Emotional feeling of panic/terror

[Echo]

Hello everyone! I used to be around on this forum a few years ago when my episode was really bad and then eventually it got better and I just carried on with life as best as it would allow. Now I'm in the middle of a new episode/flare and I'm scared more than last time.

I want to ask, does your pots/dysautonomia cause you to experience feelings of terror or awful doom or sometimes like you're going to lose control psychologically?

I'm not talking about the physical anxiety symptoms such as tremor, rapid heart beat etc which I also get. I'm talking about the internal psychological/emotional experience.  

These are not classic panic disorder type panic attacks, because I have had these and it feels different. These feelings strike out of nowhere (well not nowhere, it's dysautonomia but I hope you know what I mean) and feels like the brain is glitching or something. For me at the moment it is happening when I am falling asleep or I wake up from it. 

It is extremely frightening. 

I haven't been able to eat or drink much lately and I am exhausted. I am malnourished and exhausted. I am hoping that these experiences will subside once I am able to eat properly and get some rest, and I'm planning on contacting my gp clinic and urgently getting a prescription for some mild short term sedative to at least just give my body a break and a chance to start rebalancing itself. 

Please tell me I'm not weird and that at least one person understands what I'm talking about when I say psychological feeling of terror/doom...not just physical symptoms of anxiety.

Thank you!

P.s. this only happens when my dysautonomia is generally being awful and not at all a regular occurrence so I know it's not a purely psychological problem. It has also gotten worse the longer I've gone without eating/drinking enough which I know just puts more stress on the body/brain. I would go and take myself to the ER for an IV but my country is currently under strict complete lockdown for Covid and I'm not vaccinated yet so I don't want to take the risk of going into a hospital. 

 

 

[Pistol]

Hello @Echo - you are not crazy! These episodes of impending doom used to happen to me when I was at my worst. I have HPOTS and NCS and used to have tons of syncopal episodes and autonomic seizures. The latter are caused by sudden dumping of adrenaline causing sudden and severe vasoconstriction, which in turn stops all blood flow to the brain. When the adrenaline would spike I always had a feeling like you describe: not panic or anxiety but rather a feeling of extreme excitement and the feeling that something bad is going to happen. I do believe that in my case the RESULTING anxiety over having a seizure made it worse, but was not the cause. 

It also will happen during or right before sleep when I am in a flare. Not eating enough will contribute to the stress on the body and cause worsening adrenaline spikes. It is a horrible cycle that is difficult to stop! The best thing I can do when that bad is REST, DRINK and get IV fluids. Fortunately I have been stable since getting a port and weekly IV fluids for the last 3 years, so I can only tell you that getting infusions during a flare are the only way I can stop it. I have never been able to stop a flare without them. 

I hope you will feel better soon. I completely know what you are talking about, and it is NOT anything psychological ( at least in my epxerience ). Be well!!!

[toomanyproblems]

Hi Echo. A sense of impending doom is actually a classic POTS symptom. Not everybody has it but it's been a consistent problem for me from the beginning of when I recognized that I had POTS. It's now taken on two forms. One is just an overall feeling of doom -- like something bad is going to happen to me or the world. Like a cloud of doom hanging over me all the time. The second is a wave of horror and dread as though someone just told me my daughter had died or something that significant. The waves will often happen in the middle of the night and wake me up or as I'm trying to go to sleep as you describe. They certainly disrupt any normal activity for me and make it hard to get back to some kind of baseline.

I feel for you because this symptom is very upsetting, especially on top of everything else that makes us feel bad with POTS. The last month in particular has been very difficult for me and I'm having a hard time clawing my way back to better ground. The bottom line is this symptom is not anxiety like non POTS people experience. It's part of the disease. 

[MikeO]

Hi @EchoNo your feelings are not weird. I get feeling of some impending doom from time to time. While i do not have POTS i do have some component that falls under dysautonomia.. For me when this happens is i get very restless. I can't eat, sleep or otherwise find a way out of it. Yes it is a horrible experience.

I never attributed this to dysautonomia but certainly sounds like a symptom that comes along with it. I have had so many things go bad with my health i always figured it was triggered by one of my other issues. Before i even knew i needed heart bypass surgery this would happen all the time.

I hope you can get in to see your GP soon.

Best Wishes!  

[MomtoGiuliana]

As others have said this is a common symptom.  I definitely struggle with feelings of fear, sense of doom and anxiety when I have a flare up and I know a lot of it is being caused by the condition and not because of it (if that makes sense).  Meditation and breathing exercises can be helpful for me.  And also understanding that the feeling is rooted in a physiological cause can help a bit.  It's hard.  Sorry you are going through this.

[Echo]

Thank you everyone for your answers! It is reassuring that I'm not the only one. It feels very isolating to think no one else experiences this.

So many times in this forum I come across people talking about how they have panic attacks or panic attack like symptoms but they only discuss the physical aspects and often mention they don't feel emotionally/psychologically scared or panicked. For me this is the worst symptom and I'm glad to know I'm not the only one experiencing this. I really wish my symptoms of dysautonomia were purely physical not that I'm trying to say having physical symptoms is easy, but it's just when you feel your mind/brain is letting you down as well it's just a stress you really don't need.

Thank you for your responses!

[sunbun]

I get sudden feelings of terror at night called hypnic jerks. For me they are very bothersome and if I am flareing or overtired I get more of them, sometimes 8 times a night. I get flashes of white light that seem like someone took a picture with a flash camera. Sometimes hear whispers or people saying my name. Sinking feelings like being on an elevator hurtling towards the ground floor. Feeling like I am passing out and fainting even while lying down. Even a few episodes where I thought I was dying and screamed and leapt out of bed. I get sudden feelings of extreme anxiety and ‘dropping’ to the ground all day too. Like being on a dropzone ride at the funfair. My eyes will go all googly or ill get sudden fizzing or sizzling noises in my ears from nerves (I think) and whooshes in my head and ears.

The surges also happen in the morning for me. My body dumps a huge load of adrenaline and cortisol. My chest will feel tight and painful. I feel like I can’t breathe properly. I will feel dizzy and the walls spin. My heart rate is very high and I need to wait 10-15 minutes for it to calm down. I feel intense feelings of panic, dread, sick to my stomach when this happens. If I attempt to get up, my hr will shoot even higher and cause me to pass out and hyperventilate. So I need to just wait it out, drink some water and breathe deeply.

Before I got diagnosed, I would frequently and randomly burst into tears, from stress and cortisol overload I think. Like just randomly tears would start pouring out of my eyes. I noticed myself getting a lot more short tempered and impatient as I get older unfortunately. After years of being dismissed and called weak or a malingerer, I’m not a huge fan of other people anymore. They annoy me much more than they used to.

[Rexie]

So sorry you’re experiencing these issues, Echo. Things that have helped me with similar issues are taking 660 mg pressed root of Ashwagandha (Withania somnifera - starts working within 5-10 minutes), and if something more is needed – a 350 mg capsule of Passion Flower (Passiflora incamata) and/or Chamomile (Matricaria chamomilla) as tea. I usually take a daily probiotic (“psychobiotic”) that has lactobacilli and bifdobacteria bacteria which are able to influence central nervous system (CNS) function. The more recent addition of 400 mg of Slippery Elm to my nighttime ashwagandha has made a huge difference in positive, good feelings, both physically and mentally. Possible Sjögren’s syndrome (that desiccated intestinal, throat, mouth, eyes, etc. occurrence) had me out-of-whack more than usual these past few hot months. The Slippery Elm is a nutritive and demulcent; its mucilage and antioxidants help relieve inflammatory bowel conditions and help provide a good medium for the probiotics. 

Ashwagandha reduces serum cortisol levels; increases serotonin; increases the catecholamines dopamine and its metabolite as well as homovanillic acid; ashwagandha has also been shown to reduce epinephrine, glucose, triglycerides, creatinine, IL-6, alanine aminotransferase, and aspartate aminotransferase. For me, ashwagandha is an excellent herpes simplex 1 (fever blister) antiviral, greatly reducing reoccurrence of blisters on my face which always make me feel physically horrible, nerve-wise. 

Passion Flower increases GABA (A & B). It relieves over-stimulation, spasms, and fasciculations. 

Chamomile has anti-anxiety and mild sedative effects that are attributed to its apigenin, a flavonoid that binds to benzodiazepine receptors and potentiates the activity at GABA A receptors. Apigenin also stimulates uptake of tyrosine, resulting in increased monoamine production. Apigenin may also inhibit the MAO enzyme, further increasing the availability of monoamines. An increase in serotonin may be related to its anxiolytic effects.

Slippery Elm (Ulmus rubra) causes reflex stimulation of nerve endings in the gastrointestinal tract and at remote locations (respiratory and urinary tracts, mouth, etc) leading to increased mucus secretion and less dryness. It is used in a wide variety of GI conditions and makes for a quiet, happy tummy. Additionally, the quercetin in slippery elm is an inflammation-modulating plant flavonoid that helps alleviate my symptoms of interstitial cystitis (IC). 

Probiotics (“psychobiotics”) as capsules or as yogurt containing lactobacilli and bifdobacteria or others are able to influence the CNS function. Scientists have found that gut bacteria produce neurotransmitters such as serotonin, dopamine and GABA which have been found to modulate neural signals, affecting neurological and psychiatric parameters, as well as sleep, appetite, mood and cognition. The reciprocal influence between the GI tract and the CNS is sustained by the enteric nervous system (ENS) which is considered as the third branch of our autonomic nervous system. 

GABA (Gamma aminobutyric acid) is our principal inhibitory neurotransmitter in the central nervous system. It can be made from glutamate, the major excitatory transmitter in the brain. Cortical excitability reflects a balance between excitation and inhibition. Dysfunctions in GABA metabolism are involved in anxiety and depression. GABA is also involved in the regulation of blood pressure and heart rate and plays a role in the perception of pain and anxiety. 

Vitamin B6 is important for GABA production, so if you’re not eating properly (even a mixed ingredient smoothie counts as a meal), you might consider taking a Vitamin B supplement which will contain balanced amounts of B6.  

Once you’ve done all can you can to support proper bodily function, please remember that we’ll have many thoughts and feelings flit through our minds. It doesn’t mean they are real, right, or good or even our own. Most people with chronic conditions develop super sensitivity to the thoughts and feelings of others, audible or inaudible, near or far. Sometimes they can be fun, energy-wise (national holidays, for example), but more often than not, unpleasant. Those wake-sleep times are often opportunities for the entry of these spurious thoughts and feelings. We are in the midst of a worldwide pandemic and are constantly bombarded by horrible images and pronouncements about not only Covid but also wars, bombs, floods, fires, hurricanes, collapsing building, etc. The world is hurting and its people crying out. To remain undisturbed is getting difficult, but you must find ways to protect yourself from this undue stress not your own. I like reading, there’s nothing like a good story to divert the mind. If too agitated to read or meditate I’ll play phone games while waiting for my calming herbs to work and for my body/mind to rebalancing itself. Often just a quick errand or walk around the yard is enough to clear my head-space. You do not want to linger in these bad places, wondering and worrying – divert yourself with your favorite things then go back to peaceful sleep or wakeful productive activity. 

Hope you feel better soon, Echo! 

[Rexie]

Echo, those “feelings of impending doom” are mentioned in this review article of POTS:  
Postural Orthostatic Tachycardia Syndrome Misdiagnosed as Anxiety: A Case Report with a Review of Therapy and Pathophysiology, Hassan Kesserwani, Cureus, Vol. 12(10); 2020
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652348/ 

The point of my previous post was meant to reassure you that we can develop mental and personal habits that help us ignore the doom feelings or counteract them with improved feelings. The GABA-increasing herbs I use help me suppress/counter-balance excess sympathetic responses (hyperadrenergic) – kind of like adding brakes to a speeding sports car.