Next Came the Panic Attacks….

Let me start off this post with a little primer on just what panic attacks are and why many women with postpartum depression (PPD) may experience these frightening and debilitating episodes.   You will hear me say this over and over again:  Knowledge about PPD before having the baby is so important and parents-to-be should never think they will be immune from it and avoid reading about it.   Had I known that I was experiencing PPD, which was temporary,  I could’ve avoided the panic attacks from happening.

PPD usually occurs by itself, though it may also be accompanied by postpartum anxiety (with or without panic attacks). Women with a personal and/or family history of anxiety and/or panic disorders are at risk for developing postpartum anxiety.    Some anxiety/concern about your baby is normal, especially if this is your first and/or only child, and your fear has to do with visitors picking up the baby and either not holding her right or passing on their germs.   But some women are, like me, prone to anxiety and worrying.  These women who, as first-time mothers, may have anxieties about their mothering capabilities and worry constantly about whether the baby is taking in enough milk or formula, something’s wrong with the baby if there is no bowel movement for 1-2 days, the baby fails to reach certain developmental milestones in the usual timeframes (e.g., smile, laugh, react to your voice), the baby cries too little or too much, etc.  Many of these anxieties stem from the fact that this is your first, and perhaps only, shot at parenthood and you have no previous experience to compare this to.  I will go into more detail in my next post on IVF as a contributing factor to anxiety levels and PPD.

Strangely enough, before my insomnia started, I didn’t feel particularly anxious and I thought I was handling everything pretty well. It was after my insomnia kicked in that my panic attacks began. I thought I had a handle on the mothering thing, even my nightmarish first few postpartum days. Sure, I periodically checked on her at night to make sure she was breathing, and I was concerned I wasn’t feeding the baby enough, her poops were normal, she was going to get sick for the very first time with a cold, and I would not be able to find the right care provider to enable me to go back to work.  But there’s only so much anxiety my body was willing to take, especially since my body was already physically weak to begin with.  The following chain of events contributed toward my growing anxiety until my body gave way to panic attacks:

• traumatic delivery experience that resulted in a partial hysterectomy resulting in loss of ability to have any more children
• negative experience in the hospital–e.g., constant sleep interruptions in the hospital, constant moving from one room to another and changes in hospital staff, multiple attempts to replace IVs in my arms/hands, food deprivation (I only had about 2 meals the whole week I was there….otherwise what I had were ice cubes for the most part, plus an occasional broth or jello), below-par treatment of certain hospital staff, searing pain (felt like someone was burning me) in my abdomen that came & went for 2 days after the surgery
• constant sleep interruptions from the noises the baby made throughout the night, plus night feedings
• baby’s bad case of eczema and cradle cap
• baby’s one week colic
• anxiety from not being able to fall asleep when my insomnia kicked in

What are panic attacks?  Panic attacks are intense and debilitating episodes of anxiety accompanied by physical symptoms often occurring out of the blue, seemingly with no reason at all.  Frequency and duration of attacks will vary. They may occur as often as several times a day and last a few minutes. I experienced panic attacks at least 3 times daily for several weeks (Feb 13 to Mar 19) – at sunset, at bedtime and upon awakening. It scares me to think that this would’ve gone on for many more weeks or even months, had I not sought treatment when I did.

According to the Diagnostic Manual of Psychiatric Disorders-IV (DSM-IV), a panic attack is a period of intense fear or discomfort, in which four or more of the following, mostly physical, symptoms develop abruptly and reach a peak within 10 minutes and may last longer:

• Palpitations (racing/pounding heart)
• Trembling or shaking body and/or hands
• Numbness, tingling and/or coldness in the extremities
• Feeling chilled, having hot flashes, sweating, waking up in a sweat, sweaty hands and/or feet
• Nausea, stomach pain and/or diarrhea
• Feeling dizzy, shaky, unsteady, light-headed or faint
• Chest pain or discomfort
• Shortness of breath or feeling as if you’re choking or about to suffocate
• Feeling like you’re losing control and/or going crazy
• Feeling trapped
• Feeling agoraphobic (fear of going outside)
• Feeling like you’re going to die

Quite paradoxically, the fear of having more panic attacks brings them on – it becomes a vicious cycle.  Panic attacks are such a frightening and debilitating experience that it is only natural that those who suffer from them will feel apprehensive and on edge about the onset of the next attack.  I was caught in a vicious cycle of fear of not being able to sleep, which drove my anxiety up to a level my body obviously couldn’t handle, which then triggered my panic attacks, which caused me to fear trying to go to sleep, and so on and so forth.  Did I mention that my panic attacks would even happen while I was sleeping?!  That’s how bad it was.

My Experience

As I mentioned in my last post, I feared I would depend on Ambien to sleep for the rest of my life.  It was that fear that dragged me into a cycle of fear and despair, which developed into full-blown panic attacks that caused me to shake, my arms to go numb and my body to go so cold that a thick blanket wrapped around me didn’t help. I would wake up in the morning with my feet and hands all in a sweat but my body freezing cold. I couldn’t bear the thought I was going to be like this for the rest of my life.  I felt so despondent that I could not see the light at the end of the tunnel. I had nowhere to turn, no one to talk to that understood. If at that point I didn’t receive the help that I ended up receiving in the form of Paxil (and Xanax), I don’t doubt that I would’ve wanted to die to escape the torture I was going through on a daily basis.

February 13, 2005:   I tried to substitute Ambien with Tylenol PM on the advice of one of the nurses at the OB/GYN office. Thinking that I was saved from dependency on Ambien, I was thrilled and relieved at having stumbled on such a simple OTC remedy. When I took the Tylenol PM and it didn’t help me sleep at all, but in fact made me feel worse…..I had trouble breathing and my head started to spin…..I had my very first panic attack. I was frantic. I didn’t know what to do. At that point, I was totally at my wits’ end. I waited as long as I could before paging my OB/GYN. I knew I should only do that for emergencies, but I didn’t know what else to do. I needed someone to talk to. He didn’t sound pleased at all when I explained what had happened. I explained that I was still experiencing insomnia and experiencing what seemed to be a panic attack because I was out of Ambien and Tylenol PM didn’t work for me. I asked if he could prescribe me some more Ambien. He said “I’m afraid not. I can no longer help you. You need to see your regular doctor.” Since I was looking for a new doctor, he referred me to his own doctor. Right at 9:00 that morning, I called to make an appointment with that doctor. He had an opening for me 2 days later. Two days is not a really long time in a normal person’s perspective, but from a panic-stricken person’s perspective, it felt like an eternity. I had to force myself to get through the next 2 days without being able to consult with anyone. It was such an awful experience….quite beyond words.

February 15, 2005:  I told this new doctor what was going on (reiterating the fact that I had had a baby on December 10th, I had my uterus removed on December 13th, and a month afterwards, I started experiencing insomnia and have been on Ambien for the past 2 weeks). He prescribed me more Ambien. I had another panic attack that night. I felt so helpless and needed to talk to someone so badly that I paged the doctor. I left a message for him, apologizing for feeling compelled to call him despite the fact that this was not a medical emergency. He did not call me back.

February 16, 2005:  The nurse called me back saying that the emergency number was for medical emergencies only. I explained what was going on and she scheduled another appointment for me that afternoon.  During that appointment, the doctor listened briefly to my symptoms and prescribed Paxil (anti-depressant) and Xanax (for the panic attacks). I told him I understood why he’d prescribe me an anti-anxiety medication like Xanax, but why Paxil? He explained that Paxil is a broad-spectrum medication that is prescribed for depression and anxiety, that there is such a fine-line separating the two and that anxiety is most oftentimes attributed to depression. He reassured me that the Paxil is not addictive but Xanax can be addictive so I had to take that only when I absolutely had to. He warned me that it would take at least 4 weeks before the Paxil would take effect. And let me tell you, the next 4 weeks felt like an eternity to me. It used to be that there weren’t enough hours in a day, with my main complaint being that time was flying by way too fast. Now each day crawled by as if there were 48 hours in a day instead of 24. It was tortuous. He had me take 12.5 mg of Paxil everyday for one week, at which point I would have to double the dosage and stay on it for several months.

Being that this is the first time in my life I was prescribed a medication to be taken for an indefinite period of time, and this meant I was on 3 medications at once, I felt more anxious than ever. It’s crazy that I’d go from never taking any drugs to taking three at once. But I was desperate to be back to my old self again.    I didn’t like the idea of being on 3 new drugs simultaneously, especially when they didn’t appear to have any immediate effects, they made me feel strange (not myself), and the doctor didn’t provide adequate explanation in terms of how he chose these and why.   It was shocking to see that I needed medication for so long.

Each day, I’d stand by a window, staring out at the snow (there was so much snow that winter!) and pleading for God to help me get through all this. I’d find myself running around just to keep busy and avoid the sensations I’d inevitably start experiencing each night, as the sun went down. I just wanted to shrivel up into a tiny ball and disappear. As night approached, in the back of my mind, there was dread that I would soon be trying to go to sleep. I’d start having a panic attack where coldness would creep down both arms, I’d have a tough time breathing, and my stomach would turn to knots. Very quickly the cold would take over my entire body and I would start shaking. I just wanted to tighten myself into a ball…anything to stay warm. We kept the house at a consistent 70 degrees all winter long to make sure the baby wasn’t ever cold. There were drafts by the couch where I’d sit to watch television, and to compensate, we kept a radiating heater there. But that didn’t help me much during my bouts of coldness. I’d be shaking with cold, even under a blanket and with my husband’s arms around my shoulders. One too many times, I gave him a miserable look and told him how scared I was that I didn’t know what was going on with me and I was afraid that I’d never get better. There would be tears in my eyes but I couldn’t cry. Most of the time, he didn’t know what to say. It was way after I had fully recovered from PPD that he finally admitted that he had feared I would never get well, never return to my old self, and never appreciate watching our daughter grow up.

March 19, 2005:  The Paxil kicked in and I was off the Ambien for good!  Hurray!

August 18th, 2005:    Initially, the doctor told me I’d be on the Paxil for 6 months. By the time August rolled around, I felt I could stop taking the medication. I asked my doctor about starting the weaning off process. He told me I should take my time. I told him I wanted to be off the medication by year end. He reduced my dosage back down to 12.5 mg.  You can imagine how happy I was!

March 18, 2006:   It ended up taking me about 7 months to get off the medication completely, after first halving the dosage and then taking the medication every other day to every 2 days and every 3 days.  During the weaning off process, I experienced what I thought had to be vertigo…the sensation of losing balance while walking and everytime I turned my head.  It was a weird feeling indeed and the main sign that I wasn’t ready to be completely off Paxil yet.  Finally, at the direction of my new doctor (I finally got up the nerve to drop my original doctor), I stopped taking it on March 18, 2006. She told me that Paxil taken at such long intervals and at such a low dosage was basically not taking any Paxil at all, and I should be able to stop taking it immediately. It is critical that you wean yourself off the medication in close consultation with your physician. Look what happened to Brooke Shields when she went off Paxil cold turkey. She suffered a major relapse.  So at a minimum, you should be taking your medication until you feel you’ve returned completely to your old self, and then taking as long as necessary to wean yourself off.

Seeking Treatment

A sign that you may need medication–but let the medical professional tell you so– is when your symptoms are so bad (e.g., inability to sleep or stay asleep for several weeks, panic attacks, loss of appetite, quick weight loss) that they get in the way of your day-to-day functioning and taking care of your baby properly.

If you’re not experiencing severe symptoms and you have adequate support, you can give a few sessions of therapy a try to see whether it alone will be sufficient. Of the many stories I read about, I was amazed at the number of women who were so ashamed at how they were coping so badly-and it didn’t help that they didn’t know they had PPD-that they endured their symptoms for many weeks, months or even over a year. Perhaps their PPD didn’t debilitate them to the point that they could no longer function. I don’t know about them, but my PPD was SO BAD, I felt my only option was to seek medical help immediately. In my situation, therapy was not a practical option. But I dreaded the thought of having to rely on any medication. In fact, just the thought of having to take 3 medications simultaneously for insomnia, depression and panic attacks-all for the first time-increased my anxiety even more. As soon as the medicine kicked in, my insomnia disappeared, I was able to return to work, smile, appreciate all that I used to enjoy before my PPD set in, able to go outside without feeling overwhelmed, and function near 100% on a day-to-day basis….all without having to see a therapist.

Since my condition required immediate intervention by way of medications (first Ambien, then Xanax and Paxil) to enable me to function day to day-otherwise, I’d be rolled up into a ball crippled both physically (panic attacks numbed my arms and legs, I couldn’t sleep at all) and mentally (my state of mind was on the verge of complete and utter collapse), I am obviously going to present the case for psychotropic medications. There will inevitably, and unfortunately, always be the naysayers and Doubting Toms of the world who are ever eager to attack a person’s position on a topic as hotly debated as meds versus no meds. Hey, all I can say to that is, more people should learn to mind their own business. It’s fine for people to think that doctors seem to automatically prescribe medication for everything. In a way, I believe that the statement is true from a general trend perspective, particularly with respect to children being treated with medication for not having enough attention span to sit still for a few minutes at a stretch. But that’s my own opinion and I keep that to myself, rather than preach it everywhere….a hum, Tom Cruise, are you listening???!!!   Without knowing another person’s situation-and only immediate family and the individual himself or herself (if they are mature adults) can really know what their personal situation is, and sometimes even parents don’t know or understand what is going on with their child-how can you claim to know what is right or wrong for someone else?

In Conclusion:

A word of advice from someone who has been through panic attacks (while suffering from PPD) to a mother who is currently suffering from them:   You WILL get through this with the right treatment.  Do not endure this on your own.  Get help now.  Do not wait.  Do not worry about what other people may think if you take medication to help you be well again.  It’s not their business.  It’s your life and you must take control of it, so you can return to your old self and enjoy your baby.