Generalised anxiety disorder

JackReacher1980

Hi folks, have been diagnosed with depression a few times, am on meds, but recentyl started CBT. Therapist reckons I actually have generalised anxiety disorder, which, when I look it up, really sounds like a description of me. Meds dont seem to be working at the minute (for the last three days) and my anxiety is getting worse - fear of going mad is probably the worst. Appetite is at zeroish, and am thinking of changing meds, because I was a lot more stable on previous ones. I'm upsetting my family, and its causing a huge strain on my relationship. I was just looking for someone to share their experiences - its a really strange feeling, not being able to control your mind. I'm going to continue with the CBT, as it seems like quite a positive thing, but will need medication etc to get me through the xmas, so off to the doc on Monday methinks.

Kevster

Don't be so harsh on yourself dude. Your previous medication was Lexapro and I encurage yuo to resume that course of medication (by first planning it out with your doctor). Try to take things easy, and remember that depression doesn't mean that you are in any way flawed as an individual. it really can hit anyone, but some of us are more susceptible to it. Again, however, this isn't a flaw. The problem is that in the UK & Ireland, there is a sort of monoculture, and if you don't 'agree' with that, then you might just feel different and depressed. Perhaps this isn't the case for you though.

Good luck and Nollaig shona duit.

Kevin

JackReacher1980

Thank you Kevin. My panic seems to have gone down, but have no energy, and just want to stay in bed today. Just basically waiting for the doc to open in the morning. I'm really getting my boyfriend down (he has issues of his own), and of course, that upsets me also. The thing is, I know I have no reason to be depressed, that there are lots out there more fortunate than me.
The lexapro made me put on weight, but I guess thats the beter alternative than feeling like rubbish these past few days

Kevster

It's no problem; but you should never think that there's no reason for you to be depressed. Clearly, there IS a reason. I have discovered that most people who are depressed are simply living lives that they dont want to be living; but they dont know how to change. So, seek advice and really think about your future. What is it exactly that is in your life right now that you DONT want to be there...?

Kevin

dolphin50

JackReacher1980 wrote: »

Hi folks, have been diagnosed with depression a few times, am on meds, but recentyl started CBT. Therapist reckons I actually have generalised anxiety disorder, which, when I look it up, really sounds like a description of me. Meds dont seem to be working at the minute (for the last three days) and my anxiety is getting worse - fear of going mad is probably the worst. Appetite is at zeroish, and am thinking of changing meds, because I was a lot more stable on previous ones. I'm upsetting my family, and its causing a huge strain on my relationship. I was just looking for someone to share their experiences - its a really strange feeling, not being able to control your mind. I'm going to continue with the CBT, as it seems like quite a positive thing, but will need medication etc to get me through the xmas, so off to the doc on Monday methinks.

Hi JackReacher

I havent been on this forum in about a year for the simple reason that i would not talk about my experience with Anxiety until i was completely through it. I understand completely what is like to think that you are going to lose your mind, the constant racing in your head and thinking of the worst case scenario situation in every waking moment. You trawl through internet pages and chat rooms like this one researching this side effects of the drug that your doctor has put you on, this only fuels more anxiety. You have to believe you will get better, it will happen.

What helped me was i practiced calming down, i practiced getting anxious so surely i could reverse what happened and i did.

What i did was:

*Stopped googling the drug my doctor adviced me to go on

* I listened to my doctor and went by his instructions to the letter including how to withdraw from the medication

* Gave the drug time - a couple of weeks to work and help calm me down

* I didnt read the label with the drug, that just fuels more anxiety - a couple of side effects arent any worse then being a nervous wreck

*Stopped googling negative stuff full stop

*I used the drug as a tool in my life / stabilizer to help facilitate permanent changes in my life that would help change my habits

*These included excercise everyday or at least 5 days a week which started simply as walking for just 20 minutes as at the beginning i was very unfit, yes i was tired at the start , if your doing it right you should be !!

* Eating healthly, a lot less sugary crap. Small meals more often

*reducing alcohol intake to an absolute minumum, this is probably one of the most important along with the excercise and by minumum i mean two glasses of wine - max

*I also regularly started using self hypnosis on an ipod everynite for 6 months - one of which was the linden method, which is like CBT and the author was an anxiety sufferer, it is very good for anxiety

* I started to do daily yoga, breathing etc

* I dealt with personal issues, sometimes these are the root of anxiety as the more we try to suppress the worse it gets

If you look at my profile and see my only other post a year ago i was quering weather i should listen to my doctors advise and keep taking the tablet - I am glad i listened to my doctor.

It is now nearly a year later from the day i was told i needed to take an antidepressant, i am off the drug now 3 months and i have to say i am a happiest and fittest i have ever been, i find excercise a massive benefit, i understand myself more, i don't torture myself in my head anymore, the changes i have made in my life have made the difference, not the drug. However without the drug i couldnt have done it, you have to remember they are a tool/stabilizer. You need to help yourself also, You can do it. Its not easy at the start but you have to push through all the way and you will get well. Best of luck

Here's an inspirational video below with some really good messages, its a bit american but you will get the jist of the message

http://www.youtube.com/watch?v=vC45Eko5kd4

madliz

[quote=dolphin50;63592211

* I didnt read the label with the drug, that just fuels more anxiety - a couple of side effects arent any worse then being a nervous wreck

[/quote]

hi, i don't quite agree with this advice.

it's important that you always read the info that comes with medication, especially the first time you are prescribed something, regularly. it lets you know any side effects that you might experience in the first few days, also you can monitor how long it goes on for. generally it should only last a few days, so if something goes on and on then it should be brought to your doctors attention.

for example a while ago one medication i was prescribed, i had vivid dreams, which was a side effect. another tablet made me feel and be sick on the first day of taking it, but again that was a side effect.

the information is there for you benefit and you should read it every so often so you are aware of how the drug might make you feel.

hope you are starting to feel less anxious.

dolphin50

I am sorry I wasn't clearer on the label issue. What I meant to say was I didn't read it over and over again. If your told you can get nausea, dizziness etc etc the power of suggestion takes over especially in an anxious state and you are then on a high alert for a side effect when you are already a nervous wreck. I agree the label needs to be read, but not scruntinised and studied so you expect things to happen.

I found that my Doctors advice was a lot more important than the label and his advice was basically the drugs had to be used like stabilizers on a bike so I could get back to the work of pedalling again!

JackReacher1980

Thanks, I understood what you mean. The power of suggession is an awful thing. I intend on using these tablets as a crutch, until I can learn/ teach myself some coping skills.
And I know I have a habit of over analysing things!
Went to the doc today, and got my dosage adjsted (after one doctor told I was on the highest dosage?)
Anyway, feeling a lot better, so thanks for all the support. I am really placing a lot of hope and effort into my CBT, so fingers crossed

mclaugn

Hi,
took great inspiration from dolphin's thread - am suffering hugely at the moment with bouts of anxiety - leading to depression - maybe depressive anxiety! am so confused and lost at the moment - was on 30 mg of seroxat but kept having breakthrough bouts of depression - started seeing a good counsillor for chats and reassurance - changed to 75 mg of effexor because seroxat not working. have been on new drug for 5 weeks now and still having bouts of anxiety and depression. councillor says not to increase medication and to work through it. sister who is pharmacist says its in our genes take the increase and get on with living. Don't know what to do - paralysed with terror that if do take the increase in drug will still have bouts of anxiety and situation will get worse and worse and will end up bsket case. beggining to feel despair - have bouts of anxiety lasting a week while raising a young family and doing a hectic job - have three weeks when feel ok then back to hell. really want to get this sorted as feel am not living just waiting for the next attack - any advice , words of wisdom gladly recieved. have been on and off anti depressants for about 6 years now - but situation unbearable now!

sam34

mclaugn wrote: »

councillor says not to increase medication and to work through it. sister who is pharmacist says its in our genes take the increase and get on with living

i dont mean to be smart, but neither the counsellor nor your sister are qualified to prescribe medications, and therefore should not be giving advice about increasing dosages of it.

discuss your options with the prescribing doctor

nesf

sam34 wrote: »

i dont mean to be smart, but neither the counsellor nor your sister are qualified to prescribe medications, and therefore should not be giving advice about increasing dosages of it.

discuss your options with the prescribing doctor

+1

The only person you should be listening about drug dose levels (and how/when to take your meds) to is your prescribing doctor. Only they will be in full possession of the facts concerning your case and have sufficient experience to be able to deal with the issue.

Odysseus

sam34 wrote: »

i dont mean to be smart, but neither the counsellor nor your sister are qualified to prescribe medications, and therefore should not be giving advice about increasing dosages of it.

discuss your options with the prescribing doctor

Don't get me wrong Sam your 100% right. However, as a therapist I know how often I have been mis quoted about meds. Med compliance in such cases can be part of the therapy. If patients bring up issues around meds affects their quality of life, then that's part of the session. The thing is it is then about getting them to speak to the GP. I may suggest that a person speaks to their GP about abti/ds, now the GPs know how I work, but have come to me say X told me you said they need anti/ds big difference. GPs in my self often send the clients to me to work out a detox plan with say benzos for example. Clearly this is then done in consultation with the GP.

No the other side of this is that people with very low quals can call themselves therapists, and I have heard the horror stories first hand of these people telling clients they don't need meds.


I'm not saying you where doing this, but there can be a tendency to tar us all with the same brush. I know my team and more importantly my consultant psych is happy with the level interventions I carry out around meds.

Hope that makes sense, a good therapist will not interfer in any medical intervention [unless they pick up something significant], but it is a part of a persons life and that will enter the therapy. At the end of the day though concerns should be directed back to the GP/Psych around meds.

Edit:
Just to add Sam in case there is a misunderstanding, meds should not really come into to play that much in therapy, inital assessment to see what they person is taking. However, as they are part of the person's treatment the do enter treatment, and some issues may need to be discussed, but always then referred by to the GP/Psych. In my service I get stuck with it a lot more due the the client profile I work with. But what I'm talking about is totally different to telling a comorbid client they don't need meds, and believe me this sadly occurrs way too often form people claiming to be in my profession.

Odysseus

nesf wrote: »

+1

The only person you should be listening about drug dose levels (and how/when to take your meds) to is your prescribing doctor. Only they will be in full possession of the facts concerning your case and have sufficient experience to be able to deal with the issue.

Not a 100% correct Nesf. In my service part of that remit would fall to me especially around compliance.

sam34

Odysseus wrote: »

Not a 100% correct Nesf. In my service part of that remit would fall to me especially around compliance.

i have no issue with someone on the multi-dicsiplinary team reinforcing compliance, and indeed not just compliance with meds, but with psychotherapy and whatever other interventions are suggested.


however, nobody other than the doctor should be giving advice on dosage of meds, or whether to change meds or persist with a particular one.

others on the team are not qualified to do this and have no legal right to do it.

Odysseus

sam34 wrote: »

i have no issue with someone on the multi-dicsiplinary team reinforcing compliance, and indeed not just compliance with meds, but with psychotherapy and whatever other interventions are suggested.


however, nobody other than the doctor should be giving advice on dosage of meds, or whether to change meds or persist with a particular one.

others on the team are not qualified to do this and have no legal right to do it.

Depends on your understanding of advice Sam, I think we are on the same track just missing each other thoughts slightly. I often pick up on side effects that the client would not have metioned with the GP. If a person is sedated in a session with me and are driving, I will address that. ideally straight to GP to discuss it. However, never a perfect world and the GP may not be there that afternoon, no GP or Psych has had a issue with me suggesting a reduction or stopping until they see them. Or the advise may be "they don't seem to agreeing with you, will you have a chat with Dr X about this".

I get caught in the difficult position with those who use street drugs but are not attending my clinic for drug treatment just therapy. I actually dislike doing it, but whether its benzos or herion I'm the one left designing a detox plan. Its interesting that this would not be seen as medical advise in my service.

It's different to the case above, something I wouldn't get in too, back to GP with it. I hate the type of interference in medical treatment I think you mean, correct me if I'm wrong. It took me 9 months to get one of my client to agree to see our psych, he started her on abti/ds, then next day a project worker took the clients aside told her she didn't need them, show her loads of sh!te on the net and in 30 mins undid 9 months of work. Now that is outrageous. I fully agree with you, but do you see the point I'm trying to make?

sam34

Odysseus wrote: »

Depends on your understanding of advice Sam, I think we are on the same track just missing each other thoughts slightly. I often pick up on side effects that the client would not have metioned with the GP. If a person is sedated in a session with me and are driving, I will address that. ideally straight to GP to discuss it. However, never a perfect world and the GP may not be there that afternoon, no GP or Psych has had a issue with me suggesting a reduction or stopping until they see them. Or the advise may be "they don't seem to agreeing with you, will you have a chat with Dr X about this".

i get what you're saying, but i still disagree somewhat about the appropriateness of it. "discuss with gp/psych" is fine. i live in the real world, and i know that its not always possible for a patient to do this immediately.

but suggesting a reduction/stopping meds can be disastrous. not just from a relapse of mental state, but from potential withdrawal effects, potential seizures, etc. suppose the person was on clozapine, and they were told to stop it, and couldnt get to a psych for 2 or 3 days... at this stage they would have to be recommenced at the lowest dose and have it titrated upwards, which is a slow process (weeks) and usually done in hospital, as most teams dont have the resources to manage it in the community, due to the monitoring required.thats a bad outcome for the patient, as well as use of an acute hospital bed that could have been averted.

now, i mean no offence, but most non-medical team members will not have much knowledge of psychopharmacology, and just wont know the ins and outs of reducing/stopping meds.

if there isnt a doctor on site, perhaps a phonecall would be a better idea than giving well-intentioned but possibly wrong advice?

or, in the example you gave of someone being sedated yet driving, there are other options besides meds - leave the car and get a taxi/bus/train home, get a family/friend to pick them up..... usually these will be feasible and would not have teh potential adverse outcomes of reducing/stopping meds.

Odysseus wrote: »

I get caught in the difficult position with those who use street drugs but are not attending my clinic for drug treatment just therapy. I actually dislike doing it, but whether its benzos or herion I'm the one left designing a detox plan. Its interesting that this would not be seen as medical advise in my service.

to me, and again i mean no offence, but i feel thats quite inappropriate. you are essentially giving advice on prescription only meds, and presumably advice on increasing and decreasing doses. who is monitoring them for withdrawal effects? if you are, have you specific training/qualifications in this area? who is monitoring them physically so that what may appear to be a withdrawal or intoxicated state but is actually something else entirely is not missed? is someone actually prescribing the benzos or is the patient still sourcing them off the street?

i dont mean to sound offensive, and i realise it may come across this way, but i feel very strongly that someone who is not medically qualified should not be giving specific advice about medication.

Odysseus wrote: »

It's different to the case above, something I wouldn't get in too, back to GP with it. I hate the type of interference in medical treatment I think you mean, correct me if I'm wrong. It took me 9 months to get one of my client to agree to see our psych, he started her on abti/ds, then next day a project worker took the clients aside told her she didn't need them, show her loads of sh!te on the net and in 30 mins undid 9 months of work. Now that is outrageous. I fully agree with you, but do you see the point I'm trying to make?

thats broadly what i'm getting at, and i see it all too often, from various team members and from people in other agencies the patient may be attending, as well as from "well meaning" friends/family. recently enough, i've had a psychologist refer to me as a "pill pusher" in front of a patient and a family member. that was a step too far for me, and i took action on it.

Odysseus

Sam I'm no use at the mutli quoting so I just address your points. First and foremost no offence was seen or taken at your points. I know from previous posts that you are not like that, which is why I made the points I did. In other words you are open to discussion, I won't waste my time if I think its going to go down the wrong road; and as as Psych I'm interested in your opinions. Hopefully we are having a discussion not a battle;)

The reduction/stoppage is a last resort, and it its used it with meds that have just been started as oppossed to long term. Of course you right I'm not a medic so my understanding of psychopharmacology is not the same as yours. Really its a emergency and rare intervention. On the sedation thing, I work in the Addiction services so the driving issue is a concern and tbh most of my clients wouldn't take any of the options you metioned.

On the detox plan, in the cases I have metioned there is no GP or Psych. Sticking with the benzos it can be next to impossible to get someone to oversee a detox. My clinical director would be aware of the interventions being used in those cases. I would love a GP to take it over, but the same with OCT codeine I can't get to to happen. Remember I'm talking street benzos here, but it could be heroin, cannabis whatever you can think off.

In a lot of cases I left drawing up the reduction plan as the drugs come from the street. In order to see a GP or Psych in my service the client has to be recieving methadone. Of course, I may and do seek guidance from a GP but that is the most support I will get. I well aware of the dangers involved especially with benzos. My local psych tream refer the OCT codeine clients to me, they don't want to touch a withdrawal programme, and most of these either do not need or will not go on methadone. Then there are the AMA detoxes sent to me by GPs, I have to try guide them through the process. Do I want to be doing any of the above believe me NO. I trained as a psychoanalyst, and I have a special interest in addiction and comorbidity; which is why I work where I do. However, all of the above is sactioned by the HSE. To answer your question about training yes, I'm at this game a long time and we are supplied with some training about the effects of the drugs that we most commonly have to work with around detox plans, but its miminal. I'm stuck with the ones who are on street or OCT drugs and its just through 12 years of experience, a lot of guidance from my team and self study.

I would imagine you think this is outrageous, and tbh I concur. However, in those cases the person has no medical person taking charge of it, and if I don't do it, they will end up with someone like the project worker I described or worse still there are religious groups in my area that will take people off to the country to go cold turkey; its bad enough will heroin, but can you imagine putting someone through that who is on maybe 80-120mg of meth or the equivant of heroin and maybe a couple of hundred mg of valium.

The other side of it which I won't touch and for me it brings my profession a bad name, are those who tell clients they shouldn't be on a med, it happens a lot in addiction treatment. Someone is comorbid and told they don't need meds for their other condition, not my professions call.

I fully agree with your points Sam, just wanted to give you our side of things, well my side as they are a lot out there who are just reckless and unprofessional. Anyway hope that makes a little sense.

nesf

Odysseus wrote: »

Not a 100% correct Nesf. In my service part of that remit would fall to me especially around compliance.

Compliance is one thing. Telling a patient that they shouldn't increase the dose of a medication when you're independent of the prescribing doctor and not party to the treatment decisions? That strikes me as irresponsible to be honest. Recommending to the doctor in question not to increase meds is one thing but saying it to the patient could be extremely counter-productive if it truly is necessary to increase the dose of meds further down the line.

JackReacher1980

I cannot emphasise more with what other posters are saying, talk to your doctor. Do you see a psychiatrist or a GP?
You mention that you been on and off anti-depressants for 6 years. Have you found one that works for you? Or is it a case of trial and error.
I was on effexor, but found it didnt work for me - again, personal experience, not medical advice. But, I believe it takes up to 6 weeks for any anti-d to gain a steady level in your body.
What type of counselling are you undertaking? Its important to find the right counsellor as well as the right type. I tried a counselling psychologist. It wasnt for me, at that point in my life, but that is not to say that I wont go back to it when I feel ready. Right now, I'm doing Cognitive Behavioural Therapy, which feels much more right for me, and more pro-active.
I feel much more stable than when I was on her 3 months ago, so there is hope. I too have a hectic job, and go to college at night, and I'm almost finished my degree in law, managed to get promoted, above others my age or older. Hang in there, but first port of call should be your doctor, if you havent gone there already.

Odysseus

nesf wrote: »

Compliance is one thing. Telling a patient that they shouldn't increase the dose of a medication when you're independent of the prescribing doctor and not party to the treatment decisions? That strikes me as irresponsible to be honest. Recommending to the doctor in question not to increase meds is one thing but saying it to the patient could be extremely counter-productive if it truly is necessary to increase the dose of meds further down the line.

Nesf, I fully concur with you, sadly it is common practice.

nesf

Odysseus wrote: »

Nesf, I fully concur with you, sadly it is common practice.

Aye, mental illness often suffers from too many cooks not enough broth.

Odysseus

nesf wrote: »

Aye, mental illness often suffers from too many cooks not enough broth.

Sadly there is plently of broth, but too many people getting into other peoples area. It not only with meds, even in my area everybody is a therapist. The quality of service some people experience is appalling.

LegacyUser

Hi I've just been reading the thread. I have some of the same problems. I have an eating disorder depression and anxiety. My psychiatrist focused on the depression and ED. But I find that the anxiety is the most debiliating re everyday life etc.
She put me on 20mg of prozac that I've been on for bout 6 weeks now. It's helped the ED and depression a bit which is good but the anxiety is still a huge problem for me. It was fine at the start of the medication but it's back. Should I ring the GP? Sorry for bombing the thread. I just searched anxiety and medication and it brought me here. Hope this is okay. Also the thought of going off prozac is making me anxious (!!) because I'm afraid the depression will come back and I'll be prescribed something that will make me gain weight.
Please shed some light if you can
Thanks,
Sarah

mclaugn

hi sarah,

yes go back to your gp. Sometimes it can take a little while to find the right drug for you - don't despair but son't leave it too long before seeking help from your gp.

beste wishes
mclaugn

JackReacher1980

Sarah, I agree with the above. You need to go to your GP. There are many options, maybe Prozac is not the drug for you, maybe you need an increase, or maybe you need an anti-anxiety drug too. There is hope and help out there

doctorjohn

Sarah,
Don't ring the GP to discuss over the phone. What you need to do is ring the GP's reception and make an appointment to be seen face to face and discuss how you are getting on.
Telephone advice is fine for quick fix stuff such as ? what's best for toothache - paracetamol vs nurofen.
You need to have an old fashioned consultation where you can explain how you are and where your GP can see and sense you and make an agreed plan.
A quick phone-call is not a consultation and cannot achieve the same. Do not sell yourself short.
Good luck. It is a long road but with time and help you should get control back into your life. All the best. Get well soon.

CamperMan

this might sound daft to many people, I suffered from anxiety and panic attacks for many years until I discovered what was causing it... fluorescent lights!!

I would go into a shop or supermarket and come out all wired, dizzy, stressed out and at one point in Tesco, I was ready to fall to the floor with a strong feeling like a panic attack.

I used to work under fluorescent lights, suffering constant anxiety!

I now avoid anywhere that has fluorescent lights or keep the exposure to a minimum (like in and out as fast as possible when I go into a shop)

I now feel much much better using natural light or normal lighting... if I do spend too long in Tesco, I can feel the effects coming on and simply leave.

Gibs

sam34 wrote: »

now, i mean no offence, but most non-medical team members will not have much knowledge of psychopharmacology, and just wont know the ins and outs of reducing/stopping meds......
......i dont mean to sound offensive, and i realise it may come across this way, but i feel very strongly that someone who is not medically qualified should not be giving specific advice about medication.

I think this is a well made point and a very accurate observation. Offering advice or making decisions about any treatment should only be conducted by those with appropriate training, experience and expertise. I would consider it irresponsible to attempt to intervene in an area in which I don't have sufficient expertise.

However, it's not just with regard to medication issues that this truism holds. Psychotherapeutic interventions also require a very high level of expertise and training and yet it seems that many people who have had a brief exposure to CBT or DBT or family therapy or ACT or whatever empirically supported therapy is flavour of the month, appear to think that they can "do therapy", irrespective of their background and/or lack of specialised training and experience. I can't count the number of times I have come across a service user who has already done "counselling" or "CBT" with either a GP, a psychiatrist, a nurse or a therapist of indeterminate vintage. When you examine what "counselling" or "CBT" consisted of, it is usually laughably rudimentary and often very poorly managed.

Inappropriate psychotherapy can be every bit as iatrogenic as inappropriate medication advice, yet so many professionals who have only a very basic understanding of psychotherapeutic interventions appear to feel that they are entitled to "do a bit of CBT" or, as I memorably heard from a psychiatrist, "a few bits of family therapy". Many clients that I have worked with have ended up being completely put off using particular psychotheraeutic approaches because an undertrained mental health professional has attempted to use that approach and has ended up using it incorrectly, leaving the client feeling that the particular approach "doesn't work".

I never give advice about changes in medication to service users in my work as a psychologist - I always refer the person back to their GP or to their psychiatrist. It would be nice if other mental health professionals (who often don't even have sufficient expertise in psychotherapy to realise how limited their expertise actually is) would show me and those individuals who are appropriately trained in psychotherapeutic/psychological assessment and intervention the same courtesy. Unfortunately, there is a perception abroad that psychotherapy is just a sort of a friendly, supportive chat that anyone can have a go at, or that anyone who reads through a manualised therapy protocol with a service user is "doing psychotherapy".

I share your concern Sam about unqualified people doing work that puts patients in jeopardy. I just wish that the same concern existed within our services for all interventions that have been shown to be effective in helping improve the lives of service users, both pharmaceutical and non-pharmaceutical. Blundering around in either area can cause a lot of harm. Like you I also dont mean to sound offensive, and I also realise it may come across this way, but I too feel very strongly that someone who is not qualified in psychotherapeutic/psychological assessment and intervention should not be acting as if they are.

sam34

Gibs wrote: »

I think this is a well made point and a very accurate observation. Offering advice or making decisions about any treatment should only be conducted by those with appropriate training, experience and expertise. I would consider it irresponsible to attempt to intervene in an area in which I don't have sufficient expertise.

However, it's not just with regard to medication issues that this truism holds. Psychotherapeutic interventions also require a very high level of expertise and training and yet it seems that many people who have had a brief exposure to CBT or DBT or family therapy or ACT or whatever empirically supported therapy is flavour of the month, appear to think that they can "do therapy", irrespective of their background and/or lack of specialised training and experience. I can't count the number of times I have come across a service user who has already done "counselling" or "CBT" with either a GP, a psychiatrist, a nurse or a therapist of indeterminate vintage. When you examine what "counselling" or "CBT" consisted of, it is usually laughably rudimentary and often very poorly managed.

Inappropriate psychotherapy can be every bit as iatrogenic as inappropriate medication advice, yet so many professionals who have only a very basic understanding of psychotherapeutic interventions appear to feel that they are entitled to "do a bit of CBT" or, as I memorably heard from a psychiatrist, "a few bits of family therapy". Many clients that I have worked with have ended up being completely put off using particular psychotheraeutic approaches because an undertrained mental health professional has attempted to use that approach and has ended up using it incorrectly, leaving the client feeling that the particular approach "doesn't work".

I never give advice about changes in medication to service users in my work as a psychologist - I always refer the person back to their GP or to their psychiatrist. It would be nice if other mental health professionals (who often don't even have sufficient expertise in psychotherapy to realise how limited their expertise actually is) would show me and those individuals who are appropriately trained in psychotherapeutic/psychological assessment and intervention the same courtesy. Unfortunately, there is a perception abroad that psychotherapy is just a sort of a friendly, supportive chat that anyone can have a go at, or that anyone who reads through a manualised therapy protocol with a service user is "doing psychotherapy".

I share your concern Sam about unqualified people doing work that puts patients in jeopardy. I just wish that the same concern existed within our services for all interventions that have been shown to be effective in helping improve the lives of service users, both pharmaceutical and non-pharmaceutical. Blundering around in either area can cause a lot of harm. Like you I also dont mean to sound offensive, and I also realise it may come across this way, but I too feel very strongly that someone who is not qualified in psychotherapeutic/psychological assessment and intervention should not be acting as if they are.

i agree wholeheartedly gibs.

i have grave reservations about unqualified people doing "counselling", or as i heard from a social worker recently "taking a cbt approach" with someone :eek:

inappropriate doesnt begin to describe it

in psychiatric training, the doctor is required to have taken on patients for cbt, brief psychodynamic therapy and also the dreaded "long case"

this really unnerved me, as i felt woefully inadequately prepared for it, and if im being honest, i never found the supervision helpful. while teh supervision was provided by a fully qualified therapist, the area of psychodynamics was so vast that i could never have obtained a reasonable grasp of it in my brief training in the area.

plus, i have another issue - if i wanted to be a psychodynamic therapist, or any other kind of therapist, i'd have trained as one. simple as that. i wanted to be a psychiatrist, so i trained as one. i dont think it is at all reasonable to expect psychiatrists, or anyone else, to "do a bit" of any therapy and somehow be deemed adept at it afterwards. the mind boggles, to be frank.

as far as i am concerned, if you're going to engage in any sort of intervention with a patient, then you should be fully trained in that intervention. end of story.

seanybiker

JackReacher1980 wrote: »

Hi folks, have been diagnosed with depression a few times, am on meds, but recentyl started CBT. Therapist reckons I actually have generalised anxiety disorder, which, when I look it up, really sounds like a description of me. Meds dont seem to be working at the minute (for the last three days) and my anxiety is getting worse - fear of going mad is probably the worst. Appetite is at zeroish, and am thinking of changing meds, because I was a lot more stable on previous ones. I'm upsetting my family, and its causing a huge strain on my relationship. I was just looking for someone to share their experiences - its a really strange feeling, not being able to control your mind. I'm going to continue with the CBT, as it seems like quite a positive thing, but will need medication etc to get me through the xmas, so off to the doc on Monday methinks.

Im the exact same myself. Fair enough you might not believe me because of my posts on after hours but its easy to be happy on the outside. if you want you can PM me your number and anytime you feel bad just text me. I might not be great but every little bit helps. Im looking through this forum because I have a plan for this weekend and was just wondering did anyone else try it. You Will be fine

CandyFromABaby

This thread seems like it hasn't been used in a while but I think I'll post here anyway even if it is just as a form of therapy for myself to have an anonymous rant.

Like OP, I was diagnosed with GAD at the start of my second year of college.I think I was suffering from it a lot longer (for example I found the Leaving Cert and Junior Cert exams incredibly hard). What brought about the diagnosis was simply a complete and utter freak out on the morning of my first Christmas exam that year and the campus doc was quick to see that I had a history of this and that previous visits with GPs hadn't properly addressed the problem. I had to be given Xanax just to let me be able to get through those exams. I started seeing the doctor regularly and tried CBT but the "demon" in my head seemed to be too strong to be overcome by that alone so I started on anti-depressants. I've been taking them since, now three years on. Sometimes I wonder if they are having any effect. I hate taking them...they make me drowsy, completely eliminate libido and prevent me from doing simple things like be able to donate blood. I'd love to be off them but I'm terrified to stop taking them because I have been on the verge of harming myself before and, honestly, I don't trust myself.

The thing is, I have some exams to take over the next two weeks...they are exams I had to postpone because I had a major panic episode on the morning of the first one back in the summer. I'm utterly convinced I'm going to fail. Nobody seems to understand the pure panic that is in my head, the horrible racing thoughts, the mental block, the inability to recall anything I spent so long trying to learn. I used to be a very good student, used to get A's or B's. Now I'm even just praying to pass. It horrifies me really because I feel I've devoted so much of my time to learning that the piece of paper I'll get on graduating won't reflect that.

To add to this, all this talk of recession recession and the "smart economy"...I know I don't have a hope of getting a job and that I'll have to drag my ass back to do a Master's....that thought sickens me. I just can't handle it. I feel that I've stressed and struggled this far and it has nearly cost me my sanity.

Anxiety is taking over my life. I suppose you could call it "performance anxiety" maybe. I can't/don't want to accept that every time I do something new or face a challenge (be it work, academic, relationship) I'll not be able to rise to the challenge because of this anxiety. It's a sort of "once bitten, twice shy" type of situation. I'm anxious now about being anxious.I have great friends and family who understand and encourage me...but I'm tired of putting them through this and of always having to be reassured. I hate that I have to live with this and that I have had to reduce my dreams/expectations of myself accordingly. I want to just be like everyone else (or what it appears to me) and just be able to cope, you know?

I just want to know am I ever going to get over this? I'm at the end of my tether. Where do I go from here??

Jumpy

First things first. You are like everybody else. Everybody stresses.
Its the way you handle things that is different. Can I suggest a counsellor?
Also, you need to learn how to relax. Not everything has to be analysed and thought about.
Medication will assist, but dont rely soley on it.

CandyFromABaby

Jumpy wrote: »

First things first. You are like everybody else. Everybody stresses.
Its the way you handle things that is different. Can I suggest a counsellor?
Also, you need to learn how to relax. Not everything has to be analysed and thought about.
Medication will assist, but dont rely soley on it.

Thank you for the reply. I was sure there was no one on here!

I've been to counselling and it did help to a certain extent. E.g. over the last few years I've broadened my horizons socially, taken up a martial art and started a daily routine I call "glass half full" where I basically sum up all the good things and reasons to be positive. It has helped, especially if I am disappointed in something (e.g. relationship ending, failed exam) I look more towards how I gained from the journey as opposed to what I had at the end point.

In terms of the relaxation. It's the biggest hurdle I think. If I focus a lot of energy into it I can get really relaxed with things like sport, photography, relaxation CDs but when times get tough I always seem to revert back to old ways. It's like a rollercoaster!

Jumpy

I found I didnt breathe properly, I used to take small tiny breaths.

I went to an acu therapist (I was totally sceptical about acupuncture until I decided "what the hell" on a cruise) and she told me that I only breathed for my head, not the rest of me.

Proper breathing helped.

Also acupuncture is the single most relaxing thing I have ever done. I would recommend it to help with stress.

Also in response, you say "helped". Counseilling isnt a start stop thing. You need to keep going.
If its too costly, then go less often, but keep it up if the counsellor is good.

JackReacher1980

I totally understand the racing thoughs, and general feeling of craziness, although, it doesnt feel crazy when you are going through it.
I still sometimes wonder if my anxiety isnt some form of hormone imbalance, as my doctor first suggested.
It takes work, and while I dont feel like I've conquered it completely, I do feel more in control, and thats the worst part about anxiety, is the lack of control of your own thoughts.
I'm currently doing CBT, and it definately is helping me more than counselling - it just feels more pro-active. I always left counselling with this feeling of, ok, so thats why I'm like I am, but what do I do to fix it!
I would also consider acupuncture or hypnotherapy if I ever feel myself sliding down again.
Strangely, I dont get depressed/ anxious about the things I can control - my father died earlier this year, and I think I coped with that fairly well. Its the "what if" things that upset me the most

mickman

when you find yourself thinking "what if " - read the following over and over

[FONT=Arial, Helvetica, sans-serif]There is only one way to happiness and that is to cease worrying about things which are beyond the power of our will

[/FONT][FONT=Arial, Helvetica, sans-serif]There is nothing that wastes the body like worry

[/FONT][FONT=Arial, Helvetica, sans-serif]Worry is just about the worst form of mental activity there is

and a good one from the sunscreen song

"[/FONT]Don't worry about the future. Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble gum. The real troubles in your life are apt to be things that never crossed your worried mind, the kind that blindside you at 4 p.m. on some idle Tuesday."

you should also avoid alcohol if you suffer from anxiety

Odysseus

JackReacher1980 wrote: »

I totally understand the racing thoughs, and general feeling of craziness, although, it doesnt feel crazy when you are going through it.
I still sometimes wonder if my anxiety isnt some form of hormone imbalance, as my doctor first suggested.
It takes work, and while I dont feel like I've conquered it completely, I do feel more in control, and thats the worst part about anxiety, is the lack of control of your own thoughts.
I'm currently doing CBT, and it definately is helping me more than counselling - it just feels more pro-active. I always left counselling with this feeling of, ok, so thats why I'm like I am, but what do I do to fix it!
I would also consider acupuncture or hypnotherapy if I ever feel myself sliding down again.
Strangely, I dont get depressed/ anxious about the things I can control - my father died earlier this year, and I think I coped with that fairly well. Its the "what if" things that upset me the most

Sorry if I sound pedantic, but CBT is one from of counselling/psychotherapy. It's just one of those things that niggle at me as a therapist. Often it is described here as a treatment different to therapy, it is merely a different form, which is at the moment the flavour of the month with medics. Agin I aplogise if I sound pendatic.


Edit: Just to add be careful when you are looking for a therapist. Most of the therapists I know who say they do CBT would not be really qualified in it. I'm a psychoananlyst, so it's not really my area, but I have done various training in it over the years, but could not call myself a CBT therapist. There are only two professional bodies for CBT therapists in Ireland, there are links to these in the psychology forum, but as I was saying most who claim to do CBT would not be entitled to be a member of these bodies. They may be psychotherapists, just not certified CBT therapists. There are a lot of iffy therapits out there so be careful people, not only is it expensive but it's your mental health too.

CandyFromABaby

Thanks for all the advice and comments. In short, I've found counselling/CBT to be moderately helpful. It definitely helped to make me broaden my thought processes, to reduce my negative thinking on events and to try to just get more involved in the fun aspects of life i guess. Thing is, I found it hard to apply everything because I was in college at the time, and stupidly, i always put all things academic before my mental health. I found college so stressful and I guess I just never really had the time to "sort myself out" properly. Now that I'm out of college I can't afford to see a counsellor privately and feel that I may have wasted the opportunity to avail fully of my college's student health and counselling services.

I don't know. I think at the minute i'm just feeling super anxious about the uncertainty of the future and the fact that I seem to have devoted an awfully large portion of my life thus far to learning. always seemed to be in competition, always feeling significantly inferior to a lot of the others in my class/year. Now that's gone to a large extent, because as I had to take exams separate to the rest of my year group I'm in a sort of limbo at the moment. It feels weird: all the things that I stressed and strained and worried about during the last year - not doing so good in my degree, not getting into a postgrad, getting turned down at all the interviews I went for, being unemployed - they've all happened. This is the "worst case scenario" i was building up in my head. Logically, one would imagine, now that it has happened and I'm still alive/still breathing/still functioning that the panic and anxiety might ease a little but still no.....

LegacyUser

CandyFromABaby wrote: »

Thanks for all the advice and comments. In short, I've found counselling/CBT to be moderately helpful. It definitely helped to make me broaden my thought processes, to reduce my negative thinking on events and to try to just get more involved in the fun aspects of life i guess. Thing is, I found it hard to apply everything because I was in college at the time, and stupidly, i always put all things academic before my mental health. I found college so stressful and I guess I just never really had the time to "sort myself out" properly. Now that I'm out of college I can't afford to see a counsellor privately and feel that I may have wasted the opportunity to avail fully of my college's student health and counselling services.

I don't know. I think at the minute i'm just feeling super anxious about the uncertainty of the future and the fact that I seem to have devoted an awfully large portion of my life thus far to learning. always seemed to be in competition, always feeling significantly inferior to a lot of the others in my class/year. Now that's gone to a large extent, because as I had to take exams separate to the rest of my year group I'm in a sort of limbo at the moment. It feels weird: all the things that I stressed and strained and worried about during the last year - not doing so good in my degree, not getting into a postgrad, getting turned down at all the interviews I went for, being unemployed - they've all happened. This is the "worst case scenario" i was building up in my head. Logically, one would imagine, now that it has happened and I'm still alive/still breathing/still functioning that the panic and anxiety might ease a little but still no.....

You say you're feeling super anxious about the uncertaintly of the future. I think that is definitely worth a session of CBT and discuss this with your therapist. You have to live your life being OK with uncertainty, according to CBT. This is the worst scenario in your head, you say, but you ARE coping, aren't you? You'd prefer if you did better in your degree, got that postgrad/ job but you didn't. However you have to have good things going for you too. First of all you have a degree (who cares about the standard at the moment). Secondly, you have your health (most CBT therapists would claim Anxiety disorders are just problematic, we're not dealing with cancer here, people) and thirdly you have identified key areas in your life you are unhappy which is the first step in finding a solution. Definitely talk to your therapist about feeling this. You keep referring to this whole sensation of feeling you're surviving and getting through the worst but the panic is still there. You have to be OK with feeling panicy/ anxious - why wouldn't you? My brother in law loves his panic/ anxiety - he goes shooting a lot, big into motor cross and anything that boosts his adenaline. Your 'disorder' is just a soured relationship with adrenaline, unlike my brother in law. Think about it.

In terms of your degree could you not look into doing a Post graduate diploma of some sort or repeating the year externally (it's a lot cheaper this way). If you are so unhappy with your standard and sitting at home being depressing about it take an action. You are still alumni of your institution and should be allowed to discuss your options with a career guidance counselor or your head of department. If you do get in, try to talk to your CBT about doing practice exams in controlled enviornments throughout the year. Maybe doing a small assignment at home under a time limit and getting a tutor to correct it in the college. Exams are horrible for everyone BUT you have to learn to take the upper hand. Usually most university exams are rehashed old papers. If you can find past-papers on the college's website, for example, print them all out and construct an exam atmosphere and constantly going over the same things time and again.

Remember your first panic attack in that exam hall was heightened because you were dealing with an unknown 'intruder'. Now that you know what it is you will more than likely calm yourself a lot quicker. I had a panic attack on a bus a few months ago and developed panic disorder/ GAD. My initial panic attack was so frightening because I thought it was a brain tumor - trembling, feelings of floating, wanting to flee, bad breathing etc. Sure I'm no doctor, course I'll jumped to that conclusion! But if a doctor was there and said - mister, you're just panicking a bit, there's nothing wrong with you, I'd have sat back and relaxed. So, I will never have that same reaction again, and if I do I know that it's because of some other misinterpretation I've made about a scenario.

If your panic/ anxiety is still a problem then CBT isn't working for you at the moment. You need to have more sessions and really discuss why it's not helping at the moment. There is a fantastic book available for people in CBT I found in an Easons - Dummies Guide to CBT. Go look for it in the popular psychology section - very, very good! Basically they say your safety behaviours are actually the route of your problem. The minute I stopped carrying my Xanax around I felt a whole lot better! Very strange.

Best of luck!

Odysseus

If you can afford private therapy get a referral from your GP to the local psychological servies you should get access to free therapy there, or look for a low price counselling service in your area, they generally offer a sliding scale that can slide to next to nothing.

JackReacher1980

I initially tried sessions with a counselling psychologists. It just didnt seem to offer any solutions - I was sick of talking about the past, and why I was why I was, I wanted a solution.
I find CBT much more "active" for me, if that makes sense

LegacyUser

Me too. I have always been an anxious person but I am very sociable and generally happy (thank goodness). Having a bad patch at the moment and my anxiety has gotten out of control - but I don't think this is the end of the world, if you know what I mean. Sometimes I feel that way, then I watch this (http://www.youtube.com/watch?v=mQ4KzClb1C4&feature=player_embedded) and realise life is worth it! I mean, seriously... Ha!

I went to a psychotherapist for around three months. Waste. Of. Time. We talked about the 'fog' my life is in and would worsen my anxiety by telling me to avoid public transport! Also told me that I should make some more time for relaxation and quit my job - even thought I couldn't afford it (especially paying for this particularly lady).

Odysseus

asdpnasdCBT wrote: »

Also told me that I should make some more time for relaxation and quit my job - even thought I couldn't afford it (especially paying for this particularly lady).

This is why we need Stat Reg for psychotherapists, that is outrageous:rolleyes:

what a day

Dolphin50

Hi just wanted to say thanks for your great advice, i too suffer from anxioty and you post made me smile for the first time in a long time. Must look into this linden method thingy.

Thanks very much!

luckyfrank

I was diagnosed with GAD in december, i hadnt slepth for a whole month, racing thoughts, panic attacks i thought i was losing my mind went to my local gp for the 8th or 9th time and just broke down crying, i was giving an immeadiate refferal for portrane and was seeing by a phychricist and diagnosed with GAD being on lexapro since then, i started out on 5mg i found the initial relief i got slowly faded i went up to 10mg and still no better, last month i was upped to 15mg and ive noticed a small improvement in my general mood, my sleep is still very poor and always shattered tired but at least it's an improvement heading in the right direction

Hoping next time im in the clinic they'll up me to 20mg and that will sort out the sleep and tiredness