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'I keep worrying something will happen to me'

'My condition got worst when I thought of suicide'

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A reader asks: I really need help. I feel down and I feel that I have no control of my brain. They were saying that I might be suffering from post-natal depression. I haven't seen a psychiatrist yet. Sometimes, it seems that my life is worthless and I don't enjoy things that I used to do... I am afraid of many people... I feel their noise. My health is suffering, I can't eat well, though I eat now more fruits and vegetables. My story of anxiety attack and depression started when I was rushed to the emergency because my blood pressure was way too high that time 179/107. 

I felt that I couldn't breathe that time and would faint anytime. I saw a cardio who gave me medicines for high BP and borderline cholesterol. My ECG and echo test for the heart came normal. My potassium was a little low, but the doctor never mentioned about it. Since that day, my life had changed.  I felt anxious every time, weak and it seems that something will happen to me anytime. I am worried when will be my next attack?  I mean that terrible feeling the day I was rushed in to the emergency room.

My condition got worst when I thought of suicide. I can't bear the negative thoughts in me.  I just want to end this. I am suffering and the people around me.  I feel that I am losing my sanity. 

For my personal background, I delivered my baby last year (March) and because I delivered via C-section, my husband and I agreed that I go back home to the Philippines for vacation and come back to the UAE to work again later. My husband and my daughter, 11-years old, were living in the UAE that time. And God gave us a blessing: a baby boy.  So we went home to the Philippines last year (June) and I took care of the children.

My husband came back to the UAE after a couple of months. He came back in August.  Due to some financial difficulties, my husband and I agreed that I return to the UAE in October, breaking the earlier plan. So, I returned to the UAE and I left the children with my mother.

I was so normal when I came back, everything was fine, until that episode in January. I must admit that I wasn't conscious of my health, since I went back to work, I neglected my health relying mostly on take-outs and fast food. No exercise even. And then my cholesterol and BP began to rise. And that attack was an eye-opener for me.

My condition got better when I talked and was counselled by our church pastor.  I was okay for two days, but then things seem to go back again. I stopped taking the medication (Norvasc), since, according to what I read on the internet , it has many side-effects, including depression and anxiety. So I thought I may be having chemical imbalance or something.

Just last night, we've attended a party and I didn't enjoy it much. I used to enjoy parties, but last night I felt so sad. And I fear that anytime there would be a relapse of the episode.

Please help me to overcome this.  I have no reason to be depressed, I don't have any problem with my husband nor my children.  My children will be here soon. Yet, I feel so weak and fatigued. There are so many negative thoughts in my mind and I can't control them. Sometimes it's as if, it's not me. PLEASE ADVICE. Thank you.

Dr Melanie C. Schlatter (PhD, Consultant Health Psychologist, Well Woman Clinic, Dubai) replies:  Dear reader, it appears you have been having a very difficult time as of late, and I appreciate your courage in seeking help. I must admit that I feel you have been suffering for too long though now, and I feel that you have needed more follow-up in terms of your situation.

You have described a combination of several things — depression (your experience of feeling down, weak and tired; feeling negative / suicidal thoughts and worthless, and not enjoying things the way you used too); anxiety/panic (your experience of feeling no control of your brain and like you are losing your sanity, fear of people/social situations, feeling detached from yourself - which is called depersonalization, feeling faint and like you can’t breathe and so forth); your medical situation which includes high blood pressure and possibly low potassium; you gave birth just over one-year ago; and, you described a previous unhealthy diet and lifestyle. Yet you also say that apart from the ‘attack’ when it first occurred; life was seemingly fine and that you have no current reason to be depressed.

Part of understanding this situation, is understanding the factors involved. Firstly, when people experience a panic attack, they describe a sudden feeling of intense fear/anxiety, racing thoughts of impending doom, and several physical symptoms such as those you described. Other common physical symptoms include chest pain, dizziness, nausea, shaking, and a racing or pounding heart. On average, panic attacks can start quickly (the trigger is not always known) and peak within about 10 minutes (remaining at the peak for further time) until the symptoms start to subside. Of course, this process is different in everyone, and the duration may be longer. Secondly, although people with high blood pressure mainly don’t show any symptoms, it is still possible that in rare cases, they may experience nausea, chest pain, shortness of breath, dizziness, and headaches. Lastly, low potassium levels can cause heart palpitations, fatigue and muscle weakness. As such, you may be able to see the possible interplay of symptoms in your case here—physical symptoms feeding the psychological response, and vice versa. Norvasc as a treatment may also cause chest pains in the beginning.

Although the primary reason for your attack is difficult to ascertain; it is probable that your experience was a novel one and that your experience (including at ER) led to a feeling of anxiety. The fear response is very normal, and it is actually to protect you — the physical signs are warning you to get out of the situation of perceived danger (think of how you feel prior to an exam or public speaking!).

The problem is that with such a novel experience, you will have quickly ‘learned’ to be hyper-vigilant to anything that reminds you of the hospital situation and the time/feelings surrounding that. For instance, some people recall being in the car/ambulance driving to hospital, so even thinking about driving or seeing an ambulance might make them feel a little panicky. Others may worry intensely about having more anxious sensations and thoughts when they least expect it again (just like in your case) – so this fear often translates into particular situations, especially public situations where we feel we could make a fool of ourselves or lose perceived control. Gradually people avoid more and more places/people/opportunities and they start showing signs of depression and negative thinking.

The best approach for you (via education and coping strategies) is to learn that the anxiety is a protective and normal response; that you are not in danger; and that you will not die or go crazy. Most psychologists should be able to help you with this and they could assess whether there was any postpartum distress in your situation. You might also benefit from tools to help you address how you have been thinking, and what you have been doing since the incident (we often start to do less and worry more, which makes us more depressed). Basic stress management, healthy lifestyle (exercise and diet), and relaxation skills (especially breathing) are essential for you. I also recommend getting your blood pressure monitored regularly, and consider going back on Norvasc or similar.

Given that psychiatrists can prescribe medication (psychologists can't), it might be advantageous for you to get an assessment from them—as they could also prescribe an antidepressant if necessary, and if wanted by yourself. Indeed, it is concerning that you dipped as low as suicidal thoughts, so this has to be addressed quickly. Your husband might also benefit from hearing an explanation as to why things have changed in your life, so ask him to attend the session/s with you for support. These methods in combination will help you to reintegrate back into your daily lifestyle by managing the anxiety when/if it happens, work through the depressing thoughts, as well as keep your blood pressure and cholesterol in check.

In the interim, if you feel panic, try to sit down if possible (or pull over if you are driving), and breathe in low (through your nose right down into your stomach) and slow (out through the mouth) – this will help to tell your brain that everything is okay. Talk to yourself calmly, and keep remembering that this is normal and that it will pass. It is simply an indicator that perhaps you were triggered, so look to see what triggers you more often. Sometimes when people exert themselves or are in slightly uncomfortable situations (like your party), their heart rate increases naturally, but they become afraid as they feel that their heart beating is a sign of a full blown panic attack, as opposed to a normal sign of stress or excitation... so try your best to keep things in perspective. You may benefit from talking to your pastor again also, if that was helpful the first time round. All the very best!

DisclaimerThis blog is a conversation and is not an alternative for treatment. The recommendations and suggestions offered by our panel of psychiatrists are their own and Gulf News will not take any responsibility for the advice they provide.