How I Beat Anxiety Naturally (Part 2)

Two weeks ago I posted about my journey to anxiety (How I Beat Anxiety Naturally  – Part 1) and today I am excited to share with you my journey away from it (and how to actually beat anxiety, for the most part, anyway)!

Disclaimer #1: I am in no way putting down anyone who chooses to take prescription medication for either short term or long term maintenance of anxiety. Do what you need to do to survive, friends. For various reasons, I preferred not to take medication for more than a few days in a row at the time that I developed generalized anxiety.

Disclaimer #2: I am not a medical doctor, and the recommendations that follow are simply an account of what I myself did to treat and manage my own generalized anxiety. Please consider seeing your medical doctor or licensed therapist before trying any of the healing strategies below.

Medication Gone Bad

To recap, our family was subjected to a substantial number of challenges and life changes in a short period of time, after which I developed what was diagnosed as generalized anxiety. The initial week when I can say I truly developed the anxiety (the onset was very sudden and strong), Fergus and I were recovering from a bad stomach bug. I don’t know if being ill somehow was the catalyst in bringing it to the surface, or this was just a coincidence. In any case, after a few days of being miserable I decided to mention it to the doctor who I had previously seen for nausea relief with the stomach flu. He claimed that anxiety was very common among Dubai expats, particularly when you first arrive and try to get settled, and prescribed the benzodiazepine clonazepam 0.5 mg per day (known as ‘Rivotril’ here) for two weeks, as a temporary crutch to get me through this phase and out the other side back into normality. I was a bit unsure about it all, but truly did need relief at that point to function and get Fergus to school, etc., so I decided to take it. As a side note, benzodiazepines are very much a controlled substance here, and patients are under no circumstances put on them daily indefinitely as is commonly done in the US and other countries, for example. Legally (from what I was told), physicians can only write a script for two week’s worth, only certain doctors are authorized to do so, and only certain pharmacies are authorized to dispense them. Anyway, I took one tablet and felt much calmer in a very short period of time. I decided I was cured and didn’t need to take anymore, and then in a couple of days the anxiety came back so I took another tablet. I felt really sleepy on them, and as a friend hysterically told me before I swallowed my first dose, I could have happily jumped off the Burj Khalifa (the world’s tallest building, here in Dubai) without one bit of concern or second guessing! I continued to take the medicine every couple of days, but cut down to a quarter of the dose at a time (which extended my two-week supply by several weeks). Every time I took the one-quarter tablet I was good for a few days, but the anxiety would creep back again. At the advice of people around me who had to deal with me on a daily basis, I decided to take my self-imposed quarter dose daily, continuously until I had no more pills, and take it from there.

After I ran out of the clonazapam, I felt pretty o.k. and ‘normal’, however, I had a fear that if the anxiety returned with a vengeance, I wouldn’t have anything to put the fire out. I was booked in for a well woman check-up, so decided I would just explain the situation as part of my check-up and grab myself a few more pills to have on hand for ‘anxiety emergencies’. When I asked the doctor about this, she replied that she was not legally able to write a prescription for them, and sent me to a psychiatrist in the same clinic. I was a bit weary of going, but decided there was no harm in it. If I only knew…

So, I suddenly found myself sitting in this male psychiatrist’s office and the next thing I know he is telling me that I cannot have any more clonazapham and that I need daily long-term medication, to the tune of escitalopram (known as Lexapro in the US). I maintained that I did not think I had suffered long enough with anxiety to warrant daily drugs, but he insisted that this is what I needed and he knew best. Now, I do realize that he is a trained medical doctor and that I am not. HOWEVER, I found it at least somewhat disappointing that he did not mention (or even consider, apparently?) that there could be other underlying health and wellness issues that could be causing my anxiety, and did not bother to order any blood testing or take an extensive medical history. I left upset, somewhat in tears, and with the pack of Lexapro and more confused than ever.

Without divulging too much family history and demons, let me just make a mention that my mother and her mother are/were heavily medicated for anxiety and depression. Their illnesses are complex and multi-layered, and they were initially medicated in what seems like a completely different era from our current time and space, with little to no self-awareness of what contributes to healthy or unhealthy mental and emotion health, and much less knowledge about other imbalances which can trigger anxiety (thyroid levels, vitamin and hormones levels, etc.). Anyway, with this pack of Lexapro in my hands, I was met with the fear and realization that this, too, had become my fate. I had thought that I was ‘safe’ because I had made it way past the age that both my mother and grandmother had their various breakdowns and difficulties. However, at that moment, I hung my head in shame, feeling defeated and let down by my own brain, body and ability to stay sane.

Coming home, I sat the box on the counter and stared at it all day, refusing to take the plunge until right before going to bed. I took the tablet and went to sleep. Little did I know that was the start to one of the worst nights of my life.

A couple hours later I awoke in sheer panic. Much more so than what I had been previously feeling with the generalized anxiety. I was breathing, but felt that my brain and lungs were not getting any oxygen. My heart was racing frantically. I was completely soaked in sweat. I spent the entire night in such a heightened state of panic, that I was more than half-way convinced that I was going to have a heart attack and die in that bed before the sun came up. I was nauseous and gagging but nothing would come up, as I had an empty stomach. I felt out of control and unable to function. If we had been closer to a hospital, I would have had Kevin call an ambulance to take me to the ER. The symptoms continued the next day in full severity, and I was a disaster. I didn’t eat or drink for 36 hours, due to extreme nausea and gagging, and was so full of fear that I can’t really even put it into words. The medication had completely taken over my body and mind. I managed to call the doctor and explain this to him, and was met with lots of, “You must continue this medicine, love”, and dismissal, as if I were a child, even after telling him I had not been able to eat or drink. I hung up, was in tears, and didn’t know what to do.

I decided to consult a friend who is also a psychiatrist in the US, who off the record gave me some advice. I obviously had a bad reaction to the Lexapro, and the dosage he gave me was twice as high as she would have recommended. Also, she mentioned that she routinely gives clonazepam in addition to the Lexapro for up to several months(!!!) to lessen the intense side effects of heightened anxiety that many people experience when starting the Lexapro. She also mentioned that I could try to get some more clonazepam to try and mitigate the Lexapro side effects and get myself back to baseline normal after a few days. So, seeking out a doctor that I had not seen before and starting all over again, I got a hold of some more clonazepam. My heart rate was through the roof when I saw her (from the Lexapro), and explaining the situation, she had the sense to ask me about my medical history and order some blood tests.

At this point, I knew it was time to put on my detective’s hat and start looking for causes of the anxiety, and take on what would likely be a multi-pronged approach to reliving it and managing it. What follows is an account of what I did.

Physician Testing

The doctor above (in Dubai) tested my vitamin D, vitamin B12, magnesium, thyroid levels (including free T3 and free T4) and did a CBC, and all came back within normal range.

Not too long afterwards, I flew to Bangkok to see my endocrinologist, as I was due for a thyroid ultrasound. A few months after Fergus was born, I was diagnosed with thyroid nodules, and we have been keeping a close eye on them. {I should say that thyroid problems are apparently a HUGE cause of anxiety in women, so if you are suffering and have not had your thyroid checked, this would be the first thing I recommend you do.} I also had a thyroid biopsy performed for the first time, in order to check that the nodules were not cancerous (not fun, but manageable). Funny enough, while waiting to enter the operating room to get the biopsy done, my heart rate was 80 bpm, which was way lower than it had been for months in Dubai. I considered what I had been secretly wondering all along – that life and the environment in Dubai was partially contributing to my stress and anxiety, and funnily enough, the chaos of Bangkok was where I felt safe, relaxed and ‘at home.’ It was a bit ludicrous that my body and nervous system seemed to prefer to have a thyroid biopsy in Bumrungrad Hospital in Bangkok  to sitting in our beautiful, modern rented house in Dubai.

The biopsy results were revealed the following day, and everything looked o.k. I spoke to the endocrinologist about my blood tests, and she pointed out that my vitamin D was only within the normal range by one point, so I really needed to stay on top of supplementing. She also tested for low zinc, which she claimed can also contribute to anxiety, but the levels were within normal range. I mentioned to her that a year prior (summer 2014) I had done a 12-hour saliva test for cortisol, and the results were extremely high. A lot of people (and the internet) like to claim this is adrenal fatigue, but she said this is actually the opposite of adrenal fatigue – it’s adrenal over-activity, if you will. If not lowered by lifestyle changes, this situation of being in a constant fight-or-flight mode can result in adrenal insufficiency, where your adrenal glands are no longer able to produce cortisol and/or DHEA in sufficient amounts. So, I needed to lower my cortisol levels. I suspect that high cortisol for such an extended period of time had gotten me into this anxiety mess in the first place.

Spirituality

As a person who ascribes to a religious faith and believes in a higher power (I am Eastern Orthodox Christian), it is quite possible that my anxiety was worsened or sustained by a lack of faith in God’s control over my life. Since moving away from my home town of Houston and my beloved church community, it is true that I have felt more than a bit isolated from my spirituality at times, and isolated from God. However, I honestly didn’t feel that this was the main or even one of several of the main reasons for developing anxiety (but I could be wrong – who knows!). It really did feel like I was hostage to these unpleasant feelings from something in my body which I could not control, and not from my mind or soul, if that makes sense. It was really a case of feeling like a switch was flipped overnight, turning on anxiety. Either way, it was a helpful exercise for me, anxiety or none, to remember to place my trust in God’s will.

Another thing which I will lump under the category of ‘spirituality’ is remembering to keep in context my problems and how they compare with what could be even worse. For example, Kevin had skin cancer, but for now it was removed and he is o.k. Contrast this with someone who is actively losing her husband to some kind of cancer at this moment. I needed to remember to be grateful things weren’t worse than they were.

Lastly in the spiritual category – being kind to myself. I am not a person who is known for being kind to myself. I’m not out running marathons or doing something physically demanding, but I tend to take on a lot of things at once, am always trying to help people (with my raw food work or other areas of volunteering, coordinating, organizing, etc.). I manage the house and all the chores (which is normal for a middle class Western woman, but completely abnormal for expat women who have life-in staff), I come up with crafts for Fergus to do, I have somewhat high expectations for things. However, what I learned is that if I am having a bad day, I need to be kind to myself. With a three year old this did not mean go back to bed, but could mean to stop overscheduling during a bad week, order food in if it’s a particularly anxious afternoon, take a bit longer to reply to emails and messages if I feel overwhelmed, take a warm bath at night if I feel tense, and just generally let things go a bit more. I can always catch up later. I probably needed to adopt this mindset about a decade ago, but better late than never.

Books

Spontaneous Happiness by Andrew Weil – I picked this up by chance, as I was actually looking for something else. While the book mostly focuses on depression, anxiety is addressed more than a few times, and I got some of the herbal ideas you will find below.

The Anxiety & Worry Workbook – David A. Clark and Aaron T. Beck – This book uses cognitive behavior therapy to determine mental and emotional anxiety triggers and help to change thought patterns and behavior through reading, exercises and worksheets. It’s a lot of work, and I have been picking it up and putting it down on and off, but for those who can’t afford long rounds of CBT in-person (hands up!), this is a great book to have.

Herbs and Supplements

DHA/EPA – Although depression is not a problem at this point, I decided to up my daily intake of DHA for the sake of mental health, in general. In Dr. Weil’s book mentioned above suggests amounts of up to 4g per day as a therapeutic dose for depression (I used to shoot for 1g/day), so perhaps this would also have an effect on anxiety? I tend to rotate DHA supplements, formerly using vegan brands (from algae), and more recently using Nordic Naturals. You really burn through it when taking such high doses, though!

Just out of curiosity, I decided to do a home omega 3 blood test, the results of which indicated that I was lower than the optimal range.

Milky oats milky seed – Recommended to me by friend and herbalist Natalia, milky oats seed was the first thing I added into my daily regime to combat ‘nerve fray.’ I shoot to take a dropper full of this brand of milky oats 3 x day (approx. 1.67 ml of extract per dropper full), although sometimes I miss a dose. Natalia also suggested several other herbs, including blue vervain, which I took for a while and then took a break from.

Oxymels – Also from Natalia, I started making oxymels, using calming herbs like chamomile and lavender. They are actually really nice to drink, and I mix a few spoons of oxymel concentrate with sparkling water and feel like I have a special medicinal mocktail in my hands!

Kava – Kava is basically a miracle elixir for me, and is reported to calm the nervous system. In the beginning, I was taking a dropper full of this brand once or twice a day, although the bottle says that you can take it up to 5 x day. Kava is reported to be as effective as benzodiaphines, and although I’m not sure I get that level of anxiety relief, it’s definitely the most potent and fastest-acting thing I have found besides the benzos. I now only take it when I am feeling a bit tense. Kava contains two compounds which bind with nerve receptors on the tongue and lips, which can leave you with a bit of {temporary} numbness, so mix it with a bit of water and just chug it down quickly. Yogi Tea makes a tea with kava, but I found that it was nowhere near strong enough to make any difference to how I felt.

Ashwaganda – Previously recommended by my Ayurvedic doctor in Bangkok, and mentioned in Dr. Weil’s book above, ashwaganda is thought to be a powerful adaptogen, helping your body to adapt to stress in all forms – mental, physical, emotional.

Physical

Yoga – When things first got really bad, I found a private yoga teacher to come to the house and do hour-long sessions once a week. At that point, I felt I needed special attention and felt too anxious to want to drive across town and join a class. Taking time to myself to stretch and relax, along with a guided meditation session at the end of the yoga, really helped to calm my thoughts. During the summer the instructor took a holiday and Fergus was home, so I ended up discontinuing the private lessons and joined a group here in our compound practicing in the evenings, when Kevin was home to take over childcare.

Meditation – I had downloaded the popular app Headspace nearly two years ago, but had not been very diligent in using it. I made this more of a priority and upgraded to the paid subscription, which has guided sessions as short as 3 minutes, and special ones for anxiety (they call it, “SOS”). Before anyone jumps all over me and tells me I need to be careful of spiritual corruption, these sessions are non-religious and non-spiritual in nature. Andy, the audio guide, pleasant walks you through with breath work, noticing which of your body parts are tense or anxious, and gives you prompts for counting your breaths, etc. There is no mention whatsoever of prayer to anyone, worshipping of anyone, any religious words or terms or mantras that are repeated. I found it a good way to stop and scan my body from head to toe and consciously learn to relax any muscle that might be tense. It is amazing, when living with active anxiety, how we often have a tendency to keep particular body parts tight/clenched/flexed (e.g., jaw, stomach/abs, shoulders up as opposed to down and back and relaxed, etc.).

In order to try and add some accountability into my routine, I formed a guided meditation group in my community compound and brought in a teacher to lead us for a while.

Acupuncture – I had read that acupuncture can have a high degree of success in managing anxiety, so I started receiving monthly acupuncture treatments from a wonderful female TCM doctor here in Dubai who comes to your home (again, avoiding the need to drive across town to do this while actively anxious). Believe it or not, the home visits were actually more affordable than journeying into Jumeirah and paying for a session at one of the big clinics, where you are apparently often paraded through like cattle. If you would like the contact details of my doctor, please leave me a comment with your email address, or send me a message.

Warmth/Weight – A friend who suffers from anxiety mentioned blankets to me, specifically weighted blankets. I have seen them for babies and know they are sometimes used for helping with sensory processing disorder (in all ages), so I started using a heavy blanket at night on top of my normal bedding. This had the added benefit of keeping me extra warm, which would be an Ayurvedic technique for managing excess ‘vata’ dosha, which I am prone to, according the ancient Indian medical system. I also started making sure I was warm during waking hours, and cut back on ingesting cold drinks and cold smoothies.

Floating – I started going to the community pool in the evenings and just floating around, letting the water support me (and making sure to stay warm, as noted above). I like to call it “float therapy.” I am aware that float houses are now a thing, but they are an expensive thing, and not something I can easily be paying to do every week. Since the community pool is free, it was and still is my preferred float tank!

Walking – I tried to make a point to go for short walks at night, to just shake the jitters off, so-to-speak. The Headspace app has a nice walking meditation track which you can listen to with headphones while on short walks.

Hormones

I had suspected that hormones might be playing a role in this mess, but I wasn’t sure how, besides the high cortisol levels that had been identified a year prior to developing the anxiety symptoms. When I had implemented all of the above measures, my anxiety drastically dropped, and even entirely disappeared on most days, but I was still getting a few weird flare-ups here and there. This was seemingly at random, until I decided to start writing it down on the calendar (my ‘panic days’, as I called them to myself). Low and behold, I started to notice a crystal-clear pattern – the two or three days before the onset of monthly menstruation were my panic days! The TCM doctor had indeed asked me if I had noticed a pattern with the anxiety and my monthly cycle, but at that time when she first started coming to perform acupuncture on me, I was anxious all the time, so there was no pattern! Once my body calmed down, I was just left with a few days a month of horrible anxiety, with the rest of the month clear. So, the plan of attack was to schedule acupuncture for a few days before menstruation, in order to counter act whatever my hormones were doing to me. This has been a hugely successful tactic and one that I will continue as long as I can. I need to further investigate what exactly is happening during this time and see if there is anything I can do to balance things on my own.

On a side note, when I posted about my anxiety on my personal Facebook profile, I received numerous messages from friends my age who had started to develop the same symptoms, and who also noticed a peak in anxiety a few days before their periods. I am wondering if we are entering peri-menopause, or at the very least, our hormones are downshifting as we edge closer to our mid-40s?

Current status and a few thoughts

I am happy to say that my anxiety is largely under control at this point, nearly one year after it started. I have gotten a bit lazy about supplements because I feel fine, but I plan on trying to stay on them as much as possible for a while. Our family has some turmoil brewing in the near future, and I need to stay grounded to be able to handle what comes next for us. I am eager to look into hormonal testing and see what I can decode about how female reproductive hormones might be playing a part in all of this.

One common thread among friends that have shared their similar stories with me, is that we are all older mothers with no help from family or friends or nannies/maids in raising our children. When you are in your 40s, have a toddler, and are thousands of miles away from your own family and your own culture, with husbands that work long hours and frequently travel, it can be emotionally, mentally and physically taxing. Fergus has always been awake well before the sun rises, and still usually doesn’t sleep through the night, so it is possible that long term exhaustion is partially at play. As older expat mothers, we are missing ‘the village.’ Yes, I could have paid a stranger to help take care of my child, but that was never something that felt authentic to me, and anxiety and all, I have zero regrets about not having paid staff.

An additional theory – the mid-life crisis! While I don’t feel upset, rarely cry (maybe once a year?!) and am not depressed at all (even when I was anxious), there might be a bit of a feeling of ‘is this it?!’ or ‘now what?!’ to this type of lifestyle Kevin and I have chosen for the past 9 years. Of course, plenty of people back home in Houston with stable careers and a house they own and roots down also experience anxiety, but for me, perhaps there is an element of not having a plan in place for next year, for example, and wondering if we should be doing something different with our lives. When you are in your 20s, you still have plenty of time for ‘course correction’ if you chose the wrong path (wrong career, wrong partner, wrong place to live, etc.). In your 30s, I suspect people are distracted by child-rearing. But in your 40s – well, you don’t have a lot of time to change the course of your future (although I do acknowledge that it is entire possible, just generally-speaking). Maybe that is partially to blame, but I just haven’t really consciously thought of that until now (meaning, perhaps it was subconsciously making me anxious, bubbling beneath the surface of my psyche).

I any case, I would LOVE to hear your thoughts and feedback on all of this! I know so many of you have written me privately, and I have kept that in confidence. However, if you in any way feel compelled to share your experiences here in the comments, I am sure that many would benefit from reading them. We are all in this together, and we can all help each other get out of it together, right?!

Be sure to check out How I Beat Anxiety Naturally – Part 1, if you want to see how events in our expat life lead up to my jitters!

With love and kava,

Additional notes:

Natalia is available for herbal consultations from a distance. If you would like to contact her about scheduling and rates, please do so here.

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