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Damn Anxiety
Jun 5, 2011

I was diagnosed with AIDS in 2008 when I was 32. I got really ill with bacterial pneumonia and had to be rushed to the ER due to not being able to breathe and was turning blue. I was in the hospital for a week. I got an HIV doc and my numbers have rebounded and have been around CD4 750/vl 12,000 since.

At first, I had really bad panic attacks. I had mild depression even before my HIV diagnosis, but it has obviously gotten worse. I started a depression medication and a beta-blocker, and they really helped a lot. I rarely have a really bad panic attack now. I have come a very long way. I have seen a therapist and was diagnosed with PTSD. At first, I thought that only happened to soldiers, rape victims, etc, but learned a very traumatic event can cause this in many people.

My biggest problem now is getting really stressed out and full of anxiety when traveling. I feel like something bad will happen to me far from home. I have this irrational fear that I will suddenly not be able to breathe, or will have to be hospitalized far from home. If you have a chemical imbalance and PTSD, do you just keep treating it with meds and therapy and hope it will get better? I guess I'm wondering what you would tell your patients they can do on their own when not in a therapy session? Talk to yourself about how irrational the thoughts are? If something would happen, you're not likely to die and would just seek treatment? Meditation?

Response from Dr. Fawcett

Depression and anxiety are common among people living with HIV. About one quarter will experience some form of anxiety disorder within a 12 month period, and 60% will have either depression or dysthymia (a milder form of depression) in a 12 month period. It sounds like therapy has helped you a great deal, but in times of stress, such as traveling, the symptoms become worse. This is not unusual. There are a number of interventions you might try. PTSD can be successfully treated with specialized therapies such as EMDR or hypnotherapy - those symptoms can be resolved. Depression and anxiety can have multiple causes and selecting the best treatment requires determining the source(s). For most people, depression is most effectively treated with a combination of antidepressant medication and talk therapy. Such talk therapy includes the cognitive behavioral techniques you mention, such as refuting irrational beliefs. Meditation and breath work are also powerful tools that, with practice, are very effective. It sounds like you are on the right track - you may just need to practice and apply those skills on a regular basis.

-David



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