Treatment Options for Panic Disorder / Anxiety
Hey everyone - I usually come here for career advice, but I wanted to get some thoughts on mental health treatment options. I feel pretty stuck careerwise after a decade-long battle with anxiety and am looking for options to get back on my feet.
For the past ~10 years, I’ve been dealing with generalized anxiety and panic disorder. College was rough due to unmanaged symptoms, and I only got diagnosed and started receiving help around my junior year. I managed to get by with intermittent therapy and a medication called propranolol (helped a lot with situational anxiety), but things became much harder when I entered the workforce. I had to leave my IB analyst program after developing uncontrollable panic attacks. Even casual social situations like dinners with my close friends became difficult because I was terrified of triggering panic. I decided to quit IB and took a fully remote job I wasn’t really excited about just to stay unemployed while trying to get a handle on my mental state.
That was two years ago. Since then, I’ve been in and out of therapy but haven’t found it very effective. About a year and a half ago, I saw a psychiatrist for the first time and was prescribed Lexapro 10mg, which did help reduce my symptoms. However, I now feel constantly fatigued, and just don't feel 100%. I could easily sleep 10+ hours and often feel the need to nap during the day. Mentally, I also feel foggy and like my head is in a cloud much of the time - hard to explain but sounds like this is not an uncommon side effect for people on SSRIs.
I’m unsure what steps to take next. Has anyone had success with other medication options (or non pharmaceutical treatments)? I keep hearing therapy is crucial, but I haven’t had much luck with it yet. Ultimately I'm trying to get back into a higher performing investment professional role after going back to school (exploring MBA reset given career turbulence), and I want to make sure I'm not held back by mental health issues.
I’m based in NYC, so any recommendations for providers or resources in the area would be hugely appreciated.
pm me
could you share your advice here please? I'd love to see it too.
pm me lol
Have you tried switching up meds? Lexapro works great for me but ultimately not for everyone. A lot of other meds you can try to see better results. Would also recommend the therapy in conjunction with the meds. You may not feel like it’s helping but my therapist has helped me a ton to stop me from crashing out over dumb shit, although I have some other issues along with my anxiety so may not be an apples to apples comparison.
Thanks man, appreciate the comment. Out of curiosity, are you on 10mg or 20mg with Lexapro? My psych wants to increase my dose to 20mg but I've been reluctant - if I'm getting side effects at 10mg I'm guessing that 20mg will be worse.
Agree with you on therapy. I've been working with my current one for a while, just not confident that I'm getting a ton of value out of it (most of my improvements came after taking Lexapro).
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Hey man, I also struggle with this.
I'd love to hear more about various options from other people.
For me personally, smoking weed daily helps, but then my memory gets pretty bad, to the extent that I start forgetting words. So, I take breaks from smoking.
I was also considering just having a drink before important calls, since I don't get drunk but drinking makes me relaxed and not anxious, but this wouldn't work in person since people could probably smell alcohol.
I have agoraphobia and have been suffering from it for a couple of years. It's not an easy fight, but it gets better with time. I have suffered from panic and anxiety for over a decade, and just recently (approx. 2 years ago) got prescribed escitalopram (I believe it's lexapro) as well. If I can give you one advice, it's probably the following:
Stay away from Benzodiazepines and try out different forms of therapy. What I have found to be helpful is consulting a respiratory therapist, but it may be something different for you. At the end of the day, however, taking on something more challenging in your words, "a higher performing investment professional role", will come with stress and exposure to situations that your mental health may not like. For me, stress and lack of sleep are a big accelerator for anxiety and panic. But not something you will not be able to do. I would start slowly and get accustomed to the stress, and then make the ultimate decision to lean into the job or quit if its too much.
As already said in this comment section, exposing yourself to uncomfortable situations will help you in the future. That's mainly what I think should be done with your "new" job.
I’ll write an in detail reply to your post once I get home but I do feel the need to comment immediately - you need to get off the meds man. This is a topic that is very close to my heart having been extensively fucked over by modern psychiatry and was put on various SSRIs, benzos, antipsychotics, etc the whole nine yards. I’ve been med free for years now and I’ve developed a rigorous regimen to stay at peak performance. Will write a long post once off work.
Okay so I think I’m coming down with the flu right now but I’ll try my best here:
Address past trauma and understand who you are better: After you do everything mentioned above, you need to acknowledge that you have been damaged by things that have taken place in the past - you need to be self aware enough to know what these are how to actively work against these.
Finally please taper off the Lexapro and don’t quit cold turkey - you’re setting yourself up for withdrawal if you do that which your psychiatrist will lie to you about as your underlying condition resurfacing - this is bullshit. I hope you make it man - I did and I’m praying for you.
Exposure therapy is the ony way to deal with this. Pills do not work, period they only mask symptoms which will cause an esclation in the symptom intensity over time.
Unfortunately the modern auspices of psychology dictate that behavior and exposure based medical solutions are not the first line of attack. Rather doctors would prefer to give you meds and "monitor" the situation.
A few suggestions.
Do you consume caffeine? If so, cut it out.
Second, do you 'goon' too much? Ya know, too much crankin it? If so, stop. It's terrible for your body and your hormones. Will make you skidish and effeminate.
Third, address past trauma. Do you have narcissistic parents? Are you a people pleaser? Take an honest look at your past and the people you currently surround yourself with.
Genuinely one of the dumbest things I have read on this website.
Jerking off does not mess with your hormones, make you skidish, or make you effeminate. Good lord, dude.
This is a really solid point - caffeine doesn’t affect everyone the same way, and for people who are sensitive it can definitely trigger that adrenaline/flight-or-flight spiral you described. A lot of people assume more caffeine = more focus, when in reality it can just make anxiety worse.
There are new things like trycaffio - a bottle that microdoses caffeine from whatever drink you put in - designed to keep you steady without spiking your system. For people who don’t want to cut caffeine completely but also don’t want to feel wired or anxious, that kind of approach seems like a good middle ground.
Hi. I would try Buspirone. I started on it in college and it has been a godsend for general anxiety. It isn't an SSRI or a Benzo (good) and I haven't noticed any side affects. Talk to a doctor and specifically ask for it over an SSRI.
I also used propranolol for a time. Didn't help me much.
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Talking to a LLM chatbot when you have anxiety is so fucking dystopian
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I’m so sorry to hear that you’re going through this.
Sorry for the essay but I want to be as comprehensive as possible here. Remember that I am not a physician and this is not medical advice, just some general advice to point you in the right direction.
Managing panic/anxiety disorder can be extremely challenging. I’ve been through it all before and can attest to this.
First steps I think would be making sure you have the right therapist and psychiatrist. This is way easier said than done; I went through about 2 therapists im the span of a couple years before, and multiple doctors (psychiatrist as in is an official) MD before I found one that helped manage my condition correctly and with care.
Psychology Today is very useful for this, as is ensuring the professional is experienced as possible and has expertise in what you’re going through specifically.
Propranolol (as needed or daily) has been useful for social and general anxiety, as well as hydroxyzine for me personally. Additionally, I’d recommend having any other mental illnesses that may have not been picked up previously evaluated just in case something was missed.
Medications have come a long way and are a lifeline for people with mental health disorders. SSRIs are usually the first line treatment for anxiety/panic disorders as well as depression. They are not a one size fits all class of drugs; many people go through various versions of the drugs before they find ones that work effectively with minimal side effects. Other medications in conjunction with them may also be explored by your doctor if necessary. Unfortunately, this can be like throwing darts at a chalkboard but it will work out with patience. Last thought on these, never skip a dose if you’re gonna drink or take any type of drug on them.
As another poster mentioned, I’d take caution with benzodiazepines. They can be absolutely lifesaving for suddenly onsetting panic attacks. However, you have to be careful that you only use them when absolutely necessary. A drug like Xanax has a high dependency risk, and although generally safer, Ativan does have a risk as well. The most important thing is to not start taking them eg to fall asleep, and then fall into the trap of taking them regularly because it’s a quick fix.
Therapy is crucial, as well as is having a functional support system (friends and family you can lean on in times of hardship). My quality of life has greatly improved since finding a great therapist who I see regularly. Online support groups also exist—-I don’t have personal experience here but testimonies from others affirm this. WSO can be helpful, but is not the absolute gold standard lmao.
Sleep is another crucial one, depending on the severity of the disorder, even a few consecutive nights of poor sleep can lead to a reemergence of symptoms. A wind down routine at night is helpful, as is abstaining from screens at least an hour before bed. There are many other factors, and I recommend checking out Andrew Huberman’s content on this topic. Limiting alcohol intake is also very important, as is getting regular exercise sunlight. Diet is also completely crucial, and diets like keto have shown to be very effective in alleviating the severity of symptoms for those with mental illness.
Lastly, a word of caution on supplements; things like Omega 3s can be helpful—-they support brain health and have evidence which supports a synergy with SSRIs—- but I would have any other things beside basic vitamins approved by a doctor. This caused a complete disaster for me (one of my posts) so please for the love of god be careful here.
One quick note is that for more information with trusted sources, I like resources online like Dr. Tracey Marks and Andrew Huberman as mentioned before (both have strong medical backgrounds). Stay away from other gurus with no official training or licensure if you can.
I’d like to end off by saying that things can and will get better with time and patience. It can seem like it’s insurmountable or will never get better, but that’s far from the case. People have mentioned that this can limit the extent of your career and seniority, but apart from jobs which are extremely stressful or don’t allow you to get proper rest, I strongly disagree with this sentiment. Keep fighting and you will feel better, ultimately I think that even though you need to take so many more steps to manage this, it can make you a stronger and more disciplined person.
Best of luck OP, and feel free to PM me if you’d like.
I’m sorry to hear that you’re going through this.
Sorry for the essay but I want to be as comprehensive as possible here. Remember that I am not a physician and this is not medical advice, just some general advice to point you in the right direction.
Managing panic/anxiety disorder can be extremely challenging. I’ve been through it all before and can attest to this.
First steps I think would be making sure you have the right therapist and psychiatrist. This is way easier said than done; I went through about 2 therapists im the span of a couple years before, and multiple doctors (psychiatrist as in is an official) MD before I found one that helped manage my condition correctly and with care.
Psychology Today is very useful for this, as is ensuring the professional is experienced as possible and has expertise in what you’re going through specifically.
Propranolol (as needed or daily) has been useful for social and general anxiety, as well as hydroxyzine for me personally. Additionally, I’d recommend having any other mental illnesses that may have not been picked up previously evaluated just in case something was missed.
Medications have come a long way and are a lifeline for people with mental health disorders. SSRIs are usually the first line treatment for anxiety/panic disorders as well as depression. They are not a one size fits all class of drugs; many people go through various versions of the drugs before they find ones that work effectively with minimal side effects. Other medications in conjunction with them may also be explored by your doctor if necessary. Unfortunately, this can be like throwing darts at a chalkboard but it will work out with patience. Last thought on these, never skip a dose if you’re gonna drink or take any type of drug on them.
As another poster mentioned, I’d take caution with benzodiazepines. They can be absolutely lifesaving for suddenly onsetting panic attacks. However, you have to be careful that you only use them when absolutely necessary. A drug like Xanax has a high dependency risk, and although generally safer, Ativan does have a risk as well. The most important thing is to not start taking them eg to fall asleep, and then fall into the trap of taking them regularly because it’s a quick fix.
Therapy is crucial, as well as is having a functional support system (friends and family you can lean on in times of hardship). My quality of life has greatly improved since finding a great therapist who I see regularly. Online support groups also exist—-I don’t have personal experience here but testimonies from others affirm this. WSO can be helpful, but is not the absolute gold standard lmao.
Sleep is another crucial one, depending on the severity of the disorder, even a few consecutive nights of poor sleep can lead to a reemergence of symptoms. A wind down routine at night is helpful, as is abstaining from screens at least an hour before bed. There are many other factors, and I recommend checking out Andrew Huberman’s content on this topic. Limiting alcohol intake is also very important, as is getting regular exercise sunlight. Diet is also completely crucial, and diets like keto have shown to be very effective in alleviating the severity of symptoms for those with mental illness.
Lastly, a word of caution on supplements; things like Omega 3s can be helpful—-they support brain health and have evidence which supports a synergy with SSRIs—- but I would have any other things beside basic vitamins approved by a doctor. This caused a complete disaster for me (one of my posts) so please for the love of god be careful here.
One quick note is that for more information with trusted sources, I like resources online like Dr. Tracey Marks and Andrew Huberman as mentioned before (both have strong medical backgrounds). Stay away from other gurus with no official training or licensure if you can.
I’d like to end off by saying that things can and will get better with time and patience. It can seem like it’s insurmountable or will never get better, but that’s far from the case. People have mentioned that this can limit the extent of your career and seniority, but apart from jobs which are extremely stressful or don’t allow you to get proper rest, I strongly disagree with this sentiment. Keep fighting and you will feel better, ultimately I think that even though you need to take so many more steps to manage this, it can make you a stronger and more disciplined person.
Best of luck OP, and feel free to PM me if you’d like.
PM me!
Stop drinking coffee, all caffeine + nicotine. Also look out for being hungover on days where you have to present / deal with those instances that cause the attacks. I found caffeine almost entirely sourced this disorder for me If you understand how caffeine works in your body it is literally pumping adrenaline through your system, triggering your flight or fight response. Simply getting rid of caffeine could eliminate it entirely or make it more manageable so exposure therapy is more approachable. Our bodies metabolize caffeine differently as we get older and if you become sensitive to it caffeine can have psychoactive effects on you.
I'm in a customer facing role, and I found in these settings I would freeze up, everything would slow down and I straight up couldn't talk because my heart was racing so much from the large amounts of caffeine I consumed. I had no idea what was going on until I started noticing the correlation when I drank caffeine, even little amounts (100mgs). To hammer this point on home further, I also train in a combat sport, and our coaches do not let us drink any kind of energy drinks/pre-workout. You'll gas so much quicker and won't be able to control your heart rate.
I drill into these different examples as I don't see a lot of people talking about the impacts of caffeine on some people. And before you go and self-diagnose / prescribe yourself with something in search for answers, seriously consider taking out all stimulants. It just may be the culprit.
The older I get, the more this applies. Even if I don’t feel “hungover,” my brain feels noticeably slower, I’m less motivated, and I’m just generally more down on days after drinking anything more than a glass of wine with dinner.
This is a really solid point - caffeine doesn’t affect everyone the same way, and for people who are sensitive it can definitely trigger that adrenaline/flight-or-flight spiral you described. A lot of people assume more caffeine = more focus, when in reality it can just make anxiety worse.
There are new things like trycaffio - a bottle that microdoses caffeine from whatever drink you put in - designed to keep you steady without spiking your system. For people who don’t want to cut caffeine completely but also don’t want to feel wired or anxious, that kind of approach seems like a good middle ground.
Uh...
"Olanzapine (brand name Zyprexa) is an atypical antipsychotic medication used to treat several mental and mood disorders, such as schizophrenia and bipolar disorder."
OP is having anxiety and a couple panic attacks. He isn't hearing voices.
Those are the on label uses. The off label uses have been documented to help with sleep and anxiety without the addiction attributes of benzos.
Results - Off-Label Use of Atypical Antipsychotics: An Update - NCBI Bookshelf
"Use of atypical antipsychotics for the following off-label conditions has been documented in the scientific literature: attention-deficit hyperactivity disorder (ADHD), anxiety, dementia in elderly patients, depression, eating disorders, insomnia, obsessive compulsive disorder, personality disorder, post-traumatic stress disorder (PTSD), substance use disorders, and Tourette's syndrome.
Risperidone, quetiapine, and olanzapine are the most common atypicals prescribed for off-label use."
Feel free to PM me. I work in the field.
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