My Anxiety is So Severe I Can No Longer Function

Reader’s Question

I am a 29-year-old Civil engineer and also run a property investment company. I have been experiencing severe anxiety over the past year. I have always been an outgoing person with lots of friends and played sport to high levels throughout School, University and early work life. Problems started in my early 20’s when I started to become nervous and feel unwell before meetings, sport events and even when meeting new people. But I just ignored these feelings and carried on pushing through. A year or so later I was flying to a meeting which I have done quite often in the past but this time I felt nervous and unwell and had a fear that I had no control if I wanted off the plane, so now I avoid flying where possible.

These feelings I could cope with as they only affected me and I could hide them from people usually, but now I am turning these worries onto my wife. We lived apart for a year and a half when we were engaged and I was not concerned about her safety then, but over the last year the anxiety has become so severe that I worry about her safety constantly. If she goes away for even a night with work I am beside myself with worry and cannot even eat and need her to text or call her all the time for reassurance that she is okay.

I went to my doctor in New Zealand, who sent me to see a counsellor which I did. I undertook cognitive therapy to no avail. So I went back to my doctor and she prescribed citalopram (citalopram hydobromide 40mg per day). I have been on this for five months, but once again this has had little effect if any. I have even tried Hypnotherapy.

This problem has been severe for one and a half years now, and it is really affecting my life. My wife is supportive, but I cannot function normally anymore. Both the doctor and counsellor seem to have no answer or even know what is wrong with me. This problem has slowly become worse over the past five years and I am concerned that it will only get worse If I cannot get diagnosed or get the help I need.

Any suggestions of where to turn or where to go next or maybe any ideas of what is wrong would be a great help to me and even some hope. I feel the doctor and counsellor have put me in the too hard basket.

Psychologist’s Reply

Your increase in anxiety and near-panic probably reflects your increased responsibilities and obligations over the past few years. We often forget that good obligations can be very stressful. As your career became more successful, your stress levels increased. Using a car analogy — the faster we drive, the more stress on the engine to the point that internal pressure increases (anxiety) and the temperature rises to the point of warning lights on the dash (panic attacks). You’ve been “running hot” for many months now.

Your current treatment approach has been very limited. Many emotional issues are a combination of cognitive and neurotransmitter problems. Counseling is helpful in both — but severe anxiety requires medication support due to the significant neurotransmitter issues. Your current medication, Celexa (Citalopram), is a Selective Serotonin Reuptake Inhibitor (SSRI). It is helpful in many components of social anxiety disorder and depression, but not as effective against continuous anxiety. In the US, psychiatrists often use a long-acting antianxiety medication such as Klonopin or Buspar for several reasons:

  • they provide long-term anxiety relief,
  • less likely to be habit forming,
  • do not lend themselves to abuse as the short-acting antianxiety meds, and
  • they tend to prevent anxiety flare-ups

It’s also worth noting that 35% of people prescribed an antidepressant need to switch medications. No one should surrender after trying only one of the many antidepressants available.

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If your physician is unable to stabilize your anxiety I would consult with a psychiatrist. In my experience, family physicians try to help in any way they can. However, they often lack the clinical experience needed to use psychiatric medications in combinations. Your symptoms may require both Celexa and a long-acting antianxiety medication. Psychiatrists are trained to use medications in combination.

Your symptoms are very treatable. You might want to read my article on Chemical Imbalance on my website at www.drjoecarver.com. I’d also read the articles on anxiety and depression on this website. I would continue with your counselor as well.

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