Advice on triggering events coming up?

Sorry, just saw your message so a bit late for any Christmas advice.

What helps me is to think that no matter what I'm doing I can always excuse myself for a few minutes and either go to the toilet and do some breathing exercises or calm myself by saying that even though I am nervous at the moment I will be ok later, or I can call a friend or my partner. Just a break of some sort.

Your apprehensions are well noted and quite common among persons with significant anxiety, which in a great number of instances can dampen one's social life due to the fear of an unexpected collapse into the realm of anxiety that can often project helplessness and a need to seek the safety of one's normal surroundings.

It's important to note that while some research does indicate that medications such as Fluoxetine can relieve anxiety and panic disorder, these drugs are in the class of Selective Serotonin Reuptake Inhibitors and as such, are more typically an on-label treatment for variants of clinical depression. They can, in some persons, impose a paradoxical effect of nervousness, agitation and over-stimulation of the nervous system that you might well surmise could constitute an increase in sensations of anxiety and panic episodes.

It is also not uncommon for these medications to initially produce what appears to be relief and it is largely due to the placebo effect that generally courses 2-4 weeks before a return of symptoms originally observed. Again, SSRI medications are more aimed at clinical depression and as such, their retention of circulating serotonin results in the neurotransmitter being more bio-available to produce the upregulation in mood rather than a calming effect. While anxious depression has been described as co-existing with some variants of clinical depression, it is not an instance where SSRI treatment has shown consistent positive results regarding improvement of the anxiety component.

These specific medications also tend to demonstrate a sort of hit-or-miss result among the patient population and side-effects are quite common. The brain is quite unique in that any introduction or manipulation of certain neurotransmitters will simultaneously result in the brain's own production and levels of the same neurotransmitters, sometimes leading to unintended or unexpected results that can fall short of providing the intended relief. While benzodiazepines have fallen out of favor by a considerable portion of the medical community, short-term treatment without the risks of addiction can quickly provide targeted relief to the extent that it restores confidence in the patient that their condition has abated and unlikely to return. The furthest treatment realm should be limited to 6 weeks without continuance afterwards and low-dose clonazepam is a targeted drug of choice to relieve intense anxiety, particularly if it involves panic episodes. Again, the underlying success in its use is restoring confidence in the patient that the anxiety and panic, if present, has abated. The effects are typically long-lasting. But again, this is something to discuss directly with your primary physician. The safest benzodiazepines are those with the longest half-life. Short half-life benzodiazepines are not recommended and are associated with higher rates of addiction potential.

Coping with your circumstances is often centered upon a refrain from ruminations and particularly those that invoke fear. The reason is that ruminations are most commonly framed in irrational beliefs or thoughts and can elevate anxiety together with feelings of uncertainty regarding self-confidence and ability to feel relaxed. Most persons experiencing intense anxiety are riddled by the impending sensations that something of unknown negative outcome could occur at any given moment that is coupled by the presumption that control of the circumstances is beyond their control. Seeking safety is quite common and is associated with a "fight-or-flight" response normal within all mammals. Social interactions are uncomfortable because one's self-confidence and comfort zone has been altered, promoting isolation that often only serves to provide the environment wherein focus upon one's ruminations is amplified. It can indeed feel as though no place of safety and relief is evident.

Talking through your circumstances with a trusted close family member or best friend can help open the genie's bottle so to speak and permit you to talk through your feelings outside any interference by irrational beliefs and imminent expectations usually derived in isolation and without a sounding board grounded in reality. This is seldom easy because people with anxiety are typically highly vigilant to the impressions formed by others and there is constant awareness to how they are being perceived. This usually stifles the ability to simply talk freely without worry of scrutiny.

Anxious people also tend to project their intended personality traits that automatically establishes discomfort in one's self due to the need to remain vigilant rather than experience complete relaxation in who they are as a person. The awkwardness associated with self-performance sometimes to the point of distraction is enough to avoid social interactions of any considerable size and scope because it most commonly constitutes an overload of one's ability to remain both internally vigilant and outwardly social in a natural context.

The patterns above are merely for consideration regarding any recognition of such patterns and are not intended to define you in any absolute manner. Many variations exist among people and anxiety is fed by these patterns and many more that may exist in the realm of both common and uncommon states of mind.

Most importantly, relax in knowing that you are most certainly not alone in what you are experiencing and the context in which anxiety disorders manifest themselves and the avenues to relief are immensely more common than you might imagine.

Best regards