How do you others handle stress and anxiety?

[wylidas]

Hey everyone. I wanted to start a thread that might help myself and others learn how to deal and cope with stress and anxiety in a healthy way.

My story is long, but the abbreviated version is that I had never experienced debilitating anxiety and panic prior to 2008, shortly after I started my consistent regimen of Epzicom/Reyataz/Norvir. Prior to that, I had a 'speedy' personality and was a go-getter, able to drink caffeine and exercise with little issue. Once I started having anxiety and panic in 2008, I had to cut caffeine in all forms out of my life and I stopped exercising due to the response my body would have in revving my symptoms up.  I have always wondered if it was the HIV or the meds causing this, and I learned to live with it and even control the panic over time.

In early 2011, that all changed when I was in a bad relationship and started coming to terms with some personal issues that had been lying dormant for years. I turned to Ativan as a solution, and I got hooked, taking it daily for 8 months. I came off the drug in September 2011, and I will never take another benzo again as long as I live, but I still need help coping with stress.

I have realized through this ordeal that (for years) I have been coping with anxiety by having casual sex (which led to my HIV status), drugs (when I was younger), food (overeating where I gained about 30 lbs in 2007 which I have now lost thank god), and a host of other things that ultimately weren't healthy and were just distractions from the real work I have been needing to do. So, in a big way, this ativan nightmare has been a blessing in disguise as it has allowed me to start working on myself unlike anything I have ever worked on before.

What do others think about the possibility that these meds or HIV cause increased anxiety, and how do you all deal with it? I have started seeing a therapist, and radically changed my diet, which has done wonders, but I am still lacking the exercise portion of the equation. I am only 33 and feel like an old man sometimes. Any others care to chime in?

[wylidas]

Bueller? Bueller?

[BT65]

I would think that maybe the more you get things talked out with the therapist you may be able to add exercise back in little by little.  Are you having anxiety because you started meds you have to take for the rest of your life?  Because I know that can be overwhelming.  And when we start to deal with our demons, that can also freak people out.

Give yourself time with this therapist.  There are also antidepressants that can work for anxiety.  You may want a referral to a psychiatrist.  Just something to think about. 

Be patient and hang in there!

[Hellraiser]

Anxiety is not always the easiest thing to nail down.  Where your anxiety is coming from could be from the realization of your own mortality (which your hiv infection and the subsequent drugs you must take on a daily basis are a constant reminder of), or the stigma associated with having HIV (if you are not completely open with your status), or a host of other things.

I personally was not a very anxious person but came to the realization that I was beginning to stress out a lot more over very minor things after I had been on Atripla for a while.  Unfortunately Sustiva, which is one of the components of Atripla, has CNS side effects which are well documented.  This makes me think that is the culprit and so a med change is happening in the near future for me.

The point here is you (or you and a qualified therapist) need to figure out what the cause of this is.

[wylidas]

Hellraiser- Yes, I would say the Sustiva component of your regimen is definitely making matters worse. I took it in 2006 for 4 weeks and hated every moment of it. So it's possible that a med change may be in order for you. I responded to another reply of yours on another thread, but I wanted to tell you that Complera has nothing like the side effects of Atripla. I am really liking it so far. I see you're starting it soon, so I wish you lots of good luck with it!

BT65- Thanks for the suggestions. I think dealing with our mortality and taking meds the rest of our lives is a huge stressor. I am not sure what to do about it to accept it more. I guess make peace sooner with the fact that we will die one day. Because we all do. It could be tomorrow, or 50 years from now. It's just so scary feeling frightened of everything all the time. Anxiety is a real b****.

[MoMorrison]

Well my story with anxiety began in August on 2011. At that time I was aware of my positive diagnosis (found out January 2011). I had always been a happy go lucky kind of guy. Care free spirit and the lot. One August Saturday, I was getting ready to go to a birthday dinner for my cousin. I was fine until the drive over there. I started feeling like I was not getting enough air in my lungs and I was sure that I was going to stop breathing all together. The sensation was so horrifying that by the time we arrived at the restaurant, I was having a full blown panic attack. I had never experienced anything like it so naturally I was afraid. I was in so much fear that I could not stay at the dinner. I drove home in the state of panic that I was in praying the whole time that God please be with me and let me get home safely. I got home and thought, well I'm gonna sleep it off and hopefully I will be better tomorrow. To shorten the story, I have had sporadic anxiety episodes since that August day. I try my best to not let it effect me but it can be a real pain in the ass at times. I thought that the HIV had something to do with it as well. I am seeing a therapist and am taking 1mg ativan daily. My therapist knows that I don't really wanna take the ativan and he asked if I can give it a chance and along with therapy I can eventually wean off the ativan. I said this before in my other threads, I would be peachy keen if it weren't for this damn anxiety. I miss being myself. I wish there was a all natural easy way to get rid of it. I know getting to that point is gonna take some hard work and at this point I am willing to do whatever it takes because I don't want anxiety taking over my life. I feel you wylidas, I really do! Only those who suffer with anxiety knows what we are going through. All the best to you all.

[BT65]

I am not sure what to do about it to accept it more.

The fact that you're in therapy will help tremendously.  Talking it out more and more is sometimes what is needed for things such as these.  The more you process, the better it will be.  It's when you're quiet and not dealing that it can become overwhelming.  Do you have any good friends, or one friend, that you can talk to also?  Have you checked into your local ASO (Aids Service Organization), to see if they may have any support groups that could also help you?  Sometimes talking with people directly, who have been dealing with this for a longer period of time can be tremendous help.

Good luck, and continue to post!
Betty

[mecch]

In early 2011, that all changed when I was in a bad relationship and started coming to terms with some personal issues that had been lying dormant for years. I turned to Ativan as a solution, and I got hooked, taking it daily for 8 months. I came off the drug in September 2011, and I will never take another benzo again as long as I live, but I still need help coping with stress.

I guess 8 months daily lorazepam wasn't the greatest therapeutic use of it, yes.  Were you seeing a therapist at the time? Who gave it to you. 

I see my own history in some of what you write and also share some of your wisdom about the situation but also think differently about a few pieces of the puzzle. 

As for the lorazepam.  I had an anxious depression about a year before seroconverting and started seeing a psychiatrist.  The first chemical part of the therapy included an antidepressant, which I found quite helpful for keeping things together.  Stayed on that for half a year or so.  The following year I seroconverted and went back on antidepressants for awhile.  I ended up on HAART rather quickly and didn't react well to sustiva and was having panic attacks and rolling thoughts.  My shrink at that point gave me lorazepam and encouraged me to take it whenever these panic attacks or rolling thoughts occurred, but also we discussed other methods to deal with the anxiety as well.  What I've learned about better living through chemistry is that its possible if its overseen by a doctor who does that sort of therapy.

So it seems like you know some constructive and less constructive ways to diminish and deal with your own anxiety.  The lorazepam I think saved my job and my sanity until I got my HAART combo switched. Since then I take it every now and then, if Im really freaking out and other methods aren't helping.  I don't argue that you weren't hooked on it.  And, yes, daily use past several weeks isn't the recommended use.  I think its supposed to be used occasionally.  So it was a pity if your use wasn't being overseen by a therapist, or if you really felt like you were dependent.  Did it help at all?  I hope you don't throw out the possibility of chems again if and when they might be helpful, as recommended by a doctor.

I have realized through this ordeal that (for years) I have been coping with anxiety by having casual sex (which led to my HIV status), drugs (when I was younger), food (overeating where I gained about 30 lbs in 2007 which I have now lost thank god), and a host of other things that ultimately weren't healthy and were just distractions from the real work I have been needing to do. So, in a big way, this ativan nightmare has been a blessing in disguise as it has allowed me to start working on myself unlike anything I have ever worked on before.

Yes sex as way to cope with or diminish or forget about other anxious making situations.  But my different realization is that I don't throw out the baby with the bath water and don't put a value scheme on casual sex. Not for me and not for others.  I mean I know sometimes its been great sex, and brought rewards.  Casual sex isn't always avoidance behavior. Its sometimes just sex!  And sometimes it did help compensate, diminish, and certainly forget troubles, and sometimes, yep, it wasn't the most effective use of time or not the most useful way for compensating.

I ALWAYS remember, too, that I met all but one of my boyfriends first as casual sex partners.   

I might ask you to think again your idea:  "casual sex (which led to my HIV status)."   

In fact it is unsafe sex that leads to HIV not "casual sex".  Is there something more to be resolved, here?  I mean if you are thinking about the "recriminations" or the "consequences" of certain of your actions or habits in life.  The decision to have unsafe sex might be motivated by quite a different need or compensation or feeling than diminish or escape or compensate anxiety.  Or maybe its the same, for you.

What do others think about the possibility that these meds or HIV cause increased anxiety, and how do you all deal with it? I have started seeing a therapist, and radically changed my diet, which has done wonders, but I am still lacking the exercise portion of the equation. I am only 33 and feel like an old man sometimes. Any others care to chime in?

Yes I think some of the meds might cause certain peoples anxiety to rise, I know I clearly felt sustiva do this to me. 

I do not know about HIV - if the viral infection might create more anxiety in the body???  Or do you mean "being HIV+". 

I never heard much about the HIV virus causing more anxiety. Then there is the consideration that if one is on HAART and undetectable, a possible link between the viral infection and anxiety would be counterbalanced or quelled because the infection is relatively frozen, very low level.   

Of course "being an HIV+ person" can increased anxiety radically. We all know that. 

___________

I think its great that you have the will to rethink your life and also the will to change different behaviors, like you said about overeating. 

But also I gingerly suggest to not always think that a better life is ahead of you and what is required to get there is a "radical change". 

Subtle shifts of attitude can help a lot with anxiety.  In brief, accepting that things are OK now or at least manageable. The possibility that there are more than one ways of looking at a situation, right away, and this can diminish anxiety.  This doesn't mean giving up on projects and ambitions.  But being willing to reasonably readapt the way one feels and thinks about something right now.   

And maybe to avoid too "strict" of values schemes, or behavior guidelines, or food restrictions (when they aren't medically determined), while still keeping general agendas and preferences, and all the adult responsibilities to have a decent life. (Many of us do have to go to work. We have to take or medicine. Eat, sleep, pay taxes, etc etc. and be nice to grandma and strangers, etc etc.) 

Because setting up radical agendas, goals, and living by strict guidelines can diminish anxiety for some people (people who love highly regulated lifestyles, and rules, and routine).  But it can really increase anxiety and even guilt for others ("oh darn, I've broken my diet, its ruined now" "I'm addicted to this or that or the other, I have no self discipline, yada yada" "I can't eat, do, buy, smoke, swallow, or fuck this or that because that is the source of my problem and.... etc".)

Finally ask your doctor about this usual exercise result.  That is a real pity because obviously you miss the exercise.  And for most people, exercise decreases anxiety and has many benefits. Maybe there is a workaround or solution to get exercise back  in your life? Hope so.
 

[wylidas]

mecch- Thanks for detailed food for thought. You clearly have many thoughts on this, and I appreciate your candor and honestly.

I wanted to reply quickly and tell you that I will be chewing over all the things you mention with my therapist next week. I think you may truly be onto something in regard to the 'throwing baby out with the bath water' theory.

I wanted to let you know that I had a major setback today with my switch to Complera. I am on Day 6, and I had a major bout of anxiety and panic that seemed to come out of nowhere. As I type this, I am still feeling the ill effects from it.

Now I am scared to continue forward with taking the COmplera, and I am wondering if I should switch back to my old regimen or not. I seem to have some issues with every HIV drug regimen I have tried thus far, except the Epzicom/Reyataz/Norvir combo I was on for 4+ years, I managed to stay on it and consistently take it with minimal issues until I got hooked on the Ativan. Now ever since coming off that drug, I seem to have issues tolerating ANY HAART regimen. This is the 3rd one I have tried. Wondering if I should just go back to my E/R/N combo and stick it out til I am past the worst of this benzo nightmare.

I think my doctor was honestly placating me with this last switch because he honestly believes this anxiety is gonna be with me no matter what regimen I try. I just don't know what to do anymore.

[mecch]

If all the drugs are still on the table, go back to the one that caused you the least anxiety? 
Or, try a new one?
If you can change to a therapist or psychiatrist who can and does include drugs in the therapy, that might be a good idea. Especially an MD psychiatrist.

In any event, the most important thing may be to explain to the ID and to your GP and your therapist that they must help find a solution for your panic attacks, and NOW.  And make them talk to each other.  Explain to the therapist that you need to control the anxiety relatively quickly, if you feel today that these attacks are endangering your job or your sanity.

[wylidas]

mecch- I stopped seeing a psychiatrist because I believe psych meds do more harm than good. I won't trust any doctor that just wants to medicate away my problems again. That's how I got hooked on the Ativan to begin with.

The only way out of this hell, unfortunately, is through it. I have to find natural healthy ways to do this. I was honestly doing really well the last couple months until I switched HIV meds. I'm sorry but nobody will ever convince me that these HIV meds don't flare up my anxiety. It's the ONLY thing that has changed in the last week, and that's when I had my first panic attack in over a year. So with that said, I think the answer is to switch back to my old HAART regimen which I tolerated decently well, and to keep going forward with therapy. You can't give someone in tolerance withdrawal more drugs, it doesn't work. It's like saying you should give cocaine to a recovering heroin addict. Substituting one psychiatric drug for another won't work for someone in benzo recovery. I have to allow the body to return to homeostasis, which may take many more months.

Thanks for your concern and I will be talking to my therapist about some of the suggestions you made.

[mecch]

I believe it is up to MD psychiatrists to know if, generally, there are still uses for psychoactive drugs for a patient who has had problems with other psychoactive drugs.  Its not my field of expertise.
Some people with mood disorders really need pyschoactive drugs to have a better life.  The best experts to manage this are, I would guess, psychiatrist who do THERAPY and drugs are an option in that therapy. 
Unfortunately there are countries where contact for talk therapy AND drug therapy, with a psychiatrist, is extremely limited.  So yes you get Psychiatrists paid to prescribe drugs but not paid to provide any therapy.   You even get GPs prescribing psychoactive drugs with no therapy, and not even a psychological evaluation by an expert.  Pretty awful, but we make do with what we or our society can afford.

I hear you that you don't want anything to do with psychoactive drugs.  But it sounds like you think HAART is a psychoactive drug.  So I still say a psychiatrist would be your go-to expert, going forward.  Because that's their expertise.  But a shrink who also does THERAPY of course, and one who does not insist on drug therapy as part of that.  I think thats the only way they can closely monitor both the talk therapy, and any drug therapy that might be offered in addition. 

[wylidas]

mecch- Unfortunately, while I agree with your assessment in theory, it's not practical in today's medical industry. I have yet to find a single psychiatrist working today who does talk therapy. They only prescribe drugs now. In fact, the psychiatrist I was seeing has so much as told me that he is happy I am in therapy, but if I choose not to take prescription drugs from him, then he is not sure how best he can help me. His exact words. Not mine. And, unfortunately, that's now the norm for psychiatry.

So when you speak of other countries that are limited in their access to talk therapy from a psychiatrist, you're actually speaking of our own right here in the good ol USA. It's sad, but this is the nature of the hold the pharma industry now has. And I know it may come off sounding a little conspiracy theorist, but I'm just going by my own PERSONAL experiences, not what I read about on blogs.

On another note, I sometimes wonder about the efficacy of the HIV ARV therapy, as well. I have friends who have been positive and healthy for decades without treatment. Just interesting to me that in our country we immediately turn to drugs and pills as a way out, yet the body actually has an enormous capacity to heal on its own with phytonutrients and healthy exercise. Just food for thought....I am not going to stop my HIV treatment or anything. I just am very observant of things, especially now after my horrific experience with Ativan.

[mecch]

On your first two paragraphs. 
Yes of course you are right about the limited access to talk therapy with psychiatrists. That is why I mentioned it as a caveat in my post to you.  You are hardly a conspiracy theorists, its the real situation!  Psychoactive drugs handed out to casually and not enough support for complete therapy with experts for people who really need that kind of expert.

On your last paragraph, i am glad you started to talk about this, as it may be seeding your anxiety.

Your view on HAART is not accurate.  All HAART is effective when the doc finds the right combo for the patient and the patient takes it.  Period. You need to believe that and move on. 

There is no lifestyle adjustment that can be scientifically recommended to you, personally, to delay the need for HAART.  Anyone who needs HAART, according to the expert protocol, should start it and stay on it.  There is no lifestyle diet exercise or spiritual adjustment that one can make that does anything meaningful and provable for fighting HIV progression, or turning around AIDS.   The only sure weigh to block HIV replication is taking HAART.   People have their individual rate of destruction of immunity. You cannot measure your own in a meaningful way against others.  It does not matter very much at all to medical science, either, these days.  Its not a significant factor in longevity, either.  One takes the drug when one needs to start taking.  Or maybe sooner.

There are long term non progressors who might sell you any load of blarney about how something about their lifestyle or spirit is involved in their lack of immune destruction.  Do NOT waste your time thinking their lessons have anything to do with your HIV experience.   There are millions of people dead of HIV/AIDS in 3 decades who died because nothing could stop the progression, despite their cycling through any number of lifestyle, diet, spiritual treatment ideas.   Does not work. Dead.  If we had had today's drugs then, and if they had been available to this person, probably would not have died.

Dead dead dead. 

You might be having a sort of allergic reaction to HAART, or psychological panic about your HAART ingestion, because you are not fully resolved to taking it.  You said you were on it for years without problems.

Is there something that has surfaced in your life to make you question the value and necessity of HAART?

[wylidas]

Hmm. I understand what you're saying Mecch. But, the truth is we really don't fully understand the intricacies of HIV or AIDS. It was just discovered in the early 1980s, and as far as information goes, medical science hasn't really been able to answer all that much about it when you really dissect the answers we get.

For instance, why do so many people I know have unprotected sex and remain negative, yet a friend of mine got a blow job one time from an infected person, and got HIV. That example goes against all the things the literature tells us. Again, I am not saying that HAART doesn't slow down HIV progression, but what I am saying is that I am not so sure that if a person doesn't take HAART, that they will be dead within a matter of years as many in the medical industry would have us believe.

Bottom line: I am going back to the meds I was taking for 4 years with good results, and I am waiting for my body to return to homeostasis before trying anything new.

[mecch]

Let me propose these questions:


Did you have panic attacks and anxiety, and then decide it was related to the HAART, and therefore start rethinking your relation to HAART.

Or did you start rethinking your relation to HAART first, and then start having the panic attacks, and then say it must be the HAART, and then request a combo change, which hasn't worked out, and now having more panic about the whole idea that all HAART is poison for you?

I do think only very knowledgeable ID docs, who have the time to spend on psychiatric aspects of HIV treatment, combined with an MD or psychiatrist, are the experts to deal with these issues of mood disorders.   Because you are right, it could be quite chemical, not so much psychological issues.  But I do hope your therapist helps you find some solutions.  Wishing you the best next week for that first session.

[mecch]

Effective haart STOPS hiv replication.  Any good doc in a first world country can find effective haart for an HIV+ person.
If an HIV+ person stopped HAART therapy with a weak immune system, yes, he/she will get AIDS related illness and die.
If an HIV+ person with a good immune system stops HAART, its highly individual what happens, but sooner or later that person will die of AIDS.
The only manoeuvre room you have in your imagined scenarios is how many months or years.  The final illness will be horrible and the person will die far far before his expected expiration date.  (May also cost the health system a lot of money in those months/years of AIDS illnesses.  And make his/her family suffer terribly.)

[mecch]

You seem like an intellectual thinker. 

Personally I do not think there are any mysteries about HIV that have anything constructive to say about my living well today, and surviving HIV.

All the mysteries left about the virus itself are best investigated by expert scientists and analyzed with the highest level of statistical and epidemiological tools, all the realm for experts. 

As for the treatment, there is now effective treatment.  We wait year by year as science dribbles out steady improvements.

As for the cure, yes there surely many mysteries and challenges, since this is very high order stuff - "curing" a virus let along a retrovirus.   

Mysteries above - really not at all related to the health, today, of an HIV+ person who has access to treatment.. 

Kharmically accept  HAART as the best thing you got in your arsenal for fighing HIV. And the necessary one.

[wylidas]

I never had anxiety prior to starting HAART treatment in 2007. My first panic attacks were in 2008 and I learned to control them without the use of meds.

in 2011, i became addicted to ativan, taking it daily for 8 months under psychiatric supervision. I came off a little over 7 months ago and I did a very rapid taper, which most likely led to my protracted symptoms, and I am now in the care of a therapist, an HIV doc, and a chemical dependency specialist. The psychiatrist was of no use to me, as I said because I wouldn't let him prescribe more drugs.

My anxiety in 2011 that led me to start taking Ativan was due to a relationship I was in that was extremely negative, not HAART related. But since coming off Ativan, I have had difficulty maintaining a HAART regimen, even my old one. It most likely has to do with the sensitive state my CNS is in post benzos, because I never had trouble before benzos taking my HIV meds. In fact, I was the guy who worried if I missed a single dose.

I would suggest if you want to know more about what I am  going through, search benzo withdrawal syndrome on google or wiki. It's explained much better there than I can do it justice.

There's a very good chance once my CNS heals fully, I will be fine. Right now, I can't even eat certain foods or drink alcohol, as it completely messes with me. Hence the problem sticking to my HIV regimen,.

[mecch]

Thank you for the repetitions and clarifications. 
It seems from here that you have a good idea about how to go forward conquering the anxiety. 
Not sure what this has to do with keeping to the HAART.  If I understand correctly, after a panic attack, you will not want to take HAART because you hypothesize that HAART causes it?
I was fed up with the CNS effects of Sustiva.  I never thought of not taking it, just finding the new one to better replace it.

I hope you dont stray into any denialist tendancies about HIV or HIV Treatment, in the search for a justification for having trouble sticking to HAART, or as a justification for taking an unsupervised break from HAART. 

Hope you can get all your health providers collaborating to quell the panic and anxiety.

Ask your ID doc if maybe you should take a supervised break from HAART until you are over your benzo withdrawl.   People do take breaks for miscellaneous reasons.  Its important to do it correctly.   

Ask them to find the best way to go on with both challenges - finding the best HAART, and getting over all the aftereffects of the addition.

[wylidas]

Hey mecch- Thanks for the suggestions. I actually am going to talk to my HIV doc about taking a supervised break until I am over the benzo stuff.

To clarify, taking my HAART meds is not causing my panic attacks, it is because my CNS is so sensitive. As an example, if you took a toothbrush and scrubbed really hard on your skin for a day or two, it would cause it to bleed and be very raw for days, maybe even a week or two until it healed. During that time if you tried rubbing alcohol on it or even touching it lightly with your finger, you'd be prone to wince in pain or probably even make the it worse, i.e. infection etc.

Well that is what my CNS is basically like right now. Inflamed and agitated from the benzo withdrawal due to down regulation of GABA receptors in the brain and body. This is documented by both my chemical dependency doc plus countless research by Dr. Heather Ashton and others over 30+ years of treating benzo withdrawal. So while it;s recovering (returning to homeostasis) anything I take is a 'shock' to my system and causes extreme psychological and physical symptoms (hair loss, tachycardia, panic, depression, tinnitus, light sensitivity, migraines, etc. etc. - the list is long)

I had been seeing steady and slow improvements over the course of the last 4 months, until I switched my meds last week. And now it feels as bad as the early days of withdrawal. Even eating sugar or drinking alcohol can have this effect, as well, so it;'s not just HAART. But HAART meds DO affect the CNS. This is documented science. My HIV doc even admitted there is not an HIV treatment out there that does not affect the central nervous system in some way shape or form. THe problem is that my system cannot handle it right now the way it used to. Where as before benzos, I would have mild side effects and just tough them out, now my body goes into a state of shock and overreacts to the sugar, alcohol, meds, what have you.

So the problem I am having adhering to my meds is that I just don't want to take them because we are not talking about mild discomfort that I can easily get over. We're talking about major physical issues that lead me to going to the ER for Extremely high BP and heart rate, etc. Problems that I just simply did not have prior to taking Ativan.

Hope that clears things up. I am going to talk to my doc about a supervised drug holiday or possibly a medication alteration where I take half my normal dose or something. There has to be a way for me to live and be able to function. I can't work or live my life in a normal way, and sorry, but that's not what I signed on for with HIV treatment. Again not blaming the meds, but they are exacerbating an underlying condition that there is no real treatment for other than time and allowing the body to heal naturally.