Beating Anxiety: The diagnosis, and the future

Given my assessment experience, I wasn’t exactly thrilled about follow-up discussions. In fact, I was terrified and had had enough…

Depressing and hot. Those are  my primary memories of my anxiety assessment at the University of Chicago Hospitals’ Depression and Anxiety Clinic. And then there was the matter of the neurologist’s icy-cold exam table frosting my fanny.

Not a fun experience, though absolutely necessary…

Two days ago, we began a three-part series on the events that turned my anxiety-ridden life around. In part one I chatted about the mall visit and phone call that got things started. Part two was all about that infamous assessment.

Today I’d like to wrap things up by swirling around my diagnostic experience.

The Psychiatrist Appointment

First, a point of order. In yesterday’s piece I reported leaving the assessment proceedings with an appointment for a diagnostic consult with a psychiatrist.

As I was putting this piece together, I recalled that isn’t how it went down. In fact, I met with my assigned psychiatrist right after the assessment hoopla.

Dr. William Matuzas, I remember him well. And to test my visual memory, I just hit Google for an image. Yep, that’s him. Interesting, he’s now practicing in Maine (with Hawkeye Pierce).

Boy, was this guy an abrupt turnaround from the several therapists I’d worked with prior. The man sitting before me was a scientist, pure and simple. And he was interested in my past only as it applied to the history of my disease.

Frankly, he really didn’t give a rip about how I felt about anyone in my life. His sole mission was to manage my disorder from a medical – biological – perspective. And that was just fine by me.

Well, we finished talking; and since no test results were going to be available that day, I left with a follow-up appointment – and a whole lot of fear, apprehension, and insecurity. It seems the joy I had expected to be knocking upon my door had yet to arrive in the neighborhood.

Diagnosis (and mimicking)
So I showed up for my second appointment at an annex location on the far north side of Chicago. The atmosphere was significantly brighter, which helped raise my spirits. I was asked to complete some questionnaires, the results of which would be stirred-in with the data from our work at the hospital.

Before long, I saw the doctor.

He told me all of the lab work came back normal. And that was extremely important to know because so many physical disorders can present symptoms similar to panic disorder, or any emotional/mental health situation.

This is known as mimicking and can cause a lot of confusion, misdiagnoses, and undue misery. And this mimicking business is a two-sided coin phenomenon. Disorders such as mitral valve prolapse, thyroid dysfunction, temporal lobe seizures, and vestibular dysfunction are common panic/anxiety mimickers.

On the other side, consider this stat – anxiety disorder sufferers spend approximately $23 billion a year repeatedly using healthcare services to seek relief for symptoms that mimic other physical illnesses. Probably the most common example is the individual who rushes to the E.R. thinking they’re having a heart attack, but are in the midst of panic.

Back to biz. I was officially diagnosed with Panic Disorder with Agoraphobia, and upon the doc’s recommendation I decided to embark upon a medical management program.

And I stress “I” because it truly was a personal choice. And all of your treatment decisions need to be of your informed choice as well.

What Was the Med(s)?

I left with two prescriptions. The first was for propranolol (Inderal). This is a non-selective beta-blocker prescribed primarily for hypertension; however, it’s also prescribed for angina, risk of recurrent heart attack, irregular heartbeat, migraine headache, tremor, and variations of anxiety. It’s also an alpha-2 autoreceptor agonist, impacting the neurotransmitter norepinephrine.

It’s my supposition that my doctor wanted to provide some physical, and subsequent psychological, calm by helping me with symptoms like trembling, sweating, and heart palpitations.

He also wrote a prescription for the tricyclic antidepressant (TCA) imipramine (Tofranil), which was specifically for panic and anxiety. He told me imipramine was the first drug of choice for the disorder (remember, this is 1989) and, if we were lucky, would work well for us. If not, we’d try other medications until we found a regimen that worked.

I’m guessing you’ve heard that before.

 And On to the Future

It took about two days of almost fainting upon standing to pull propranolol from the mix. But you know what? In fairly short order the imipramine worked. And I was incredibly grateful!

Ah, but that was only the beginning.

So it appeared I was “biochemically balanced.” But I had so much more work to do. I mean, there were so many confidences to regain, so many dysfunctional patterns of thought, emotion, and behavior to repair…

And I began to do just that, and did it well.

And That’ll Do It

I hope you enjoyed the series on the events that turned my anxiety-ridden (and pretty much dead-end) life around. It was really important to share them for so many reasons…

Community, a fresh perspective, a heads-up, a morsel of hope, and perhaps a personal cleansing – and more.

You know, we all have a price to pay for our freedom. And even if “freedom” is so much less than what we might have expected, it sure beats the heck out of the alternative.

‘Course, coming to peace with that bit of wisdom takes a smidge of insight and effort. Right?

More on the biology of depression, anxiety, and bipolar disorder? Right here. Meds? Here.