Just Diagnosed- What to expect?

[Anselm]

Thanks to those who have replied to my previous post. Saw my psychiatrist yesterday and went through a list of my symptoms. Which include:

- Fear of meetings, conferences which I have to attend. I sit there sweating fearing I am going to lose control.
- Fear of going out to dinner with friends. So anxious I can't eat
- Always sitting close to a door when in a room of people so I can leave when I want
- Fear of driving, after a serious car crash.
- I'm studying to do a PhD and in some lectures I am so anxious I can't take in what's being talked about. Also when I have to give a talk, I do, but hate it. I'm told I do really well but I hate doing it. I guess this is down to years of hiding my anxiety.

She told me I have a case of text book agoraphobia panic disorder. A part of me feels relieved. I've had this disorder since 2006 and its been hell. I was self medicating through alcohol, to a dangerous level, which I understand adds to anxiety, but I've cut back.

I've been on 10mg Diazepan for about two years. Not everyday. Maybe once or twice a week when I felt a panic attack coming on. She now has me on 30mg Mirtazapine which I started last night. A couple of question:

i) What to expect from Mirtazapine? ( She called it a mild anti depressant.)
ii) How long does it take to kick in?
iii) Should I quit alcohol altogether.

Any advice greatly appreciated.

Kind Regards,

Anselm

[alankay]

Anselm, I too have Panic Disorder without Agoraphobia(some Social Anxiety too). The AD will help reduce your "base level" of anxiety but will take time(a week or two, sometimes a tad more). May also work to block panic. Main passing side effect is sleepiness, maybe dry mouth a little dizziness.
I won't necessarily quit alcohol, just limit it to weekends, etc. The drug may make alcohol a bit strong to you so be careful.
You will feel better in time as the period you self medicated was worse. I suffered until meeting a good pdoc. My advise it to work with her. You need to and can get this anxiety under better control. I did. Don't be afraid to lean on the diazepam just a bit more as you might be more anxious in the first week of so of the remeron(mirtazapine ). Maybe not.
Tell your doc all you problematic symptoms. All of them. With treatment this will get better... but not exactly go away. But you can still have a great life and finish your PHD! I know, I had a very similar experience in college. But I finished, speech class and all, and am now, with meds and a good dr., pretty much panic free. I just have to manage it via all I've learned. PM me any time and I mean that!!! Alankay.

[Anselm]

Thanks for the reply alan. She's also putting me on a course of CBT which I understand is very good.

[alankay]

Yep. It will help.

[Anselm]

PS Alan you say you have Agoraphobia without panic attacks. Did you mean agoraphobia with panic attacks.

[alankay]

Panic Disorder without Agoraphobia. Not all folks with panic disorder are afraid of open spaces, crowds, malls, etc. I thought you would not be agoraphobic as you are out about at school, etc. I think you sound more like me. Just Panic Disorder(Nowadays they call is Panic Disorder without aagoraphobia. Whatever.:) Alankay.

[Anselm]

Ah, now. That's a common misconception about agoraphobia. I'm an academic and I've done my research. Agoraphobia is not a fear of open places as such, although it can be and people not educated in the condition automatically presume its a fear of being in open places. Its also fear of being in places that you can't escape easily. For example a dinner at a restaurant, a conference call where you are speaking, giving a lecture, driving a car on a motorway/ freeway, driving over a bridge etc etc All these fall under the category of agoraphobia. I don't have a fear of supermarkets/ malls etc etc

' Panic disorder with agoraphobia
Panic disorder with agoraphobia is an anxiety disorder in which there are repeated attacks of intense fear and anxiety, and a fear of being in places where escape might be difficult, or where help might not be available.

This pretty much sums up my condition. I would call my condition, while horrible, not severe. Some who get it can't leave their houses. I can and do leave the house but its always been one hell of a struggle. I don't have a problem going to a supermarket/ mall etc etc but going to meetings, driving on motorways, giving lectures... I do. Anyway my psychiatrist says I'm a textbook case of it :)

[alankay]

True but the term goes back to Greek Times(Agoraphobia (from Greek ἀγορά, "marketplace"; and φόβος/φοβία, -phobia) as is a nutshell description and untreated cases ultimately come to fear...................open spaces "in general" over time and the course of the illness. The term for a full description would be too long so they just use a general definition. The illness in a nutshell..... although there can be variations. Of course.
Whatever the diagnoses there's almost always features of another anxiety disorder. In fact OCD is really related to anxiety as worries are what ultimately lead to anxiety are obsessive thought patterns. Truly definitions don't mean much except for insurance purposes and classification via the DSM-4(sure, it guides treatment too). DSM-5 will be out 5/2013 and there's always debate over dividing lines, blah, blah, blah, etc, even among the most prestigious docs. Hilarious. To the patient, it doesn't matter but does help to understand what anxiety is overall. Panic disorder untreated almost always become agoraphobia if left UNTREATED so no worries. Alankay.

[Anselm]

Cheers guy. I knew the origin of the term agoraphobia. I guess, at the end of the day, its all just semantics. Anxiety is just that, anxiety. We just all have different triggers.

Kev, being an antique dealer would you be sitting at the back of an auction room? ( My father and mother are antique dealers.) I worked in an auction house for a while. I'd hate to have anxiety disorder and be the auctioneer!

I might, next time I attend a lecture, try sitting near the back of the room, just for an experiment. I have learnt one thing. A healthy lifestyle; good sleep, good diet etc etc, also helps. Have to run now but will post later. I'm from the UK by the way.