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Was it Trump or Just a Bad Trip?: Anxiety Begets Anxiety

answered 02:53 PM EST, Thu March 08, 2018
Hi Dr. Schultz,

I don't know if you're still answering questions on this site, but I ran across an excellent and empathetic response you wrote to someone three years ago and thought I might as well try... life is difficult for me right now, and I am seeking help wherever I can find it.

I am a 34-year-old woman who has suffered from occasional bouts of depression and low-grade anxiety my whole life. However, besides a year or so on Prozac after a close friend passed away, I've been able to lead a successful, healthy life without medication. That all changed when I took mushrooms with my friends this past March. I had done shrooms at least four, possibly five, times before, and had had either pleasant or negligible experiences. This time was different. I had extreme anxiety to the point where I feared I was losing my mind, and ever since then, I have suffered debilitating panic attacks and anxiety. I had to deplane an aircraft - I've never had a fear of flying - and see a psychiatrist, who prescribed me Gabapentin. However, while the Gaba does help if I feel a panic attack coming on, it ironically increases my anxiety since I fear long-term side effects and don't want to be reliant on a medication to (barely) get through my day-to-day life. Everything has changed for me. I've always been a bit of a hypochondriac, but now I am devastated by any negative change in my health. For example, last night I went dancing with friends, and my ears have been ringing ever since, and I am currently battling panic over the possibility that I sustained permanent hearing loss (the ringing has never lasted this long in the past). I get anxiety before social events and have a very hard time motivating myself to get up and get ready in the mornings. Things that used to give me pleasure no longer do, which I know is a sign of depression (when I'm not battling high anxiety, I often feel empty inside). I went on a retreat to Guatemala this summer and bought some herbal pills with valerian root in them, and I now have to take them almost every night to sleep. I hate that I've gotten to a point in life where I am taking something or a combination of somethings every day just to survive. And when I DO feel normal, the mere thought, "Hey, I feel normal!" makes me panicky because I remember that most of the time, I'm battling anxiety. It's a vicious cycle.

The election has made everything ten times worse. At least in the past, my issues were my issues, but I felt confident that our country was moving in the direction of progress. Now I feel like my security blanket has been yanked away; not only do I not trust myself, I don't trust the world I live in. I used to be a very upbeat, trusting, and generally optimistic person, but now I feel this underlying gloom and doom that dominates my waking hours. I don't know where to turn for comfort. Talking about it with my friends and family often makes the anxiety worse.

Do you think it's possible I suffered permanent neurobiological damage on my mushrooms "trip" and that I will never return to my old self? If so, or even if not, do you have advice for how I can manage my debilitating anxiety without having to be drugged for the rest of my life? I feel like I've lost myself.

Thanks so much, and happy holidays,
Sabrina

Dr. Richard Schultz Says...

Hello Sabrina, and thank you very much for your question.

 

After an extended hiatus from Choose Help, I just recently returned and found your inquiry waiting for me. I do apologize for this extremely delayed reply, and am quite curious to know how things progressed for you in regard to the symptoms of depression and anxiety you were experiencing in December of 2016.

Coincidentally, that was the precise point in history when a GREAT many of us in the United States, and around the globe, “lost our security blanket.” Understandably, it sounds like for you the administration change compounded an already waning sense of general safety and security in the world. It challenged and violated many of your deeply held beliefs and expectations about yourself, your life, and your future. This is the way trauma may impact and shape us, and it may take the form of a great many different direct and vicarious experiences.

From your description, it seems as if your most recent mushroom trip played a similar role in your life. The experience shocked and terrified you, as psychedelic journeys have the potential to do, and it seemingly triggered a severe panic attack. You did not mention any history of such acute episodes, so I will assume it was your first of that magnitude. The feeling of “going crazy,” combined with many other distressing physiological and cognitive phenomena, all hallmarks of panic, is likely to have awakened and/or redefined, at least temporarily, your previous repertoire of distressing symptoms.

Thereafter, it is not surprising that you became increasingly vigilant to changes in your anxiety level, and your functioning, with a particular focus on physiological effects (given the nature of panic and your own prior vulnerability to health-related anxiety). As vigilance and increased focus on symptoms tends to intensify the subjective experience of those symptoms, and movement away from distress-inducing stimuli is negatively reinforcing (meaning that avoidance will continue and broaden), your anxiety worsened.

In addition, your pre-existing beliefs, judgments and fears about the potential risks of medication were heightened when your condition necessitated that you actually engage in such treatment. This step may have also eroded your self-confidence as you came to see yourself as now “reliant” on such medication. This is not to say that you somehow erred in taking psychotropic medication. On the contrary, it sounds like a smart decision. Doing so, however, consequently triggered anxious beliefs and further heightened your vigilance to physiological and/or psychological shifts.

In summary, the unpleasant unfolding of your symptoms across time perfectly illustrates the “vicious cycle” of anxiety. As is quite common, the narrowing of your activities caused by the negative reinforcement loop of avoidance can have easily triggered depressive beliefs about yourself and your life. You saw how your behavior repertoire had narrowed, perhaps compared this to your previous functioning, and became highly self-critical and despondent. This is often how depression arises and worsens as a counterpart to anxiety.

Although research has offered many compelling models of epigenetic, neuroanatomical, and neurobiological bases and correlates for panic disorder and anxiety, none have thus far yielded results which suggest causal damage in any of these areas. The same is true for psilocybin. In fact, increasing clinical and scientific attention is being paid to the potentially therapeutic effects of mushrooms in treating depression and anxiety.

In terms of “getting your life back,” I am guessing that there is a very good chance you have already done so by now, given the significant interval between your writing to me, and this reply. If so, please do write back and let me know what you have done to effect this change. I am sure that a great many Choose Help readers will be very grateful for your explanation, as will I. If you have not yet fully recovered from this distressing episode, Sabrina, I would highly recommend that you seek out an excellent therapist with whom to consult. This professional would ideally have a significant grounding in the treatment of panic and other anxiety disorders, and will also have a strong grounding in cognitive-behavioral therapeutic technique. As you have clearly read other of my opinions on this site, you will find more detailed criteria for finding a qualified therapist among those responses. You will also find some guidance on how to begin to reverse the constricting effects anxiety and depression have had on your life. I wish you strength and peace on this journey, Sabrina.

Sincerely,

Richard E. Schultz, Ph.D.

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