SeekingHelp,
I have gone to a psychologist and have not been to a psychiatrist but I understand that there are similarities. On the one hand I don't want to waste your time if my info isn't useful - on the other hand - I do remember howmuch I worried about that first visit. SO I will offer lots of info here because I type fast and used to work as a writer/editor and hopefully by the time you finish reading it - other posters with more relevant info will have shown up and posted better info.
I also believed for most of my life that worrying and insomnia were my character traits, in addition to the habit of disappearing in social situations. (I have perfected the art of leaving a room without being seen).
I first went to a psychologist when I didn't know if I could continue my relationship with a family member. I wasn't there for anxiety but I wanted to mention myfirst impressions. The psychologist had a waiting room at the top of a flight of stairs. She told me that when I arrived I should flip the switch next to her door - which would discretely let her know I had arrived without interupting her conversation with the client with her at the time. I was to take a seat in the room to the side. The client ahead of me would exit and the psych would come and get me in a moment or two. Now I was there for family issues but my SA was kicking in - I couldn't bear the thought of being 'caught' sitting outside a psychologist's office (wouldn't that go along way toward proving something was wrong with me like others said?). I put alot of dread into worrying about how to manage that waiting room and it really never was the horrible thing I feared it would be. I saw her about 5 sessions. She was grandmotherly and warm and I didn't want to talk but the room was small and there was no where to hide. She asked me why I was there and then asked me alot of back ground questions that I couldn't always see how they related. It helped.
It was years before I went back to counseling - this time for my inability to attend company dinners, birthday parties, christmas parties etc. This counselor had two chairs facing an elevator immediately in front of his office. I didn't think I had SA but I knew I was socially awkward and I dreaded sitting out there - so I didn't. I always walked to the end of the hall where, like a wolf, I had commanding view of the corridor- where I cold see absolutely nothing. And I could not be seen. But I could hear the other client leave. I was very nervous but he was rather approachable, he made the effort to get the conversation going and keep it going. He asked me why I thought I had a hard time in social events etc. and what I was thinking during those times when I left social settings etc. He asked the background information "Tell me about where you lived where you were growing up" and "How did you get along with your Dad". Many background questions and sometimes encouraging statements when I said soemthing negative about myself (reframing- where they tell you how you worded it and how that might make you feel negative and suggest a more accurate, positive view). Wait...I am still getting to GAD.
I had to push back in the conversation sometimes - he was a big tough guy and when he contradicted me, if felt like bullying. He was truly baffled by my perception of him as bullying - no one had told him that. He always impressed me when I said something like "Ok the way you said that makes me feel like you are exasperated and I should just get over it" Every time he tuned in and explained himself etc. I couldn't see how working on developing a more accurate view of my past would help me go to a birthday party. But we did alot of that. Lot's of re-evaluating the life that seemed so 'normal' to you because that's all you ever knew. For me it was painful to revisit things like my mother dying of cancer etc. but there was always something that I needed to learn or see. I think I quit counseling twice with him. Eventually enough peripheral issues had been cleared away that subconciously I began to get close to an issue that was life long and buried. Suddenly - I had GAD. I had always had unhealthy levels of anxiety (insomnia and worrying, over analysis, isolation) but GAD was different. I was at work and I was so anxious that I couldn't read or understand emails. I would look at email and it was like it was a photograph - I could not understand it. I was expected to handle large amounts of detail but even though I had people repeat it to me several times - I had an impossible time understanding it. The anxiety got worse and I stopped sleeping entirely no matter how many days passed. I was in the hot seat at work - my boss was away and I was supposed to avert a disaster but I was incapable of functioning - at the 10 day mark I was completely desparate and told my counselor that I had to quit counseling - it was making me too anxious. This caught him off gaurd because I had been 'normal anxious' for over a year and I dind't know what topic was causing the GAD - and I usually knew when topics were bothering me. He repeated once again - prescription drugs. We had a joke where I would threaten to kick him in the shins if he suggested drugs. He held a bulky file folder over his shins when he made the suggestion. But I was kind of thinking even if I quit counseling I would still not sleep and lose my job because I had no idea what was causing my anxiety. So I went on Lexapro. Unfortunately it took about 2 weeks before the drug took the edge off the anxiety to a point I could recognize.
I was digging through my personal life, journaling and grieving everything I could to get rid of the GAD but I believed it wasn't helping. Lexapro causes diarhea (spelling?) and I didn't need that to complicate my life. It also causes fatigue and dry mouth. You have to start at a certain dossage level, stay there two weeks, and then if you need to go up, you take the new dose for at least two week before you can go up again. YOu also go off the drug in the same two week intervals - you can't abruptly decide to stop taking it - you must taper off. This is true for many of this class of drugs.
I started with such a low dosage of Lexapro that I had to go up 2 or 3 times before I felt I could concentrate in a normal manner. I am the only one I have talked to who gets a caffiene like effect from this kind of drug (and prozac) so sleep was impossible unless during the day - exhaustion over took me and I napped. Eventually - in all the issues I was agonizing over - I came across one issie hidden from myself for so long - opposite everything I logically knew. It was traumatic digging that up. I didn't realize that this was causing my GAD. Unconcious fear of getting near that live wire. I was still sleepless and day after day...as the GAD fell away beneath the drugs I didn't know it...I began to become too tired to function. It happened gradually - my psychologist would not have noticed and Iwould not have thought to tell my GP. Everynight - because I experience an unusual caffiene affect from Lexapro (And Prozac), I would be wide awake - but by day it became almost impossible to stay awake and I would come home from work, drag over to a chair and sleep sitting up until it was ok to go to bed. At which point I was awake between 2am and 7:30am when it was time for me to get up. I don't know how I would know that the GAD had dropped. In hindsight I wish I had recorded amounts of sleep I was receiving and amounts of activity daily - that might have at least indicated to me that I was becoming sedentary and the dose needed to be reduced. I could have backed off of it that way. I became quite depressed because I thougth I still had GAD and I couldn't sleep and I couldn't stay awake and household tasks were too hard for me to do. Eating became too much trouble. It's my opinion that docs don't take you off the drug readily when you say you are tired and having side effects because a) the symptoms often decrease with time for many people b) they want you to give the drug a fair chance and don't want you skipping from drug to drug in search of a quick fix. I backed down off the drug at two week intervals and when I stopped taking it - it took a few weeks to completely clear my system. In hindsight - would I take Lexapro again? Yes - I had to take something to help me keep my job and I truly believe that the LExapro lowered the anxiety I felt all my life enough for me to allow myself to face the awful truth etc. I don't think my mind would have relaxed it's guard on that issue - Lexapro helped me keep my job and reveal the issue - but I sure did alot of complaining along the way.
In total I was on Lexapro for about 8 months I think. I gave up trying to get over SA when the psych told me it was time for me to start practicing social interaction in baby steps to help me become desensitized. He said I had a fear of the fear - and he wanted me to ask a man out on a date. I felt that I was being asked to climb the outside of a glass sided office building. I reasoned that there was no getting over the SA but that I had truly gained from counseling - for the next 6 mos I slept deeply for the first time in my life. I went around telling people what sleep was like as if I discovered something uknown...and they all told me yes - sleep is like that for everyone. You can imagine how disappointed I was to awaken with a full blown panic attack. The next morning I called my GP and explained what had happened. She started me on prozac. After 9 days...I felt like the panic had sort of a strobe light effect - I could feel the panic had breaks in it. Prozac did not make me as tired as Lexapro but it did have the same caffeine effect on me so sleep became a thing of the past. On my worst panic attack nights - a combination of PRozac, Xanax, and Ambien did not eliminate the panic nor give me any sleep. Therapy with another psychologist lessened the panic attacks and I went off Prozac at the 8 month mark - but my friend tired of my comments about getting off the drug every day - I wanted to sleep so bad. This counselor has a more comfy waiting room arrangement for someone like me. There are podiatrists, cardiologists etc. all sharing a waiting room and no one really knows why I am there and people tend to rattle newspapers and look out the window. Same introductory format - the doc made the effort to set me at ease and keep the session rolling. Starts with background iformation and what you are hoping to get out of counseling. This counselor practices CBT and I think that this type of therapy is more effective for me. I stopped taking Prozac after 8 months. I now take half a xanax before bed and sometimes I don't awaken in the night but the sleep is not deep enough (still anxious) and I often am still tired when I awake.I will take this over life threatening emotions of full blown panic attacks any day of the week. I had to stop taking Ambien to fight drug and anxiety induced insomnia because after 5 days in a row on it, I start driving through red lights. I can see that they are red but it's an impersonal detail that doesn't matter until it's almost too late. Some people are able to take alergy medicine Benadryl to allow them to sleep. Iwish that worked for me but it doesnt'. As you can see - my information is not typical and I hope that in the mountain of it - you might find a useful sliver. I will say that the quality of my life has improved (peace, spirituality, etc) dramatically and I always encourage anyone going into counseling to go and not give up no matter what. I say that out there, somewhere, is a doc who can help us and if the one you see for a few weeks or months isn't able to communicate with you well or you just can't relax around them - change docs. I've walked out of counsleing sessions about 3 times and gave up on counseling about 3 times but for ever effort I expend in trying to get help, there is an improvement. I work hard when I am in counseling - I reflect on the sessions afterward and write about thoughts and dig up things and ask the doc questions. I so want to be done, finished, through etc. but I have learned that for every hour I stay in it - it does help. It's helped me with things I didn't even know I needed help with and it is chipping away at my SA.
