PA and anxiety.

I get a lot of incoming searches with terms having to do with anxiety: “eplerenone + anxiety,” “aldosterone + anxiety” to name two. While I can’t address the issue of eplerenone, as I have not yet taken it (and hope to not have to), I can definitely share my experience with the misdiagnosis of “anxiety.”

I know that for many, many PA patients, a throwaway diagnosis of “anxiety” and a prescription for an SSRI is often the first mis-step on the long winding road to a true diagnosis. Over at the Yahoo hyperaldo group, this same story is shared time and time again. A number of folks in that group continue, even after diagnosis, to take SSRIs and to believe they have anxiety (or its counterpart, depression) – while I’m sure some truly do, I’m also certain that others probably do not and are likely doing more harm than good to their bodies by ingesting SSRIs, which have been linked to metabolic disturbances. We already have metabolic disturbances; we don’t need drugs that exacerbate them!

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In the autumn of 1997, I had my first “panic attack.” I was driving home from school one night, on the interchange from the eastbound 10 to the northbound 110 – a hairy traffic situation in the best of circumstances, but one I did almost daily and had been doing without incident for some time. Suddenly I felt like I was going to lose control of the wheel. I could feel my heart pounding, I felt like I couldn’t breathe, my vision got blurry, and I thought I was going to die. I didn’t die; instead I recovered, made it home, and asked my roommate to take me to the ER.

At the ER, I was EKG’d and poked and prodded and asked a bunch of questions that I recall seemed intrusive and irrelevant. I was hooked up to an IV that burned like hell – in retrospect and in all likelihood, my first ever potassium infusion – and given Ativan. I was kept there for hours but given very little information; I only know they kept checking my electrolytes. After one of these checks, I was told I was free to go. I called my roommate for a ride home, went to work, and proceeded to get on with my life as normal. Looking back, it’s pretty clear that this was probably the very first sign of my adrenal gland going haywire.

Several weeks later, a bill came from the hospital for an astronomical amount of money. My then-lousy health insurance company denied payment, as my diagnosis in the ER was “anxiety” and the health plan I had at the time did not cover mental health care.

Not long after that, one night I was enjoying a pleasant evening at home reading when it happened again: the pounding heart, the trouble breathing, the blurry vision. This time I also had chest pain. By this time I had changed jobs and had a health care plan that was a bit more comprehensive, so again I asked a friend to take me to the ER. I’m not sure what the workup involved but the end result was a referral to a psychiatrist and, yes, a diagnosis of “anxiety.”

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It took a few years, but eventually I figured out that the “anxiety” diagnosis was, in my case, a lot of bunk. I’m not exactly a Type-A personality – granted, in the early years of this wrong diagnosis I was living a pretty hectic life (fulltime job at a Holocaust history archive, part time school) but I was pretty good at making sure I had plenty of decompression time. Looking back, I wish I had had this perspective then, because that initial wrong diagnosis led to many years of wrong medications, and many reasons for my doctors to not really look any closer at what turned out to be a relatively rare condition. After all, writing it off as “anxiety” and prescribing the top-selling drugs in the nation is a much easier, and more profitable, approach. Yeah, I’m a bit bitter. And a bit cynical.

I’m not saying that for PA patients, anxiety doesn’t exist. On the contrary, it does, and can be very real and very frightening. What I am saying, though, is that the problem is in the adrenal gland(s) and not in the brain chemistry, so I would be very, very wary of taking any medical advice that involves drugs that alter said chemistry.