I found that after 3 days, there is a very noticeable difference. You are
probably about 70-90% recovered at that point. But it takes a good 6-12 months
to get that back that really sharp "edge" that you once had, the remaining
10-30%.

But, as I hope I have related in this story, it's not just about getting back
the intelligence and sharpness of mind. It's that even when you get that stuff
back, you will still be left with the consequences of whatever dumb shit you
did while living your life high all the time.

~~~
Xcelerate
Did your wife stay with you through all that craziness?

~~~
priorstoner
Yes, she is a saint.

------
taterbase
For me, the most difficult part of conquering anxiety is the physical
symptoms. Stomach duress, stress, sweating, and bracing for the next wave of
anxiety. These symptoms feed into each other and can set off a new attack or
make an existing one worse.

I've found Hope and Help for Your Nerves by Claire Weeks to be the most
helpful book on dealing with the physical symptoms. Once you're able to remove
or at least tame the physical aspect you can better fight the mental
manifestation.

This book literally changed my life and I'd recommend that you don't hesitate
to check it out if you suffer from anxiety in any capacity.

[http://www.amazon.com/Hope-Help-Nerves-Claire-
Weekes/dp/0451...](http://www.amazon.com/Hope-Help-Nerves-Claire-
Weekes/dp/0451167228)

------
aantix
I had been feeling a little blue the past few months. I didn't want to take an
anti-depressant (too heavy and too many side effects).

I read this book : [http://www.amazon.com/The-Mood-Cure-Program-Emotions-
Today/d...](http://www.amazon.com/The-Mood-Cure-Program-Emotions-
Today/dp/0142003646)

She basically advocates for the supplements 5htp and St John's Wort taken
three times a day (empty stomach ideally).

Her theory is that a lot of our depressive moods are due to nutritional
deficiencies and that the amino acids that help with serotonin production are
easily depleted (via drinking coffee, alcohol, aspartame, stresses, and lack
of sleep).

Nonetheless, I am feeling better, and feeling like I am making incremental
improvements each week. Much less anxiety.

No side effects to report (sexual, clouded brain syndrome).

St John's Wort:
[http://examine.com/supplements/Hypericum+perforatum/](http://examine.com/supplements/Hypericum+perforatum/)

5-HTP
[http://examine.com/supplements/5-HTP/](http://examine.com/supplements/5-HTP/)

L-Tyrosene is also advocated in the book as a motivational booster (increases
dopamine). It's effects feel like a strong cup of coffee.

I'm not in any way connected to this book or these supplements; just happy to
share something that worked for me regarding depression and anxiety.

~~~
aantix
Why the downvote?

~~~
sjf
Because you're effectively taking unregulated medicines with similar
mechanisms to standard anti-depressants?

~~~
aantix
So because they could be dangerous, I shouldn't post the information?

I included the links to examine.com which gives a descent meta analysis of the
research behind each of them. Both of them show promising research results.

Safety is never guaranteed. Certainly I don't have to spell this out for the
HN audience?

Do your own research. Weigh the risks. If the safety profile is to your
liking, then find a trusted supplier and ramp up slowly. Stop immediately if
any undesirable effects are noticed.

~~~
UrMomReadsHN
>Stop immediately if any undesirable effects are noticed.

Probably not the best idea since if you are taking something that actually
increases serotonin you will give yourself antidepressant discontinuation
syndrome by stopping abruptly.

[http://en.wikipedia.org/wiki/Antidepressant_discontinuation_...](http://en.wikipedia.org/wiki/Antidepressant_discontinuation_syndrome)

~~~
aantix
You're exhausting to discuss with, even over the Internet. 300mg is a very
normal dose. Serotonin syndrome isn't going to be induced with such
conservative dosing.

~~~
UrMomReadsHN
....?

I never said anything about serotonin syndrome...?? ...

Furthermore, I wasn't even the original GP, so how am I "exhausting?" The only
thing I said was supplements are basically unregulated (theres a good chance
your bottle of St Johns Wort is actually rice powder * ) and talk to your
doctor before taking supplement and before stopping supplements abruptly.
Trust me, antidepressant discontinuation syndrome is complete HELL.

* [http://mobile.nytimes.com/2013/11/05/science/herbal-suppleme...](http://mobile.nytimes.com/2013/11/05/science/herbal-supplements-are-often-not-what-they-seem.html?pagewanted=all&_r=0)

------
manmal
I had anxiety years ago, with panic attacks whenever I was on a train for more
than a few minutes. I was also constantly afraid of having contracted fatal
diseases.

No more. I did a lot of different probiotics (Mutaflor, some generic
L-bacillus stuff, homemade kefir, Kombucha,...) in the last years, and anxiety
has completely gone away. Here is some possible explanation:
[http://www.psychologytoday.com/blog/reading-between-the-
head...](http://www.psychologytoday.com/blog/reading-between-the-
headlines/201309/gut-bacteria-transplant-new-treatment-anxiety)

I know such comments are often downvoted, so please drop a comment if you do,
and contribute.

~~~
throwaway_217
Not sure if related, but my severe social anxiety started after I had a flu
(as a kid, 2 weeks in bed) and was probably treated with antibiotics. I've
just recently realized that there could be a connection. Haven't got rid of
it.

Edit: Just found this: [http://www.scribd.com/doc/28819342/Experimental-
Treatment-fo...](http://www.scribd.com/doc/28819342/Experimental-Treatment-
for-Social-Phobia#scribd) I'm going to try it and report back.

~~~
manmal
Sure - I had antibiotics treatment early in life and had chronic diarrhea at
age 3. Later, I was an outsider as a kid, and had difficulty making eye
contact. There might be a connection.

------
contingencies
Random naturalistic option: After quitting smoking I found drinking cocoa with
hot water (not milk) helped me to calm down and concentrate.

Obviously if you're flipping out properly it's not gonna help, but it does
appear to have a surprising effect for the tamer challenges in life. I hadn't
expected or heard of any such effects, but consistently felt so much more
relaxed and focused after drinking it, which piqued my interest enough to look
it up. There does appear to be some nebulous positive medical review of its
effects in areas like blood pressure.

------
Xcelerate
As long as I can remember, I've always had intense social anxiety, but never
generalized anxiety. In other words, interacting with people I don't know very
well gives me intense anxiety, but that's about the only thing that does. I
have no problem with public speaking, and I don't get anxiety when I'm by
myself. Well, maybe a little bit, but not like the guy in the article. My main
problem is that I obsess and overanalyze _everything_. For instance, I stood
in the grocery aisle for half an hour trying to figure out which of two
products was the better one. I ended up accessing research articles through my
university's proxy service and reading them on my phone while I stood there.

I started Nardil after a very weird/disturbing relationship left me in a
depressed state for many months. I had never been depressed before that. But
it eliminated the depression almost instantly, and greatly diminished my
social anxiety. Although I'm thinking of stopping it soon because the side
effects are pretty bad. I didn't notice them at first, but they've crept up
and are very noticeable now. Hopefully when I stop it my ability to handle
social interactions will remain now that I've had some practice with it.

------
autokad
how I manage panic attacks and public speaking: public speaking: i pretend
everyone in the audience is just 2 or 3 people, and that they are friends of
mine. going into it isnt easy but once I get started that helps quite a bit. I
teach a class so there is no avoiding public speaking, but I dont find that
its much of a problem despite my dislike for it.

for panic attacks, they are really something separate from the anxiety of
speaking to a lot of people. so far the only thing that I have as a weapon is
to try and thwart them before they start or ride out the storm by distraction
- 2048 helps, it really does! after 4 years of no panic attacks I thought they
were conquered, but I did have an episode, so its ongoing but managed I guess.

depression: I was depressed for a long time. I was able to put an end to it by
putting dark thoughts out of my mind, concentrating on good things, and not
talking myself into thinking how bad things were. I consider it safely
conquered. it sounds like a platitude "dont think negative things and you will
get better" but its not. at first it is hard but then one day you will wake up
and everything has changed.

History: I get panic attacks every (so far) only on even years and so far
(only between the months of may-august). i dont know why... I can have close
calls outside of those time restraints but the full blown the world is ending
panic attacks have only happened during those time frames. I really dont have
an ability to stop them once they trigger from happening, they can happen at
4am or 3pm at work. distraction and not thinking about them seems to help the
most.

depression: I was depressed from 1998 to 2012. from 2010-2012 it was managed,
but now I'm like a different person. I have never taken any medication for
anything above.

------
A_COMPUTER
I guess this is a good place to mention this in case anyone experiences the
same thing. I naturally have terrible anxiety, but for a while I was having
even more horrible anxiety attacks. I eventually figured out that taking
probiotics made it happen. If you're using probiotics it might be worth a try
stopping for a month and seeing what happens.

~~~
mmastrac
That's bizarre, but given the amount of research lately tying gut flora and
inflammation to mood and depression, unsurprising.

------
Apocryphon
I'd be curious if the author had every tried psychodynamic therapy, which has
a different approach from CBT.

------
gumz11
This article is great. I have fought with social anxiety for 5 years as a
result of family complications and high school drama. I have been doing talk
therapy for 6 months with very positive affects on my previously negative
outlook on life.

I've always viewed it as a disease, but this article portrays anxiety in a new
light. Maybe my ability to view the world this way enables self creativity
that I never knew existed... That thought is exciting.

Thanks for sharing!

------
0xdeadbeefbabe
> Stoic philosophy, and audiotapes I ordered off a late-night TV infomercial.

Would a stoic be happy or sad that stoic philosophy didn't work for him?

~~~
Kenji
A stoic does not judge reality like that. He acknowledges that it did not work
and moves on. He need not ponder about the fact that it did not work because
it cannot be changed and no thinking should be done without a purpose.

~~~
0xdeadbeefbabe
Stoic philosophy sounds something like mindfulness or meditation [0], except
for the part about "no thinking should be done without a purpose."

[0] [http://amzn.com/0385303122](http://amzn.com/0385303122)

------
applecore
If you feel intense anxiety prior to public speaking, you should directly
address your issues with public speaking, rather than resorting to self-
medication.

------
mrjj
Guys please stop looking for the reason why you are using drugs. They are just
awesome thats why. Nowadays we could be honest saying that.

When anything awesome comes to our life we forget about stomach aches, spine
aches or mental aches and feel the drive. But drugs and medicines have not
awesome side-effects. I could be very nervous on weed and stimulators and
after psychedelics (we are not talking about opiates usually its one-way
road).

The medical fact that you could be born predisposed to be nervous or could
became that after the shock. So its your body nature.

And there is only two ways: 1\. Be where is awesome and do something awesome.
You need it more then others. 2\. Radically change your metabolism, reject
yourself and became a Z-Zombie.

Or the grave, but you can't avoid it, so it can wait, finally there will be no
nerves to be nervous anyway.

And you shouldn't dramatize what's going on. Panic attack its just several bad
hours and you are not physically damaged after that. I have a couple of them
per week, and one a day in bad times, but you're not dying, event not
physically disabled, just misbalance moment in your nervous system. Ok just as
planned 56 hours per week for a sleep, 3 for a toiled, 25 for internet
hangout, 10 for a meal and 5 for the panic attacks, everything just as
planned. When you are resting well, eating enough you'll reduce this time. So
there is even a good news)

When you have a hard panic attacks with adrenaline outburst (you know, you are
"really dying", but before you should run to the toilet like sprinter) that's
a bright moments, and you have couple bright days after them, just because its
not happening with you now. Everyone wants a bright life, right? You've got a
little for free, some kind of death and resurrection cycle)

Brotherhood of anxious guys and girls are just a part of big picture, there is
a epilepsy, head traumas and other ns diseases and we are not holding even the
bronze medal.

Want another good thing? Hypochondria, i really killing my physician with it.
How dare you to say that i have no cancer! Lets check again! Two MRI per week
is too much? Not too much for the such ill person, im sure that bastard is
hiding somewhere between spine and lungs. My heart is ok?! I'll go to the
other physician! You said something about spot on pancreas? Oh, that spot will
kill me in a year for sure. (why did they asked me how long i didn't fart?).
But my real hope is a inborn cyst "without diagnostic meaning" it's a real
black horse, when i feel the headache i know that there is no brain left, only
cyst with a liquid and alchohol inside, ready to explode.

Hypochondria helps us to visit physician in a time, discover early problems
and prevent them, so, statistically, we are more bulletproof that guys which
seen a doctor once a life and suddenly dying from the stroke just before 50
anniversary.

But there was a real killing thing in my life. One day i haven't sleep because
i was anxious, guy from my work said something wrong (or i thought that he
thought something wrong, i don't remember clearly). Then i feel strange smell,
i sniffed and decided that there is a fire in my flat. So i raised a panic of
the highest probe and evacuated my family. There was a real fire downstairs
and all flat became filled with acrid fumes after 5 minutes.

So my anxiety save me and my family, and we are in very good relations after
this accident.

------
a3voices
I've always had lots of anxiety, and I was once in a psychiatric hospital for
2 weeks several years ago. I stopped taking meds though a while ago. I figure
anxiety is just part of my life, and it's not worth fighting.

~~~
spammyusername
I am curious to hear a little more. In many senses, worry/anxiety is endemic
to humans. 'What will I eat/drink to survive?' at the most basic level if you
look at how we as creatures have come about. Since these needs are largely
fulfilled in modern society these questions get much more idiosyncratic; that
is, they are suited uniquely to our individual situations so it's hard to
proceed without knowing a little more about what drives some of your feelings
of anxiety.

------
hackaflocka
Learn to meditate. It can cure anxiety.

Source: personal experience.

~~~
someone903209
Anxiety and the meditative state are, to put it simply, impossible to
experience at the same time. Who is it that is anxious, when that anxious
person no longer exists?

~~~
0xdeadbeefbabe
In my experience meditation effectively reduces panic, but I'm still aware of
panic. It's like holding a hot coal.

~~~
someone903209
The hot coal is in your throat, not in your hand. Do you try to swallow it, or
try to spit it up?

~~~
0xdeadbeefbabe
Swallow. "try to spit" sounds like trying escape, and I think it would
intensify the anxiety. But spitting does involve letting go. Hmmm maybe I'll
try it. Now what would make me anxious.

