Sunday, June 27, 2021
Alex Papp MD & Julie Myers PsyD
Carla is a 48 years old woman, the owner of a car dealership, a gregarious woman with a very busy life. No one would ever suspect that she has been suffering from anxiety since an early age. She has been having panic attacks since age 16, although she did not seek help until age 30 when she had a single visit with a psychiatrist, who started her on Prozac 10 mg and Klonopin 1 mg (twice a day). All subsequent treatments were merely refills given by ever-changing primary care physicians or nurse practitioners at her HMO.
Because she did not receive any psychiatric or psychological support during her almost 2 decades of medication-taking (a medication refill provided upon request by an unknown prescriber is anything but proper treatment!), she tried to educate herself about her condition and treatment. This caused her to worry about the “horrible side effects” of psychiatric medications, and the more she worried about them, the more she read about them.
You can guess the result … it was an ever-escalating set of worries, even about worrying.
When I first saw her, she had been taking the same dose of those medications for the past 17 years. A few times on her own initiative she tried to stop taking them, but she never succeeded for longer than a week. On the medications she was free of panic attacks, but she had “lots of worries about everything”. She believed that she should be able to control her anxiety by “curing herself” and was disappointed in herself because she had not been able to do so. I made a few changes in her medication regimen, which resulted in better sleep and fewer medication side effects.
After she was a bit more stable from a pharmacological point of view, she began to see Dr Myers for psychotherapy. Although cooperative and eager to change, Carla had difficulty benefiting much from therapy due to her rigid-thinking about her condition and her avoidance of certain topics. At some deeper level, she believed that her anxiety was keeping her “safe” from harm. Standard Cognitive Behavioral Therapy, considered to be effective for her condition, was just not working.
Carla began to receive ketamine, which started to decrease her rigid thinking, making her more open to a new psychotherapeutic approach about her ruminative worries. Psychotherapy was timed 24-48 hours after her ketamine treatments. But the real break-through occurred when psychotherapy was conducted while on a ketamine “trip”, when she began to talk about her traumatic childhood, which she had previously insisted was “wonderful”. During this ketamine augmented session, Carla had a leap in insight about the origins of her anxiety and hypervigilance, which began as a child to keep herself safe. After this noteworthy session, Carla began to improve more rapidly. Today, she continues to improve, learning to let go of her hypervigilance and worry.
