I knew I'd hit bottom when I started paying my therapist to ride the subway with me.
We would act like we weren't together - I'd sit at one end of the car, pretending to read my New Yorker, and he'd stand down at the other end, purposefully not looking at me. The whole thing felt crazy. I was crazy. Our subway ride was a form of exposure therapy, the latest in an increasingly desperate series of attempts to cure my panic attacks. I had been plagued by them on and off for 20 years, starting when I was 12, but this was by far the worst they had ever been.
Unlike the early days, when I'd ended up in the emergency room in the middle of the night, (convinced I was dying), I understood was happening to me. I even knew why: I'd stopped taking the medication that had kept the panic attacks in check for the last decade. Why would I do such a thing? I was pregnant.
By no means was this a tragedy. I was pregnant by choice two years into a marriage with a man I loved. A few months earlier, I'd landed a great job. But instead of feeling blessed, I was imploding.
It had all started with the subway. As soon as the doors closed my heart would start hammering and my throat would close up. I could feel my ribs expanding but I wasn't getting air. I'd get myself through the ride by measuring my breaths and reminding myself that it would pass. When all else failed, I'd dig my nails into my palms to distract myself with physical pain. I started inventing reasons to leave the house earlier so I could ride to work with my husband in the mornings.
Eventually, I gave up the subway and started taking cabs to and from work - but the panic attacks soon found me again, whether I was riding in a cab or walking my dog in the park, having a drink with friends or sitting at my desk at work.
I panicked whenever I was alone. How was I supposed to be a mother when I couldn't even take care of myself?
The medication I'd been taking before getting pregnant was Lexapro, a selective serotonin reuptake inhibitor (SSRI), which is a popular type of drug for people suffering from anxiety and/or depression. I had sought out a psychiatrist to help me get off the Lexapro because the risks associated with SSRIs were frightening: pre-term birth, congenital heart defects, autism, ADHD. I felt that I had to try to get through my pregnancy medication-free.
My panic worsened but I persevered: I saw an acupuncturist/Chinese herbalist who tried to help me. I felt great during the sessions, but the effects dissipated soon afterward; I would often have a panic attack on my way home from her office.
Meanwhile, I continued seeing the subway therapist. Most visits were spent not on the subway but in his office, where I would describe a panic attack in great detail, over and over. The goal of the retelling was to desensitize myself and neutralize the power of the attacks. I also saw my regular therapist, where we talked about possible contributing factors. Was it because I'd never properly processed the breakup of my first marriage? Was it my mother's fault? Both were definite maybes (sorry, Mom). But while talking through these issues was important for my long-term mental health, I needed immediate relief.
My husband's generous reserves of patience were running out. I panicked whenever I was alone, and I was becoming completely dependent on him. I was either in the throes of a panic attack or crying because my life was such a mess. And I was pregnant. How was I supposed to be a mother when I couldn't even take care of myself?
It all came to a head when, one morning, I couldn't leave the house. My heart started pounding as soon as I got out of bed, and I knew I couldn't go any farther. I had no choice but to call my boss at my new job and explain everything. She was incredibly kind and understanding, but it was still humiliating. Would she think I was nuts? Would I lose my job? As soon as I got off the phone with her, I started calling psychiatrists.
I found a psychiatrist who specialized in working with pregnant women. She assured me that taking medication would be less risky than trying to get through my pregnancy in the state I was in. She gave me some medicine that she felt was safe. Within a week, my panic attacks had all but disappeared.
I now have two children, both completely healthy. I take medication every day and see a cognitive-behavioral therapist once a week. Aside from the very occasional "breakthrough" panic attack, I am completely symptom-free.
Why me? I'm still not sure. There is no identifiable traumatic event to blame. My best guess is that it's just how I'm wired. Looking back over nearly three decades I can see a pattern: The panic attacks usually appear in the calm period that follows a major life upheaval - getting into college, getting a job, getting a divorce. I seem to marshal all of my strength to get through the difficult part, and then I totally fall apart.
The scariest thing about the panic attacks, aside from being in the middle of one, is knowing that the wall separating me from mental illness is so flimsy. It's terrifying to be on the other side of that wall, to be able to see normal life carrying on around you but to be completely cut off from it. Friends, spouses, and parents can only do so much.
For me, the answer is medication. It's not for everyone, and I know that. There can be physical side-effects - like sexual dysfunction and weight gain - not to mention social stigma. For a long time I felt terrible that I wasn't able to "pull myself together," even for my unborn baby.
I don't feel that way anymore. Mostly I just feel grateful that I live in a time and place in which a treatment is available to me. It has allowed me to live a good life, to be a mom, and to ride the subway all by myself.