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>> No. 27186 Anonymous
24th July 2018
Tuesday 10:09 pm
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I've come to accept I have a problem with anxiety. Any situation outside of my comfort zone, while I believe I can psychologically handle it, triggers a "life or death" physiological feeling to things which are really mundane. It's so frustrating, it feels like a limiting factor when I'm doing everything else right.

As such I've also accepted I need help. Now I already lead a very healthy life -- gym three days per week (lifting and cardio), good food with little to no sweets, negligible amounts of alcohol (I've had all of two beers since New Year). I've also cut down caffeine to a minimum recently, one of two cups of tea per day.

I know others on .gs have been down this road, too. What can you lads tell me about CBT, medications you've tried, your experiences with anxiety generally, etc.?
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>> No. 27188 Anonymous
24th July 2018
Tuesday 11:09 pm
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You should try confrontation therapy, or see if you can find a therapist who specialises in it.

Facing your fears and the things that cause them is often the best way to overcome your anxieties.

Some people are simply born with higher "baseline" anxiety, and I know what I am talking about because I am one of them. Some of it will probably always stay with you. You will never be the exact opposite of the person you are now. And yet, confrontation therapy can teach you to not be afraid anymore of certain things that are at the moment triggering your fight or flight responses, or "life or death", as you call them.

For the time being, one thing you can do is try to analyse what exactly, i.e. what types of situations or circumstances or even what types of people raise your anxiety that way and cause a life or death response in you. That could be a place to start on your own, while you haven't found the right therapist for you.

I'm getting kind of a perfectionist vibe from you between the lines. You seem to be very body conscious, and only want the best for your physical well being. And there is nothing wrong with that, within reason. But maybe if that extends to other areas in your life, it's that perfectionism that causes your anxiety. Maybe there's some performance anxiety knocking about there. Anxiety often stems from the fear of not doing the right thing in a given situation. Or making yourself look silly perhaps.

In the end though, you probably do need professional help. That's what I did, and it helped me dial down my anxiety. It's still there, and it always will be. But you learn to gain a certain degree of control over it, so that it doesn't completely derail you anymore in typical anxiety raising situations.

Best of luck to you.
>> No. 27190 Anonymous
25th July 2018
Wednesday 12:53 am
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The first step is probably to go to your GP. He'll either accept "I'm feeling anxious" at face value or administer a quick test called the GAD-7, which is a short questionnaire to assess your level of anxiety.

https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7

If you're diagnosed as suffering from moderate or severe generalised anxiety, you'll probably be offered a choice of SSRI medication and/or Cognitive Behavioural Therapy. If you're diagnosed as suffering from mild anxiety or context-specific anxiety, you might be offered a beta-blocker (usually propranolol) or guided self-help. You're perfectly within your rights to ask specifically for any of these treatments if you have a preference. Your doctor can refuse if they think it's inappropriate, but you have the right to a second opinion.

SSRIs are a class of drugs commonly used to treat depression and anxiety. We don't really know why they work (aside from some vague hand-waving about serotonin levels), but they seem to be among the most effective treatments form moderate to severe anxiety and depression.

Sertraline is the default SSRI because it's the cheapest and works about as well as anything else. The evidence suggests that escitalopram is the most effective SSRI for the treatment of anxiety followed by citalopram, but we're not particularly sure. You might find that the first SSRI you try works for you, or you might need to try a few until you find one that works. The most common side-effects of SSRIs are sexual - your libido might reduce, you might find it more difficult to get an erection or take longer to reach orgasm.

If you're under 30, SSRIs are associated with a slight increase in the risk of suicide. If you're feeling depressed or you have ever tried to deliberately harm yourself, you need to tell your doctor so that they can keep a close eye on you. If you've been taking SSRIs for a while and suddenly stop, you might get some withdrawal symptoms, so you should be gradually tapered off through a succession of lower doses when you decide to stop taking them.

Cognitive behavioural therapy works by teaching you techniques to challenge the negative thoughts and beliefs that cause you to feel anxious. It works about as well as SSRIs; both together work better than either alone. If you're referred for CBT, it'll usually be through a programme called Improving Access to Psychological Therapies (IAPT).

You'll typically get about six half-hour sessions with a therapist, either one-to-one or in a group. Some IAPT services also offer psychoeducation, which usually consists of a series of talks and workshops teaching you techniques for managing your symptoms. Waiting times vary wildly across the country, from just a few weeks in some areas to over a year in others. If you can afford it, you can pay for therapy privately and get seen pretty much immediately. Anxiety UK offer therapy on a sliding-scale fee structure for their members, which is probably the most affordable private option.

https://www.anxietyuk.org.uk/our-services/accessing-therapy/

Beta-blockers like propranolol inhibit the activity of adrenaline, so they reduce the physical symptoms of anxiety like shakiness, sweatiness and a racing heartbeat. They can work well if you're only anxious in certain situations and are determined to do those things anyway; they're widely used by musicians and actors who suffer from stage fright. They're less useful if you feel a low level of anxiety all the time, or you tend to avoid things because the thought of doing them makes you anxious. They're generally very safe.

Guided self-help can include things like books or online CBT courses. It can be almost as effective as face-to-face therapy. Most libraries have a Books on Prescription section of self-help books that have been vetted by the NHS. Your doctor may be able to give you a login code for an online CBT course; alternatively, you can try Living Life to the Full for free.

https://llttf.com/

Some people find mindfulness meditation to be very helpful when dealing with anxiety. There's some evidence to support that, but it's not as strong as the evidence on SSRI drugs or CBT. It's probably worth a go; this lecture is a fairly good introduction and includes a short guided meditation. There are a variety of books available on the topic, of which I'd recommend Mindfulness: A Practical Guide to Finding Peace in a Frantic World by Dr Mark Williams and Dr Danny Penman.



https://www.amazon.co.uk/Mindfulness-practical-guide-finding-frantic/dp/074995308X/

Most importantly, if the first thing you try doesn't seem to help, try something else. Most of these treatments have a success rate of about 50%, so don't get disheartened if you try something and it doesn't work. If you keep trying different things, your odds of finding a successful treatment keep increasing. Any one of these treatments might be the solution to your anxiety, but you won't know until you try it.
>> No. 27196 Anonymous
25th July 2018
Wednesday 11:44 am
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>>27188
>I'm getting kind of a perfectionist vibe from you between the lines.

Well... You certainly pegged me pretty quickly. Yes it's a problem, and that exact kind of performance anxiety is what I have experienced. I am hard on myself and expect high standards, and feel guilt/shame/embarrassment when I don't hit a specific mark (usually near flawless).

I understand how those feelings impede learning. For a while I was at a stage of more or less "guilt-free" learning where I felt pretty good about myself, and forgave myself easily. This has slipped out of reach with time, mostly because I've taken on a new job which makes me feel generally quite listless and negative. It also limits the amount of time I have to regroup, reflect, and keep my mind generally healthy.

I believe some sort of mindfulness will help, as this is what I've done today with great effect. I've never heard of confrontation therapy, but I will look into it.

>>27190

This is fantastic, and really should be some sort of sticky for /emo/ generally. Thank you.
>> No. 27198 Anonymous
25th July 2018
Wednesday 12:29 pm
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>>27196

>Well... You certainly pegged me pretty quickly. Yes it's a problem, and that exact kind of performance anxiety is what I have experienced. I am hard on myself and expect high standards, and feel guilt/shame/embarrassment when I don't hit a specific mark (usually near flawless).


In that case then, ask yourself if it'd really be the end of the world if somebody perceived you as ordinary or average. And even if they do, it is not for other people to judge you that way. As a fundamental rule in life, everybody just tends to blag it. When you look past the veneer of the oh so perfect lives other people lead, and which they talk about incessantly, most of them are shit at almost everything they do and stand for in their lives. They have a mediocre level of education, they just about get by on the job, which usually isn't a stellar career by any measure, and they have fat arsed wives and ugly looking children at home.

Allow yourself to be average. Allow yourself to fail, and to be shit at something. And keep telling yourself that nobody has a right to point fingers at you. Tell yourself, this is what I am, and if that's not enough for you, then go f*ck yourself.
>> No. 27204 Anonymous
26th July 2018
Thursday 5:16 pm
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>>27190
> SSRIs are a class of drugs commonly used to treat depression and anxiety. We don't really know why they work (aside from some vague hand-waving about serotonin levels), but they seem to be among the most effective treatments form moderate to severe anxiety and depression.

I feel like I'd be doing the universe a minor disservice if I didn't point out that there are certain types of anxiety (such as anxiety from bouts of bi-polar mania or sub-mania) where SSRI and especially SNRI drugs can not only worsen your anxiety but can lead on to full blown psychotic or schizophrenic symptoms.

If you feel that your anxiety is worsened by SSRI or SNRI drugs or if you have any incidence of bi-polar disorder in your family make sure to bring this up with your GP.
>> No. 27207 Anonymous
26th July 2018
Thursday 6:18 pm
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>>27204

SSRI-induced mania is extremely rare in patients with no prior history of manic episodes. If you experience a worsening of symptoms or new symptoms after starting a treatment, you should always tell your GP.
>> No. 27215 Anonymous
26th July 2018
Thursday 8:09 pm
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>>27207

I definitely wasn't trying to piss all over >>27190 (which is a fantastic post), but I felt like it was something that I should point out.

Whether my own mania and submania was entirely induced by SSRI and SNRI medication or whether (as my current hypothetical diagnosis is continually coming closer and closer to confirming) I have suffered for a rather long time from undiagnosed bi-polar disorder (and my anxiety was caused by sub-manic episodes) is still up for debate.

What I can say with absolute certainty is that SSRI/SNRI drugs made my anxiety worse to the point where I was taking near-life threatening doses of a variety of sedative medications and still feeling like I'd just smoked an 8ball of crack with Super Hans.

Your advice of "If you experience a worsening of symptoms or new symptoms after starting a treatment, you should always tell your GP." is of course perfectly correct. I just wanted to make sure people knew that there are pharmaceutical alternatives to SSRIs and SNRIs available for people who do not react well to them.

Sage for whinge and pedantry. Apologies.
>> No. 27221 Anonymous
27th July 2018
Friday 12:13 am
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>>27215

I was prescribed mirtazapine for insomnia, PTSD, depression and anxiety.

I know it's a different kettle of fish as it's a NaSSA and not an SSRI, but I can only say positive things about it. Maybe it's an alternative if your SSRIs fuck with your individual brain chemistry too much.

The only downside to mirtazapine is that it makes you a bit drowsy during the day, and sometimes you can feel slightly more apathetic than you would as your usual self without it.

What I like about it though is that it has been massively effective in treating my insomnia. One 30 mg tablet every night, and I usually sleep like I'm dead. And then every morning, I feel like I am waking up from a deep, long sleep.

Oh, and it really brought down my anxiety. And my aggression, especially my autoaggressive tendencies. It's like every day just moves inside a comfortable, enjoyable, haze filled bubble for me. And I tend to enjoy every minute of it. Maybe it's because I have diagnostically confirmed schizoid tendencies to begin with, I don't know.
>> No. 27222 Anonymous
27th July 2018
Friday 12:46 am
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>>27221

The best available evidence suggests that mirtazapine is slightly more effective than SSRIs for the treatment of depression (we're not sure about anxiety). It's usually reserved as a second choice option if one or more SSRIs have failed, because it carries a significantly higher burden of side effects, namely drowsiness and weight gain. For some people, this will be a price worth paying. If you're a lanky insomniac, those side-effects might actually be useful effects.
>> No. 27232 Anonymous
27th July 2018
Friday 10:32 pm
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>>27222

>because it carries a significantly higher burden of side effects, namely drowsiness and weight gain. For some people, this will be a price worth paying. If you're a lanky insomniac, those side-effects might actually be useful effects.


Let's say I have never been noticeably overweight my whole life. With mirtazapine, I gained about half a stone. Which I felt was tolerable, being that I am indeed more of a slim build.

The drowsiness is the worst in the morning and during the typical afternoon performance low that pretty much everybody has. I mean that time after about lunch when you are settling back into your routine at your desk. That tends to be much more drowsiness inducing now than it used to be without the mirtazapine.

Some people have actually asked why I look spaced out and detached from the outside world at times. I know this to be the combined effect of my schizoid tendencies and the mirtazapine. I was also actually stopped by police once for a minor speeding violation, and was told that my eyes looked peculiarly glazed, and if I had been taking any illegal drugs. I said no, but also didn't feel like telling them I was on antidepressants. They then gave me the whole run and performed a wipe test on me, told me to follow the movement of a pen with my pupils, and discussed the idea among themselves of asking for a canine unit to have my car sniffed for drugs. For some reason, they then decided against it after all and let me off.

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