High Cortisol, Stress & Acne: My Anxiety Story
Powerful photo. Photo credit: "Anxiety" by Christian Sampson Photography.
This is going to be a long one, folks, but it offers a glimpse inside my life, inside my anxiety disorder, and inside my journey toward a clear mind, and clear skin. So buckle up, if you're ready.
I suffer from anxiety and I used to suffer from depression. Not just a "cutesy" anxiety that hipsters claim to have ("Like oh em gee, if my latte doesn't show up in the next 5 seconds I'm going to have an anxiety attack!"). And not just a feeling-bad-about-myself-lately depression. Like, no, I had a full-fledged anxiety and depression disorder and I am prone still to severe anxiety attacks (although, lucky me I haven't had one in months! Go, Sam!).
First, let me just say that if you don't know if you have anxiety or depression, but think you might - you should obviously see your doctor and get a referral to find out. It's troubling to live with anxiety and depression, but it's even worse living with it and not knowing you have it because it makes treatment very difficult.
I personally love the heck out of this comic by Nick Seluk (the creator of the adorable Awkward Yeti comics which constantly put a smile on my face) that shows what it's like living with anxiety and depression. It's kind of cute, but dark and sad, and then positive and empowering all at the same time. If you have anxiety and/or depression, you'll probably shed a few tears as you relate with this little stick figure along the way.
I didn't know they were anxiety attacks initially, (I thought I had a breathing problem, that my asthma had come back) until I finally went to the hospital.
Photo from around the time of my first anxiety attack.
One night I was sitting at home by myself, on the couch, doing something on my laptop. I don't remember what it was, and I don't recall the trigger. It was many years ago, now. All of a sudden this overwhelming feeling swept over me that I wasn't getting enough air into my lungs, that my breathing was being restricted somehow. It was like every time I took a breath, something stopped it from reaching my lungs, like a little stopper somewhere along the way was closing and the air only got part of the way in. This made me feel like I was losing air, that I was suffocating in a completely open room, and so I panicked.
I just sat on the couch, TV on pause, trying to make sense of it all, focusing hard on my breathing.
Every once in a while a full breath would get in, just enough for me to calm down momentarily. But the feeling that I couldn't breathe just kept coming back. After several minutes of this, I was sufficiently terrified and my anxiety was only escalating to the point where I didn't feel safe. The longer it continued, the more it felt like this "stopper" in my chest was growing, and was beginning to creep up into my trachea. So now it felt like my throat was closing up. Great.
I called my mother on the phone, crying, and in between gasps for air, I told her I needed to go to the hospital, that something was wrong. She got out of bed, drove to pick me up, and we went to the hospital. I breathed deep, desperate and raspy breaths the entire 25 minute ride, tears streaming down my face. I don't think my mother and I were able to speak the entire ride, as I was hysterical. All I managed to blurt out was that I couldn't breathe.
I remember walking up to the intake desk at the emergency room. At this point my breathing was so heavy, loud and raspy the nurse behind the desk gave me a brown paper bag and had to help me steady my breathing. She seemed like she wasn't impressed with me, almost impatient. She kept telling me I needed to breathe slowly, that I was going to hyperventilate.
Unfortunately, I did just that, and everyone in the waiting room was staring at me. I probably looked like a drama queen who didn't get the last purse on sale or something. This was an emergency room, after all, and there was a man next to me with a stab wound in the arm.
The wait in the waiting room didn't take long - breathing problems tend to be a high priority, especially as I was also experiencing chest pains (probably from my strained breaths). Sorry, stab wound guy, in hindsight you definitely should have gone ahead of me. But at the time I was about ten seconds from passing out, and Stabby McGee was just casually checking his Facebook and calling his friends to tell them about the crazy fight he just got into with his girlfriend.
They ran every test on me that they could think of. They took blood from several different veins - one from the radial artery (the artery you take a pulse from on the wrist) and holy sassy molassy that was the most painful thing I have ever endured to this day I swear (and I once sat for a 9 hour tattoo). It was like they were bending the needle inside my arm, under the bone, to get to the damn artery. I had been stuck with so many needles that night I felt like I had no more blood to give, which only served to heighten my anxiety and make me feel lightheaded. That, coupled with my still sporadic breathing, my anxiety was only getting worse. I still get chills thinking about it, and I distinctly remember turning away crying (I never turn away from needles) and asking the technician impatiently "DON'T YOU HAVE ENOUGH OF MY BLOOD YET?!". Poor guy probably hated me. But I was freaking the hell out.
Needless to say, my "breathing" was fine. The blood work was fine. The inhalers did nothing. They couldn't hear any problems on the stethoscope. The nurses were highly impatient with me as they all thought I was lying. One nurse made me do the same test several times because he thought I was "faking it". In hindsight, the hospital staff was ill-prepared to deal with a mental health issue, and although I realize now that anxiety attacks are nothing to go to the emergency room for, I legitimately believed I couldn't breathe, and was terrified. The least they could have shown me was a little sympathy, a little compassion and understanding.
They were convinced there was nothing wrong with me, but I knew something wasn't right. I got booted from the hospital cot when they realized I was a "liar", and it was here that I waited several more hours. They had ruled out me being a high-risk priority patient, and clearly the "danger" was now behind us. I wasn't breathing as heavily, and although I still felt like I couldn't breathe properly, it had been a few hours and I was beginning to calm down. Regardless, I felt flustered that they kept telling me nothing was wrong with me, when I knew damn well there was. I just didn't realize that it was something wrong with my mental health, instead of my physical health.
I remember sitting in the crowded corridor of the hospital emergency room, late in the evening, around 12am. I had already had all of my tests done, I was out of the gown and back in my regular clothes, feeling like I wasn't being taken seriously. Feeling defeated and confused.
The doctor who had initially seen me, but whom I hadn't seen since I first got there, walked up to me and sat down in the chair beside me, my mom on my other side. He was quiet, looking at his clipboard and I thought he either had the worst news ever, like I was dying - or he was trying to figure out how to tell me I was a nutjob without offending me.
"Samantha, do you suffer from anxiety?"
I remember not really understanding him. I was tired, and lightheaded. It had been a long night and I was officially out of energy. Why was he asking me about anxiety when I was here about a breathing problem? I shook my head and said no.
Then he explained to me that I had just had an anxiety attack, a pretty severe one at that, and that he could give me a prescription to help prevent them in the future. He gave me a pill to take then, to help me "calm down" and then gave me a prescription to fill. I don't remember what the prescription was, but it was a very heavy-duty anti-depressant/anti-anxiolytic (I remember that much).
And that was that. We filled my prescription and we went home, leaving me with a lot to think about.
I took the medication, and went to bed. The next day, I took another and without going into detail, let's just say that the medication turned me into a zombie, and I somehow got all the way from the university back home, driving myself (that's a 30km drive), with no recollection of how I got there. What. The. Hell.
I stopped taking it (obviously), and went to see my regular doctor. We talked for a while and he referred me to a psychiatrist because he worried about the possibility that I suffered from depression. He was apalled that they had prescribed me such a strong drug, and instead prescribed me a "lighter" anti-depressant/anti-anxiolytic, called Effexor (I say "lighter" because it was allegedly not as strong, despite the fact Effexor is used for major depressive disorders and I felt like it was heavy enough to tranquilize a horse). Plus, I find it amusing that symptoms of Effexor (intended for depression, anxiety and panic attacks) also include anxiety and panic attacks. What a load.
For whatever reason, I was still denying that I needed the medication and so after wasting my money filling the prescription and trying it a few times, I decided I wasn't going to take it anymore. I didn't need it, I told myself. I don't have anxiety. I don't have depression. Clearly all of the medical professionals around me thought differently. But I still believed there was nothing wrong with me, and that was the last time I ever took "medication" for my anxiety and depression.
Either way, it was the first time I experienced an anxiety attack, and that's when I discovered I had developed an anxiety disorder, and that I was unknowingly living with depression. I still cannot figure out how or why these disorders developed, but it has unfortunately persisted for years. This was sometime back in 2009-2010, and other than the first prescription I took I have never medicated for my anxiety or my depression. I guess that I've always prided myself on being the type to self-heal, or to be resilient.
Even though I no longer consider myself to have depression, I do unfortunately still have anxiety, even though it's mostly under control (I say mostly because there are days when it consumes me, and there are days when I am able to handle it just fine, but the majority of my days are good days, and the bad days are few and far between).
But that doesn't mean I don't suffer. I suffer constantly, with Bruxism that is a relentless result of my anxiety, and with flare-ups of anxiety attacks that are sometimes unpredictable and unwavering. Sometimes it can be caused by something as small as having an argument with my husband over something silly, or feeling rushed or pressed for time. Being asked too many questions, having too many deadlines, putting too much on my proverbial plate of life. They can all act as triggers. Stressful events are triggers. Sometimes the silliest event can be a trigger, it just depends on how other things are going in my life, how well I am feeling. If I am having a bad day and everything is going wrong and then I come home and drop my papers in the mud, I can break down crying and have a panic attack right then and there. If I'm having a great day and I get into a car accident, I may not have an anxiety attack at all, even though the two dilemmas are very different. It all depends on how I've been coping lately, and how much stuff I feel is stacking up in front of me, things I can't control, things out of my reach, places I thought I'd be, etc.
Knowing that I have anxiety, and I am prone to anxiety attacks, though, does help. It helps me know that an anxiety attack will pass, and that I don't have a breathing problem and I'm not going to die. But it can still be scary for me when my anxiety attacks are long-lasting. Unfortunately, while my first couple anxiety/panic attacks were intense and short-lived (under 24 hours), my latest anxiety attacks are much less severe, but last a long time. Imagine feeling like you can't breathe properly for 3-4 days at a time, going to bed thinking it will be gone in the morning but you wake up and it's still there, which just gives you more anxiety. To make it worse, I'm also claustrophobic, and so my anxiety attacks are doubly terrifying. It's like knowing the problem is just in your head, but there's nothing you can do about it, no matter how hard you try to be positive or optimistic and ignore the problem. I don't know why my anxiety patterns have changed. Perhaps they're not as severe because I've learned more about my condition and I'm able to talk myself through breathing, and even when I feel like I can't breathe, I manage not to panic. But I don't know why these episodes last several days.
Just writing this makes me thankful I haven't had an anxiety attack in months. Maybe that means I'm learning to handle stress better, I don't know.
Regardless, this was all before I got acne, and I've had many attacks since I got acne, as well. So when I started researching the real root causes of acne, stress really stood out to me. Stress plays such an important role in everyone's life, and a proper amount of stress can be good for us (my level of stress, however, is often not - it's not good for anything; it's irrational). But stress is very often ignored when it comes to acne, and I think it deserves to be acknowledged.
When I finally put the pieces together, I broke down in tears. How could I have not seen this pattern? I know that stress can cause acne - I know that hormones can cause acne - I know that I was both chronically stressed and suffered from acne - and I know that I also suffered from night (and occasionally day) Bruxism (teeth grinding, common in people with anxiety or stress disorders, which can result in very painful headaches as well as damaged teeth). How - how - had I not realized it sooner?
With increased stress comes increased cortisol levels. Cortisol helps to reduce inflammation in the body, which is good, but over time this can also suppress the immune system. Chronic inflammation caused by things like stress keeps cortisol levels soaring, wreaking havoc on the immune system, which can lead to a myriad of increased susceptibility to health problems. So, keeping cortisol levels low in a healthy way is very important for overall health, as well as mental health. And keeping stress low is the key to keeping cortisol levels low. For someone with an anxiety disorder, whose stress levels are pretty much constantly high, that's kind of a problem.
But how does someone with an anxiety disorder keep stress low without medicating? Some people with anxiety may find medications to be extremely useful, and if that works for them then I think that's fantastic. Unfortunately, I just felt like it made things worse. I felt like I was worse off on the medication. I may have had less stress, but I felt like I had no emotion at all. I felt nothing on the medication. I literally felt like a zombie, watching my life go by behind the eyes of a lifeless and emotionless vessel.
And although my stress levels are lower now than they were before (I know this based on how long my anxiety attacks have been in remission, and how my Bruxism isn't as bad), it wasn't always this way, and it may not stay this way for long. I know I am still likely going to have an anxiety attack in the future, and I still know that even though I don't feel anxious, or I'm not having any episodes, it doesn't mean my anxiety levels aren't high.
One thing that I have found helps with my anxiety, my anxiety-induced acne, my sleep, my Bruxism, etc, is a supplement called Seriphos. Seriphos is an adaptogen and adrenal support supplement. It helps to bring down cortisol levels, but it's important to be positive that your cortisol is high prior to taking this, as nothing good will come of making already-low cortisol levels even lower. You can visit your doctor to get an adrenal saliva or blood test done to test when/if your cortisol levels are high throughout the day - and when they are high is when you will take the pill (i.e. my cortisol levels are high at night, making for a restless and tense sleep, exacerbating my nocturnal Bruxism, and making my morning cortisol levels very low, which makes for a sluggish and anxious day).
Obviously being mindful and mentally-aware of myself, my surroundings, and my anxiety, have helped tremendously, more than anything else. It's done wonders for me to be able to talk myself out of an anxiety attack - I can feel them coming on. As things mount and I begin to feel overwhelmed, I get a "choked up" feeling, and I know that means an anxiety attack is coming. I'm usually now able to quickly diffuse the situation by walking away, by talking myself through it, by allowing myself to "succumb" or "feel" emotions I may be denying, etc.
Drinking lots of teas, like spearmint, green, and chamomile, help me throughout the day to keep my composure, to help me sleep, etc.
Overall, it's been a very long journey with my anxiety and although I'm not yet where I want to be (ideally anxiety-free, but realistically I know that may never be the case), I'm happier and healthier and closer to being free of the constraints of anxiety than ever. I practice all kinds of techniques to lower stress, which I mention in my eBook, and I am constantly working on improving myself to lessen the impact that anxiety has on my life. Finally finding the connection between my stress and acne was just a nice gift to find out along the way.