Hello Dr. Duff, I’ve been in a long distance relationship for about 16 months now, I was supposed to move in with my fiancé back in April, but due to consulates being closed we’re having visa issues and now we’re stuck in different continents unable to see each other because of closed borders. We haven’t seen each other in 8 months. Though I know our love will survive and he is so supportive and loving through these difficult times, I lost my job and have been stuck at home. A lot of the times I feel anguish and desperation, a hole inside me that can’t be filled and I just feel like disappearing. How do I deal with these feelings? How do I stop feeling like it’s the end of the world? It seems so hard to focus on anything that even Netflix won’t help. I know many have experienced these feelings for other different reasons and it would be great to have some advice. Thank you and stay safe.

First off. Damn that sucks. I won’t sugar coat it. I’d be pissed and frustrated and lonely too. So I’m sorry that you guys are going through this. I’m sure that there are a lot of things that you are already doing well. I imagine you are probably already doing plenty of video chatting, talking, playing games together etc. If you haven’t checked it out and you feel comfortable, there are also a lot of really interesting sex devices that are available now that you can use together synced up over the internet. Just something to help pass the time. It’s also important to be careful about conflating the despair that you feel from being alone, stuck at home, and without a job with negative feelings about your relationship situation. It’s really easy to get the two mixed up in your head and succumb to the feeling that everything just sucks. There is nothing that you are going to be able to do to make things move faster. You’re just going to have to get through it and do your due diligence when it comes to the visa issues etc.

I would say that one of your best bets is going to be diving into other activities. If there is a hobby, a new game, or any other interests that you can pick up, this will serve you really well. Also don’t forget your fundamentals. Make sure you are eating enough, getting out for some walks or something, and not drinking yourself into oblivion. It might be a good time to see a therapist, even if it’s on Zoom. You can also take medication if it looks like these circumstances are throwing you into a significant depression. Many people go on medication in the short term when dealing with things like the loss of a loved one or in your case the loss of your expectations for how your relationship was supposed to work. No shame to doing what you need to do to get through. This is weird and unprecedented. It sucks and it is going to continue to suck until it’s over. We just want to try to lessen that suck as much as possible.

I would encourage you to start with one small change. Perhaps journaling each day (or as often as you can). Journaling would actually be great for you right now. Either way, pick one thing to do differently that you are pretty sure would help. Could be adding in a daily walk, journaling, reading/listening to a relevant self-help book, etc. Start with that one thing rather than throwing the whole kitchen sink at the problem. Once you get that locked in and start actually benefiting from it, you might notice that you have a little more motivation to try one of the other things that would be helpful. Anything is better than nothing and as long as you’re trying to try and making some form of active effort, you are going to be better off. If you have the chance to, consider doing some gardening or any type of art. It can be great to create and cultivate something. With gardening, you also get to care for your little plant babies, which in a funny way can make the days seem less lonely.

Hopefully these tips give you something to think about and I hope you have the opportunity to see each other soon.

Dr Duff, I get adrenaline surges that sometimes causes severe tachycardia (panic attack, I guess?), which is started by me adjusting myself in bed from either waking up or not having moved in awhile. It’s confusing and my doc doesn’t know what could be causing it. Could it be from anxiety? Have you heard of this before? I’m scared and desperate. ☹️

Let me start by saying this is a hard question to answer since I am not your provider and I’m not even a medical doctor. I want to address this though just in the off chance that it will point you in the right direction. There are a variety of medical issues that should be looked at and ruled out. They truly run the gamut from thyroid issues to heart conditions to blood pressure problems to other hormonal issues. It’s impossible to say what it could be, but I’ll explain how some of these could play a role.

First off, it’s fairly common for people to get what’s called orthostatic hypotension. It’s basically a drop in blood pressure that happens when you’ve been staying in one position for a while and then move. The most common way for people to feel this is when you go from laying or sitting to standing. If you’ve ever stood up too quickly and got a head rush, that is orthostatic hypotension. You can get a variety of symptoms from this including dizziness, feeling light-headed, blurred vision, weakness, fatigue, nausea, heart palpitations, and headache. In more rare situations, people can have a syncope response, where you actually pass out or have what look like convulsions from a drop in blood pressure. I’ve seen people get this from getting blood drawn. People can get this sort of hypotension as a symptom from another issue, such as dehydration or other medical issues. In other cases, it just happens somewhat more common to certain people than to others. So this could be one potential explanation. If you think about those symptoms I listed and the overall feeling of a head rush, it can feel a lot like the “adrenaline surge” that you talked about. You can also definitely have momentary irregularities in your heart rate from this, which can absolutely be freaky.

One important thing to consider is that anxiety essentially serves as a big magnifying glass. For someone without anxiety, they might have an irregular heartbeat or feel thrown off by their ears being clogged, feeling dizzy etc. But they are able to go, “Whoa. That was weird. Okay, I’m better now.” But with anxiety, you start to associate certain sensory experiences with the experience of having a panic attack or significant anxiety. So when you feel that irregular heartbeat, your anxiety goes, “Holy shit. What was that? Are we having a panic attack? I think we are. Let’s go go go!” This can be the case with anything. Whether it’s the blood pressure drop or some other physical issue, your anxiety can take an inkling of something weird going on and blow it up into a full panic attack.

SO – other medical stuff. Definitely make sure you get some blood work done. Through blood work, they can check not only vitamin levels, but also your thyroid hormone level. If you have an overactive thyroid, it can really mimic the symptoms of anxiety and when it’s too low, it can mimic depression. Whatever the situation, you need to make sure you are getting thoroughly evaluated for the little medical things that can cause issues. If you feel like you aren’t being taken seriously, feel free to switch doctors or insist on seeing a specialist like an endocrinologist.

So, things you can do would be to focus on bringing your overall stress and anxiety level down before bed. Spend some time disconnected from electronics and social media. Focus on relaxation by reading, listening to nice music, stretching, doing a guided meditation, or doing anything else that brings you peace. Sometimes when you know that something’s coming, it doesn’t impact you quite as much. So the knowledge that your reaction might not be a true sign of danger might allow you to manage your reaction a little bit and instead focus on doing whatever you can to better cope with the temporary surge of anxiety. Obviously, I have a lot of resources about this – check out the course.

Hopefully that helps!