A country at war. The soul needs to be dealt with without delay / Official website, Sderot Municipality Spokesperson
Dear Dr. Rabinovich,
Thank you very much for the opportunity to help. I went to an HMO and there is no appointment close to a psychiatrist.
I am 38 years old, completely healthy, do not smoke with normal blood tests. I have been taking Cipraclas for the past two years at a dose of ten milligrams, which was given to me by the family doctor at the HMO following a divorce crisis, which caused severe anxiety and stress characterized by distress with an accelerated pulse, distress and a feeling that everything was closing in on me with no way out. But since then my life has entered a new and good normal.
The first alarm on Saturday took me backwards and hugely. The girls are with me most of the time when I don't have school, I try to work from home but have a really hard time concentrating. Every whisper makes me jump. The TV is on 24/7 so we can catch up and not miss any warning, the girls went to sleep with me, the building is old and without a safe room or shelter, so every alarm goes off we sit with the neighbors in the stairwell, scared and hugged.
"I am considered by my friends to be Superwoman with receipts for impressive results in various fields and now I am exhausted, I want to get under the blanket and not be here, wake up from the nightmare to another reality."
I'm very nervous. Fears run through my head all the time about negative scenarios of Hamas terrorists who infiltrated from Gaza, continued to the center and took over our building. I see pictures on TV from Sderot and the Gaza envelope and am convinced that the residents of the center are also not vaccinated. Since Saturday, I've been experiencing tightness in my chest and a feeling that it's hard for me to breathe and I don't have air. I run frequently to the bathroom (with the door open), I haven't showered for a week for fear that the alarm will catch me in the middle. Yesterday, following the great barrage of missiles on Gush Dan, I couldn't fall asleep all night.
What do you advise me - increase the dose of Cipralax to one and a half pills (15 milligrams)? Would it be right to take a 0.25 milligram Bondormin sleeping pill from my mother?
Am I losing control and going crazy? Rationally, I understand how to drive, but without control over my situation, which makes me even more nervous. I am considered by my friends to be Superwoman with receipts for impressive results in various fields and now I want to get under the blanket and not be here, to wake up from a nightmare to another reality. I empathize so much with the bereaved mothers and wives, I cry with the families of the abductees and missing in front of the TV. I'm ashamed that I feel that way compared to them.
I would be very grateful for your help,
M. Ramat Gan
Dr. Ilan Rabinowitz replied:
Hello M. dear,War
is a stressful state of the highest order and completely normal. It is forbidden to compare the objective reality in which people find themselves, because what matters is what the person feels. You must not feel guilty in front of the families of our fallen and missing.
From the same place where you are considered a soldier's wife who successfully juggles between a career and home and raising two daughters, you are the perfectionist, Control Freak, currently suffering from a recurring flare-up of anxiety that manifests itself in a variety of physical manifestations, as you described: accelerated pulse, chest tightness, shortness of breath, urgent and frequent runs to the bathroom, and more.
These symptoms describe a panic attack, a condition in which a person feels a sense of loss of control, on the verge of fainting, and whose body collapses, just as happens during a heart attack or neurological event. In addition, these symptoms are accompanied by uncontrollable intrusive thoughts that cause distress and additional stress.
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"These symptoms describe a panic attack, a condition in which a person feels a sense of loss of control, on the verge of fainting, whose body collapses, just as happens during a heart attack or neurological event. In addition, these symptoms are accompanied by uncontrollable intrusive thoughts that cause distress and additional stress."
You must listen to the news all the time, not to miss a crumb of information. It is likely that there are symptoms of OCD (obsessive-compulsive disorder known as "the disease of smart and successful people") because what helps you succeed in life is your perfectionism, workaholism, the fact that you are a control freak, orderly work and study methods, a head that works non-stop, and more. And all of these are currently at your disadvantage. Because the situation on the ground does not allow you to be in full control.
The problem in such a situation is that it is the result of an imbalance of the autonomic nervous system and the activation of the sympathetic system into survival mode: fight or flight, that it can be progressive, like a snowball on a slope, and then the "anxiety in the face of anxiety" begins, sleep disturbances (insomnia) or early awakenings begin. In addition, there may be a slide into depression that accompanies anxiety.
If for two weeks in a row you feel at least five of the following symptoms: low mood, lack of interest and pleasure, sleep disturbances, appetite disturbances, decreased concentration, lack of energy, restlessness, thoughts of guilt towards surrounding family members, thoughts of despair and loss accompanied by functional decline, I recommend that you:
1. You must get at least seven hours of sleep in a row at night. Sleep is non-aggregate and includes the first four stages and then REM sleep, the dream sleep. Even if you are a Mercedes, your body needs fuel and quality sleep is essential.
Sleeping pills from the benzodiazepine group such as Bondormin, Valium, Vaben, Lorioan Clonex and Xanax - are not recommended over time because the body gets used to them easily and within a few weeks you will have to increase the dose and then comes an addiction problem. When you want to stop, a "withdrawal syndrome" occurs, which includes, among other things: restlessness, anxiety, sleep disturbances, even seizures. These drugs do not treat the balance of the autonomic system, they only relax and make a person sleep. It is recommended to take them only with the approval of a doctor for a short fixed period, until the treating pills begin to work (about three weeks).
Adults over the age of 65 may be given only Stillnox/Zodoram, Nocturno/Imovan, as normal benzodiazepines may cause cognitive impairment.
Your physician should consider prescribing a low-dose Miro/Rameron/Mirtazepine at a low dose of 15 milligrams (a 30-milligram hemisphere), which is an SNRI antidepressant-anxiety pill that induces sleep without habituation and without addiction. It will treat both the sleep disorder and its cause: the exertion of anxiety. It goes great with Cipralax 10 milligrams. In the first days there is an adaptation and the ball "drops" for a long sleep. It's the only antidepressant-anxiety treatment that doesn't hurt sexuality, but it does increase appetite.
Another option is to administer a low dose of regular Serocowell, 25-50 milligrams. Originally used as a neuroleptic, antipsychotic and mood stabilizer therapy. But it helps sleep , and also it is without habituation or addiction. It also works great when combined with Cipralax 10 milligrams.
There are things we have no control over. IDF soldier in the combat zone in the south/Walla!, Amir Bohbot
2. Regarding the dose of Cipralax: Only your attending physician who knows your medical record well and examines you clinically can decide to increase the dose.
Cipralax is the sixth pill in the SSRI group, pills that increase serotonin levels in the brain. A specialist doctor should customize the treatment for each person. What corresponds to one, will not necessarily suit the other. Each pill has an individual profile of different effects and effects, but all of them have no habituation or addiction.
Cipralax is a very popular pill because its positive effect begins within about 10 days. It comes in doses of 10, 15, and 20 milligrams. In low to moderate doses it helps with depression. In moderate doses it helps in anxiety attacks and in high doses it helps in obsessive compulsive disorders. Unfortunately, sometimes this pill is given too easily, without thorough clinical thought by an expert. It is imperative to be monitored and monitored by the attending physician for fear of entering a manic state (high-irritable mood, overactivity, sleep disturbances, wasting money, speaking fluently, etc.).
3. No less important than proper drug treatment, recommend that you take the following steps:
- Adapting goals of positive thinking: There is no existential danger to the State of Israel, we have the strongest army in the region with the best fighters, the highest quality in the world. We have the full backing of the greatest power in the world. We will win and all we need is patience and patience. The girls and you are not in real danger as long as you follow the instructions of the Home Front Command.
- Turn off the TV or switch to children's channels and movies. You are exposed as a compulsive need for information overload that does not serve you and is only stressful. Install a Home Front Command app on your mobile device and you will receive real-time alerts, in addition to the alarm system that gives time to go down to a protected place.
- Soothe yourself with deep breaths; Be sure to shower daily, it is relaxing and refreshing; Be sure to drink water. When you take care of yourself, you also take care of your daughters – you can't lie to children and they recognize a stressed parent. Soak confidence on them, answer their questions. Don't lie, but always refine.
- The education system has started onlineclasses on Zoom from today, and in places where there is protection, face-to-face classes are also held. A busy and rich schedule is very important for you and the girls. A daily routine of work/study, playing, movies and more is the need of the hour for the home front.
- Start doing daily exercise at home with your daughters, using apps or online videos. 20 minutes at a time. Exercise is essential and releases serotonin and endorphins in the brain, which induces calm and peace.
Wishing you complete health M., and remember - together we will win!
To previous articles by Dr. Ilan Rabinowitz from the period of fighting:
1. Rest assured - we will win. But in the meantime, follow these rules:
2. Optimism, now? So yes, and you have 7 reasons to feel this way
All of the above is not a substitute for medical advice from a specialist. These are general recommendations and each case should be examined individually by the attending physician.
Any questions about depression, anxiety in children, sleep disorders, ADHD during wartime, the elderly, mediating information for children and more can be sent by text message or WhatsApp only: 054-4693068
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