In memorial of two victims of Hurricane Ike.

This piece memorializes Delores Brookshire and Charles Garrett, a mother and her adult, agoraphobic son, both of whom perished in Hurricane Ike in September 2008. A snippet:

Charles left school early, but self-educated himself [sic] at home. He recited Bible scriptures and had an uncanny knowledge of science and word usage. He liked to talk science with his uncle, but he could also readily converse about sports and was a big fan of the Rockets, Astros and Dallas Cowboys.

I read both these sad obituaries early one morning and thought about them several times during the day, mostly because they were published in May about deaths that happened in September.

Then I thought about agoraphobia and realized the strong significance of the whole story. People who suffer agoraphobia can’t go outside their own homes. They must keep to their personal space. And so Charles couldn’t flee from the storm. And the mother who loved him wouldn’t leave him.

Sad.

Take your vitamins.

It may be time to add taking your daily vitamins to the list of little things to do to decrease anxiety, like get adequate sleep, eat well, exercise, meditate, and whatnot. According to a new study by New Zealand psychologist Julia Rucklidge, "micronutrients" (vitamins and minerals) may be efficacious in treating obsessive-compulsive disorder. The study's abstract reads as follows:

Obsessive Compulsive Disorder (OCD) affects 0.5–2% of young people many of whom are resistant to conventional treatments. This case study describes an 18-year-old male with OCD who first underwent cognitive behavioral therapy (CBT) for a 1-year period with a modest response (his OCD had shifted from severe to moderate). Within a year, his anxiety had deteriorated back to the severe range and he now had major depression. He then entered an ABAB design trial using a nutritional formula consisting mainly of minerals and vitamins (together, known as micronutrients). After 8 weeks on the formula, his mood was stabilized, his anxiety reduced, and his obsessions were in remission. The treatment was then discontinued for 8 weeks, during which time his obsessions and anxiety worsened and his mood dropped. Reintroduction of the formula again improved the symptoms. This case illustrates the importance of considering the effect micronutrients have on mental illness.

No indication of the exact recipe of micronutrients used.

Fish on a Hook Redux.

A repost, but it's been awhile and this short (depicting how terrifying just going to the market can be when you have agoraphobia) is really excellent.

Margaret Drabble on depression and agoraphobia.

Here is a very worthwhile essay by the English writer Margaret Drabble. A taste, on agoraphobia:

I used to criticise my mother for her inertia, her agoraphobia, her unwillingness to walk down the street. She'd feel better, I told her, if she got out and about more. In her last years she lived in a large, detached house in Suffolk without ever visiting the village shop. I didn't know where the shop was, and had assumed it must be out of range, but on one of my visits, curiosity and restlessness compelled me to seek it out. I discovered that it was only 10 minutes' walk away.

Man, oh, man, this hits home. I used to feel this way about my grandmother, a tiny, sweet, anxious woman who rarely left her Brooklyn apartment. Who hated travel of all kinds. Who never learned to drive. Who depended on my grandfather to deal with the outside world -- to do the grocery shopping, and drop off packages at the post office, and pick up her prescription medications from the pharmacy. Before I started having panic attacks, I couldn't fathom what was wrong with her. Why in the world would anyone stay inside all the time -- or refuse to learn to drive?? I loved my grandmother deeply, but considered her to be frail mentally as well as physically. Her refusal to engage in life? That was a character weakness. Something that could be cured by sucking it up a little.

Only later, after I'd developed my own case of agoraphobia, did I begin to grasp what my grandmother had been going through all those years when I was looking down my nose at her from my perch of youthful self-satisfaction. Only then did I begin to understand the depth of her fear, the way it had taken over her life, worming its way into all her thoughts, whispering its plans of ambush should she venture outside her comfort zone.

It's at least good for that, panic. For teaching compassion.

Another taste, on coping:

We all tackle it in our own ways. I have long been a believer in the therapeutic powers of nature, and had faith that a good, long walk outdoors would always do me good. It might not cure me, but it would do me good. I agreed with the poet Robert Southey, who in his old age mildly remarked that "I am less sensible of the want of spirits when engaged in walking than at any other time and therefore spend more time out of doors than I might otherwise do."

There's a good reason your mom would tell you to go spend some time outdoors when you were down in the dumps as a kid. It works. When I was living in Los Angeles in the early 1990s, my version of this method of dealing with panic and depression was to spend upwards of ten hours a week mountain biking. I rode the trails of the Santa Monica Mountains obsessively, as often as I could. I'm confident that it was the single most effective thing I did to stay sane during that time.

Sara Benincasa talks about a reeeaaally bad case of agoraphobia. (NSFW.)

Super Bowls of Pee


"This is me being functional in a basement."

Panic and anxiety are TV stars.

Later this month, the A&E cable television network will begin airing a non-fiction series called "Obsession," about how regular folks are dealing with a variety of anxiety disorders. From the A&E website:

"The series sheds a light on the vast world of anxiety disorders, while offering those who suffer from these debilitating afflictions a path to recovery," said Robert Sharenow, Senior Vice President, Nonfiction and Alternative Programming, A&E Network and BIO.

Check your local listings. (I've always wanted to say that!)

Rave on, this crazy feeling.

Turns out that the party drug ecstasy (we called it X when I was a kid and it first hit college campuses, and nowadays they call it E, but technically it's known as MDMA) may have efficacy in treating post-traumatic stress disorder (PTSD) -- and by extension I'm assuming panic disorder, too.

Don't believe me? There's no reason you should. But maybe you'll believe The Economist magazine, where an article called "Agony and ecstasy" recently was published. From the article:

Dr Mithoefer’s Phase II research, which used MDMA from the only legal source—a chemist at Purdue University licensed by the DEA to distribute controlled quantities from a supply synthesised in 1985—is directly descended from the first generation of LSD psychotherapy. Subjects were given MDMA while attended by Dr Mithoefer and his wife, a psychiatric nurse. They rested on a futon, listened to music and were encouraged to revisit their trauma.

“I remember feeling incredibly safe and very motivated,” says Ms Westerfield of her first session....

The patients who received MDMA showed statistically significant improvement of their PTSD symptoms compared with those who received the same day-long therapy sessions with an inactive placebo. “All the major approaches involve revisiting the trauma in therapy”, says Dr Mithoefer, “but patients may be overwhelmed and retraumatised.” He believes the fear and defensiveness that characterise PTSD are obstacles to treatment, and that it is MDMA’s attenuation of these emotions that permits concurrent psychotherapy to be effective. He will publish the study shortly.

Sounds like MDMA may help those who panic process situations that trigger their attacks -- e.g., it might facilitate more effective cognitive-behavioral therapy (CBT) treatment. Maybe someone will do similar studies about MDMA's potential in treating panic and agoraphobia. Until then, though, rave on.

But keep it clean -- self-treatment with unprescribed medications is a risky game.

Anxiety, panic, and inflammation.

About seven years ago, I started experiencing bouts of mystery swelling in my feet and knees. A couple of days of swelling, in the minor cases. A couple of weeks, in the more major ones. Sometimes the swelling would come after a long hike or the likes. Sometimes, though, there was no real cause that I could point to; the swelling simply came from out of the blue.

This is real pain I'm talking about. In my time I've suffered more than my share of cuts, scrapes, bumps, bruises, burns, dislocations, sprains, muscle pulls, and whatnot. I've broken my neck (5th C.V., playing rugby in college), gone under the knife, been bloodied in fights. The pain I'm talking about is right up there with all of that, typically. Indeed, one bout of mystery swelling was the most painful thing I've ever experienced. (As in, the weight of a mere bedsheet on my foot caused me to cry agonized tears.)

I attributed the mystery swelling bouts to aging and wear and tear, basically. In my lifetime I've played probably 10,000 hours of basketball, a sport that may well be harder on the feet, knees, and back than any other. (Can't play hoops any more, since this swelling business started. Only time I get to feel that hoops feeling these days is in the occasional dream.) I blew out my knee skiing 12 years ago, and had surgery to repair my ACL. So as far as I was concerned, my problems with swelling was just a symptom of worn-out joints -- and maybe some arthritis, which runs in my family.

Then I came across this, about a study positing a link between inflammation and panic:

Background: Proinflammatory cytokines have been reported to be elevated in individuals experiencing chronic stress as well as in those with major depressive disorder. Much less is known about cytokines in anxiety disorders such as posttraumatic stress disorder (PTSD) and panic disorder (PD). We hypothesized that PD and PTSD would be associated with a generalized proinflammatory cytokine signature...

Results: Individuals with primary PTSD or PD had significantly elevated median peripheral cytokine levels for 18 of 20 different cytokines compared to age- and gender-matched healthy controls...For men and women, 87% of anxiety patients had six or more detectable levels of these proinflammatory cytokines, compared with only 25% of controls...

Conclusions: These findings suggest that a generalized inflammatory state may be present in individuals with PD or PTSD.

Now I wonder: Could there be some link between panic and the inflammation I experience? Might panic, or my genetic predisposition to it, have some role in my bouts of mystery swelling?

How about you other panic sufferers: Have you experienced inflammation you can't readily explain?