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Increasing Panic/Fear of Death


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I'll try to make this relatively brief, but the context may be longish. I hope this isn't TL:DR because I am really hoping someone will give me some advice (and comfort).

My immediate problem is that I keep having sudden, intense, unignorable panic attacks, with my whole body and my mind overcome by a feeling that I am imminently going to leave my body. This is sometimes accompanied by a temporal distortion, feeling as if the present moment is a very slow-motion recall of a past moment of my life--that I am in the process of dying, and reviewing my life. Then my mind kind of goes into a loop thinking about how "now" is always slipping into the past, and how my childhood and everything in the distant past is just barely more than a dream to me. The feeling is as if everything--my whole life--is happening in a moment and also coming to an end in that same moment, and that the more I realize that, the more I realize I'm dying or dead. This is a new phenomenon, but I know where it began.

Here's the overall mental (and physical) health context:

  • I know that I have severe lingering anxiety and depression from my adolescent years. I am gay, and I was severely abused by my peers in school, going from a happy childhood to an entirely alienated, friendless, and abusive adolescence (7-12th grades). I developed a deeply entrenched suicidal pathology over those years and in any little uncomfortable situation from that time forward, I began to default to "I can escape this by dying." 
  • I made progress after high school, dated (sort of, but never developed any real romantic relationships). I have bad acne scarring and other scarring (I'll get to that) all over my body and these have been hurdles I've never overcome self-esteemwise--and as a result, I've never been able to get close to anyone romantically.
  • I avoided drugs all throughout my youth, but that changed recently because...
  • In my early-mid 30s, I developed a severe neurological disorder of unknown origin. After about three years of intensive medical visits, multiple sclerosis, ALS and other disorders were ruled out. But the symptoms persisted--from partial paralysis to cluster headaches to excruciating nerve and joint pain, fatigue, and panic attacks that I had never had before. 
  • I started drinking a lot after this happened, and also started seeing a psychiatrist (at a neurologist's recommendation). For a time, I was having mental visions of my body going over the edge of my apartment building roof, just playing on a loop. It terrified me. My shrink put me on Zoloft, Klonopin, and Wellbutrin, and after about a year she also put me on a low dose (25mg) of Seroquel to help me sleep. Several years later, she told me that I have an adjustment anxiety disorder and possibly bipolar II, but nothing extreme like bipolar I, borderline personality, etc.
  • My health continued to decline and I was drinking even more and wanted to change my life, so after being more or less bedbound (able to work, but that's all--my social life came to an end because of fatigue and pain), I spent about 18 months reading about ayahuasca (a potent psychedelic plant medicine) and took a leap of faith in trying it. It's the first drug I had ever taken, and I did it as a last-ditch effort to regain my life, or at least to come to terms with dying--at that time, my declining physical health really made me feel like I was dying. And I was praying for that, to be honest, because of the pain.
  • My first ayahuasca experience literally severed my interest in drinking alcohol. Since I took ayahuasca, I tend to become nauseated at the thought of being drunk--the thought of it--and I have never had more than three drinks at one time since then--and that's only been once or twice.
  • Shortly after having taken ayahuasca, I was re-diagnosed with Lyme disease, as well as bartonella and babesia coinfections. My doctor explained that Lyme can cause inflammation of the brain and CNS and very often causes severe panic attacks as a result, besides the depression and anxiety that come with being so ill. After about six months on antibiotics, my physical and mental health problems improved 80-90 percent, with intermittent flare-ups.
  • My psychiatrist, who I've seen monthly for six years now, has told me that she has witnessed a remarkable change since I began treatment for Lyme and has since reclassified my diagnosis and told me I've developed a "melancholic" personality, but that I'm not mentally ill in any profound or serious way. She's now encouraging me to be more outgoing.
  • I didn't take ayahuasca for years until this winter. My father had a major heart surgery and I was scared to death about it, and I thought ayahuasca might help me come to terms with the life-or-death consequences. I took it shortly before his surgery and the experience, unlike previous enlightening and life-affirming ones, was terrifying. I had hallucinations that I'd never had before, and I felt (and still feel--the sensation was so real) that I actually died during the experience. And it was terrifying because 1) I didn't want my life to end and 2) I was in this timeless void in which everything was just pure information, and I flashed back and forward on my life and other lives and saw some horrific things--and in the end, it was just too much to handle. I could not believe it when I actually awoke the next morning. When I did, I didn't believe I was alive for the entire day until I finally told a friend what I had done and she confirmed that I was really there. I was grateful for everything, even gravity.
  • So this last ayahuasca experience was life-affirming in the sense that it "scared me straight" and made me want to just live my life. Just live, live, live. Unfortunately, I am still often very unwell because of Lyme disease--but I am better than I was before I found treatment. Now I WANT to live--and paradoxically, that's where my anxiety is coming from. I am no longer afraid of people, but I am profoundly afraid of dying.
  • I got a medical cannabis card because I had read that cannabis can help people who have Lyme. I had never tried marijuana before. I got two tinctures, one very low in THC and high in CBD--and so it should have little to no psychoactive effect. The first few times I took it (a half dose), I felt a mild temporal distortion and relaxed. And then the couple of times I took it after then, this tiny amount of cannabis sent me back into that ayahuasca void and I was certain that I was dying and dead. And since then--it's been a few weeks now--that feeling has occurred spontaneously without any trigger.
  • I'm almost certain I will never take ayahuasca or any form of cannabis again. I'm back on my psych meds, but my psychiatrist prescribed a quick-acting benzodiazepine to treat my severe impromptu panic attacks--and taking it just seriously amplified my panic attack.
  • It's that same thing: a feeling that I am imminently going to separate from my body, and like time is collapsing in on itself. I've even started questioning the reality of the world vs. a "Matrix"-like holographic/imagined reality, and I am so afraid of my death now that it's got me on edge ALL the time.
  • I've never in my life been afraid to die in any conscious way. In some ways, I actually interpret this as a positive thing because at age 38, with a chronic illness that causes a lot of real life challenges, I have never wanted to live more than I do. Yet, in keeping with that, I am afraid that I'm going to lose this life and the people I love.

Have I developed some type of dissociative/depersonalization disorder? I keep feeling like I am jumping outside of my body's time, and like I am in extreme denial about no longer being alive, and I'm afraid that at some point I'm going to let go and just zip away from this world. And of course, I know that I am going to die just as everyone else does and there's no way of knowing when it'll happen. But I am scared to death that it's going to happen any time now, and it seems that even benzodiadepines intended to calm panic actually contribute to it now. I feel like there's no way out--but the last thing I want to do is commit suicide, so I guess that's the silver lining?

Any words of advice for this crazy person? (Aside from "don't do drugs"! I am fairly certain I never will again.)

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I too have no advice :( I am an enormous mess myself honestly..  

My first full blown panic attack was the same as you said,  about feeling like you're not yourself and seeing things from the past.  Horrible!  

I really hope you start to feel better and I'm sorry you're going through such a difficult time.  

And yes that is an excellent silver lining that you don't feel suicidal anymore!!!!  And yes,  drugs are bad.  Bad.  Bad.  

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No real advice except sometimes I get very terrified about death. I can't think about it or I'll lose it. Some of those feelings you described I have felt during a panic attack before abd they really scared me. My panic attacks come on fast out of the blue as well.

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You present a very complicated case, and I don't know if I can contribute anything useful, but I'll try.

11 hours ago, MrPacMan said:

Shortly after having taken ayahuasca, I was re-diagnosed with Lyme disease, as well as bartonella and babesia coinfections. My doctor explained that Lyme can cause inflammation of the brain and CNS and very often causes severe panic attacks as a result, besides the depression and anxiety that come with being so ill. After about six months on antibiotics, my physical and mental health problems improved 80-90 percent, with intermittent flare-ups.

1

Unfortunately, I don't know anything about Lyme disease or bartonella or babesia infections, but from what little I read, it seems your doctor is right about them being able to cause panic attacks, depression, anxiety, etc.

11 hours ago, MrPacMan said:

I didn't take ayahuasca for years until this winter. My father had a major heart surgery and I was scared to death about it, and I thought ayahuasca might help me come to terms with the life-or-death consequences. I took it shortly before his surgery and the experience, unlike previous enlightening and life-affirming ones, was terrifying. I had hallucinations that I'd never had before, and I felt (and still feel--the sensation was so real) that I actually died during the experience. And it was terrifying because 1) I didn't want my life to end and 2) I was in this timeless void in which everything was just pure information, and I flashed back and forward on my life and other lives and saw some horrific things--and in the end, it was just too much to handle. I could not believe it when I actually awoke the next morning. When I did, I didn't believe I was alive for the entire day until I finally told a friend what I had done and she confirmed that I was really there. I was grateful for everything, even gravity.

 
12 hours ago, MrPacMan said:

I got a medical cannabis card because I had read that cannabis can help people who have Lyme. I had never tried marijuana before. I got two tinctures, one very low in THC and high in CBD--and so it should have little to no psychoactive effect. The first few times I took it (a half dose), I felt a mild temporal distortion and relaxed. And then the couple of times I took it after then, this tiny amount of cannabis sent me back into that ayahuasca void and I was certain that I was dying and dead. And since then--it's been a few weeks now--that feeling has occurred spontaneously without any trigger.

1
 
 
12 hours ago, MrPacMan said:
  • I'm almost certain I will never take ayahuasca or any form of cannabis again. I'm back on my psych meds, but my psychiatrist prescribed a quick-acting benzodiazepine to treat my severe impromptu panic attacks--and taking it just seriously amplified my panic attack.
  • It's that same thing: a feeling that I am imminently going to separate from my body, and like time is collapsing in on itself. I've even started questioning the reality of the world vs. a "Matrix"-like holographic/imagined reality, and I am so afraid of my death now that it's got me on edge ALL the time.
 
 
 

Discuss this with your psychiatrist... I probably have no idea what the fuck I'm talking about, but I feel like I could be onto something here...

Benzodiazepines cause disinhibition, and it could be that whatever the cause of your anxiety/panic may not be GABAergic in nature (what benzos target), so the benzo is just disinhibiting the anxiety/panic trigger, causing your anxiety/panic to worsen.

I have a hunch that an atypical antipsychotic with very strong antiserotonergic properties might benefit you, especially at the 5-HT2A and 5-HT2C receptors, more importantly the 5-HT2A receptors, like 1. Saphris (asenapine), 2. Rexulti (brexpiprazole), 3. risperidone (Risperdal), or 4. ziprasidone (Geodon), with maybes being 5. paliperidone ER (Invega), 6. Latuda (lurasidone), 7. olanzapine (Zyprexa), and 8. quetiapine (Seroquel)/Seroquel XR in the higher dose range. The typical antipsychotics chlorpromazine (Thorazine) and loxapine (Loxitane) actually have enough antiserotonergic properties at the 5-HT2A receptor to be considered as well. This is my explanation for this.

From what I understand about ayahuasca, it's brewed with dimethyltryptamine (DMT) admixtures that vary depending on the region (Toé, Mapacho, and one that's a variant of yerba mate to name a few). The ayahuasca acts as a MAOI, specifically an MAO-A inhibitor, likely reversible, which prevents the DMT from being broken down in the digestive tract, enabling it to cross the blood-brain barrier. DMT binds non-selectively to a number of serotonin receptors but has agonist actions at 5-HT1A, 5-HT2A, and 5-HT2C. It also has affinity at dopamine D1, α1- and α2-adrenergic, and sigma-1 (σ1) receptors. Apparently, it has more affinity for 5-HT2C then for 5-HT2A, but its overall effects come from its actions at 5-HT2A, 5-HT2C, 5-HT1A, and σ1.

The pharmacology of THC and CBD is waaaay complicated, and I'm not going to attempt to cover that.

So 5-HT2A agonism is the main or one of the main mechanism(s) of action of many psychedelics, including LSD, psilocybin, psilocin, MDMA/MDA, etc., which is very capable of producing "bad trips." Some of these psychedelics also have "flashback" effects that can trigger without warning, where the user experiences the effects of the drug long after they have used it and it has left their system. I'm hypothesizing that maybe these feelings of death felt from ayahuasca and cannabis that are occurring spontaneously without any trigger might be some form of these aforementioned "flashbacks?"

Antagonizing the 5-HT2A receptor would make sense in this case.

So again, maybe an atypical antipsychotic might bring you some relief?

Other 5-HT2A antagonists are:

  • Antidepressants
    • NaSSA
      • Mirtazapine (Remeron)
    • SARIs
      • Nefazodone (Serzone)
      • Trazodone (Desyrel, Oleptro)
    • SSRIs
      • Fluoxetine (Prozac) (very mild, probably only exhibited in high doses)
    • Tricyclics (in order from strongest to weakest)
      1. Amitriptyline (Elavil)
      2. Nortriptyline (Pamelor)
      3. Trimipramine (Surmontil)
      4. Doxepin (Sinequan, Silenor)
      5. Clomipramine (Anafranil)
      6. Protriptyline (Vivactil)
      7. Desipramine (Norpramin)
    • Tetracyclics
      • Amoxapine (Asendin) (has atypical antipsychotic properties)
      • Maprotiline (Ludiomil) (not very strong at all, about like desipramine and fluoxetine)
  • Antihistamines
    • Cyproheptadine (Periactin)
    • Hydroxyzine pamoate (Vistaril) / hydroxyzine hydrochloride (Atarax) (the pamoate form is more lipophilic, crosses the blood-brain barrier better)
    • Probably promethazine (Phenergan), but might not be worth your time...
  • Misc.
    • Addy (flibanserin) (this is indicated for female sexual interest/arousal disorder, but could possibly be prescribed off-label, it's basically a failed antidepressant that got repurposed as a drug for another condition)
    • Nuplazid (pimavanserin) (this is an atypical antipsychotic without dopamine antagonism indicated for psychosis in Parkinson's disease)

I hope this helps, and I hope I don't misguide you in any way. Definitely talk to your psychiatrist, please, about this.

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Thanks to all of you for the support and information. I have actually been totally honest with my pdoc about everything along the way--otherwise, what's the point? To take ayahuasca, I had to stop taking SSRIs for six weeks because of a potentially dangerous serotonin syndrome interaction. I think the ayahuasca I took the first time, three or four years ago, saved my life in a certain way because it made me value life and feel grateful for it. The experience from earlier this year really messed me up, though, as it was a "breakthrough" dose that really gave me far too much information to be able to handle intellectually. I've always been a curious "seeker"--careful what you wish for!

Anyway, my pdoc prescribed Ativan this month becsuse it's evidently faster-acting than Klonopin, but it like the low-dose cannabis tincture did seem to exacerbate a spontaneous flashback experience. I feel like if I can distract myself and become more outgoing, maybe that'll keep my mind too busy to go into these thought loops. It doesn't help that I've been cooped up inside with a fever for three days. :(

I've had panic attacks for probably 10 years now, and I do believe they were initially triggered by Lyme infection because they began at the same time as my peripheral neuronathies, memory loss and and other cognitive and sensory problems. But while those were terrible, they were always triggered by social situations and so there was a context. And when I slide into depression, that feels almost comfortable because I was that way all my life since about age 12 until a couple of years ago. These sudden existential crises are something else entirely, really upsetting, and leaving me afraid I may lose control over my reality. Lyme disease is closely related to syphilis, which famously can cause madness when not properly treated, and unfortunately Lyme is far more difficult to treat than syphilis is.

I really long for a simpler life.

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