Question: I take SSRIs for GAD. I keep it fairly well under control but it flares up and worsens every few months. I have a very demanding job and I am under a great deal of stress most of the time. I know that the crazy stress I put myself through worsens my disease but paradoxically, when I am busiest I feel the least anxious. It’s like I don’t have the time to start ruminating about stuff. When things slow down at work and when I have some time to myself that is always when the anxiety gets much worse. I feel as though I am in a bit of a catch 22 situation and I am not sure how to get out. I manage it by trying to stay ridiculously busy all the time but this is not an ideal situation for me since I am now a new dad and I also want to be able to spend a good amount of time with my family. Do you have any suggestions that might be useful to me? Thank you for taking the time to answer this question.

Jill Palmer Says...:

Great question. The problem with SSRIs is that they take the edge off of anxiety but they don't teach us coping skills. I always recommend therapy in conjunction with SSRIs. It is best that you don't keep so busy you miss out on your family. You'll need to learn to cope with the anxiety so you can get a peaceful life.

There are a few ideas you can start with. There are anxiety workbooks available at book stores you can work through. They teach you to pay attention to the thoughts and give you ideas on how to conquer those thoughts. You can also try meditation or mindfulness. There are books about being present which help us not worry about the past or the future (anything by Eckhart Tolle). I would also recommend exercise if it isn't already part of your lifestyle.

The other thing I recommend is to have quiet time for some amount of time that is uncomfortable but manageable. Sit with the anxiety and deal with whatever emotions are coming up for you. As you get better with that manageable about of time, increase the time until you can be with yourself in quiet for a reasonable amount of time without too much anxiety. This way you are teaching yourself that you can manage your anxiety in time chunks.

Staying super busy is only a distraction and avoiding the issue. Learning to deal with the underlying issue will allow you to manage the anxiety and eventually get off of the SSRIs.

I wish you the best.

Question: My brother has late onset schizophrenia and my sister in law recommended that I get tested for pyroluria which they think caused his disease and which apparently can run in families. I had never heard of pyroluria before and the information on the internet is confusing and contradictory. Should I get tested for this condition or is it a waste of time and a made up disease?

Jill Palmer Says...:

I'm not a medical professional so I don't know anything about Pyroluria. I would not trust what is on the internet unless you are researching on a reputable site. I do have some questions for you to think about though. How would you realistically handle this information? What would you do with this information? Would you make any lifestyle changes? Are there any preventative things you can do with this knowledge? Are you emotionally ready for this type of information? Would you live your life any differently? Do you have healthy coping skills and a support system in place? How would you manage a positive diagnosis knowing what it could turn into?

I would contact a medical doctor to get information on this disease and the testing procedure for it. I would also ask if there is any thing to do lifestyle wise if you were to get this diagnosis. If there is no medical benefit from getting this information then I would seek counseling for the emotional side of it.

Getting this potential diagnosis seems like a big deal to me. You'll have to decide if you can live a happy life knowing that you are a candidate for getting schizophrenia. 

I would also recommend good health overall regardless of what you decide to do. Regular exercise, eating healthy, joyful hobbies, low stress and friends. Maintaining a healthy lifestyle helps will all potential ailments and helps to prevent some ailments. Learning to take care of yourself will go a long way without whatever medical issues arise.

I hope this helps some. Good luck.

Question: I am terrified to speak in public. I have done it a few times as an adult but only after having a bunch of drinks to calm down or lose my fear. I have to give a conference presentation in a month and I am terrified, and since I don't think getting half cut before my presentation would win me any points with my supervisors. I have to figure out a way to do this sober. I've got 36 days. What do I do?

Jill Palmer Says...:

Public speaking is one of the most common fears. It's probably true that everyone else speaking at the conference is also fearful to some degree. What's the fear about? People won't like you? You'll mess up and embarrass yourself? You'll freeze? Whatever the fear is, the goal is to stop your adrenaline from flowing too much so you can keep your wits about you. The fastest way to control adrenaline is deep breaths. I would recommend practicing your presentation in front of friends or coworkers so you are more confident with the material and potential questions that might come up. I would also practice deep breathing so you get good at it before the conference. Deep breathing happens from your diaphragm and not your chest.

We're good at what we practice doing. If you can do mini - public speaking engagements before the conference, you'll get better at managing the fear. Make sense?

I wish you the best of luck!

Question: How do I deal with loud noises when I am feeling very anxious. When I am having a bad day a door slam down the hall or a loud motorcycle or even someone laughing loudly suddenly can almost drive me crazy, like for real crazy...not regular anxiety crazy lol...! It's a big issue for me. Is there any way I can minimize the effect loud noises have on me? I don't expect that there is but I am just asking in case you can think of something that  have not.

Jill Palmer Says...:

I'm not sure what you've already tried or thought of so I will tell you what I can think of. Since you can't really control loud noises around you, I would first notice when you are in this type of mood. Having the awareness of it is the first step. Once you notice you are in this type of mood, I would take a bunch of deep breaths on a regular basis to keep your frustrations at bay. Once you hear noises that bother you, I suggest you either close your eyes and breath deeply or give yourself a time out and go to a quiet place to breath deeply. The goal of the breathing is to keep your adrenaline from flowing out of control.

Meditation is a good practice for many reasons including this one. Mediation teaches you to not be distracted by what is going on around you. Being able to calm your brain and focus on yourself would help in these types of situations.

I also suggest the basics of general care like getting 7 to 8 hours of sleep, eating well and exercise. Those 3 things work wonders in every day life.

Question: Hi Jill, I have a friend who needs guidance regarding social anxiety disorder. She is a really nice lady and is looking for somebody to talk to (on the phone). In particular she is looking for a Christian guide, counselor or sponsor and a 12 Step background would also help. Do you do that, or do you know anybody who does? Thanks in advance.

Jill Palmer Says...:

Is she looking for weekly therapy or someone to just talk to one time? Is her social anxiety preventing her from driving to a therapy session in her city? There are many online links to find a therapist in her area. Different therapist profiles might say whether they do phone sessions or whether they specialize in social anxiety. You can try "Psychology Today" or "Good Therapy" for therapists in her area. I think face to face sessions for social anxiety are very helpful.

Question: I accepted a new job in London in Dec. We decided it was too tough on the kids to bring them out in the middle of the school year so we decided that I would go first and get us all settled over there and the rest of the family would join us after the school year ended. I am currently working 3 weeks on and 1 week off back at home with the family. The hours and stress of the new position are considerable and there is substantial European travel as well as the twice a month Trans-Atlantic flights. Most days I leave my hotel room before 8 and if I’m back by 9 at night I count myself lucky. I have started to have frequent and reoccurring headaches, twisting feelings in my stomach and I will sometimes feel my pulse just racing for no reason at all. I feel stressed all the time and it is interfering with my abilities to think clearly and perform to an acceptable standard on the job. I also have a real nagging worry that I am making a big mistake with this new job and that my family is going to suffer some terrible fate from my selfish need to get ahead at work. I am starting to wonder if the way I am feeling all the time is not caused by normal job stress but maybe instead I am getting some sort of mental illness. I really don’t feel well psychologically. What worries me the most is that my feelings of stress don’t really abate when I am on my weekly vacation periods once a month back home with the family. I am normally able to turn work off when home with my wife and kids but these last few weeks I still have the nervous feeling in my stomach even when I am supposed to be feeling relaxed. How can I know if the way I am feeling is normal due to increased job stress related to a new position or if is caused by something deeper that is wrong with my mental health?

Jill Palmer Says...:

It sounds like your stress level is extremely high!! I'm not surprised that you're having physical symptoms with everything you have going on. The top 3 stressors are a change in job, a move and a change in relationship. You are doing all 3 of these at the same time (you aren't changing your relationship but you are apart most of the time which is a change) so I'm not surprised you are experiencing high levels of stress and anxiety. I'm not sure what "normal" is but I would expect an elevated level of stress, depression and anxiety in your situation.

If you choose to see a therapist, you could learn relaxation techniques, various coping skills, and anxiety reducing techniques to make the stress and anxiety more manageable. It might bring you some relief so you can enjoy more of your week off and give you the confidence that you can make it through this rough time. It might also be helpful to talk to someone about the choice to move the family to lower any guilt or regret. You'll want to get the anxiety under control so you don't feel the panicky feelings you seem to get.

I would continue to pay attention to how you are dealing with all of the stress. It seems overwhelming from my perception but some of this might be alleviated as soon as your family moves in with you. I wouldn't assume there is anything wrong with your mental health in general unless these symptoms continue long after your family is settled.

I wish you and your family the best. I hope everything settles down for you soon.