Best meds for social anxiety

Particular attention in this list should be given to pregabalin, which belongs to the group of antiepileptic drugs. It should be noted that for a long time in the medical and pharmacological communities there has been a discussion of changing the existing approach to the classification of psychotropic drugs. Often the name of a group of drugs, such as antidepressants, antipsychotics (neuroleptics), or anticonvulsants (antiepileptic drugs), does not correspond to the diagnosis for which they are prescribed. So, antidepressants can be prescribed for anxiety, bulimia; antipsychotics - for anxiety, depression; anticonvulsants - for the same anxiety or bipolar affective disorder. Assigning a prescribed drug to any of these groups often confuses patients, which can be a cause for additional concern or reduced compliance. Discussion of the transition from the old classification model based on symptoms to the new one was one of the main topics of one of the largest annual world conferences on psychiatry and psychopharmacology "ECNP Congress" in 2014, 2015 and 2016, and it is possible that in the near future this new model will be implemented.

Pregabalin differs in its chemical structure and mechanism of action from SSRIs and SNRIs, while remaining highly effective in generalized anxiety disorder, as evidenced by its inclusion as first-line therapy in various management guidelines for these patients. Pregabalin is a γ-aminobutyric acid derivative and was originally used and approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of epilepsy and various types of chronic pain syndrome, including diabetic peripheral neuropathy, postherpetic neuralgia, and fibromyalgia. Later evidence began to emerge for its effectiveness in anxiety disorders, especially generalized anxiety disorder and, to a lesser extent, social phobia.

Recently, this drug has increasingly become the subject of study specifically in the context of anxiety treatment as an alternative to SSRIs. The problem of the widespread use of the latter is mainly due to the relatively slow onset of action, the risk of withdrawal syndrome and the lack of a significant effect in relation to such often comorbid conditions as chronic pain syndrome of various origins. In addition, in about ⅓ of patients, the use of SSRIs and SNRIs does not lead to the desired effect and there is a need to look for another therapy with a different mechanism of action.

This was reflected in a systematic review of scientific studies conducted by the staff of the Villa San Benedetto Menni clinics in Rome, Maastricht University and the University of Miami. Summarizing the available evidence base for all drugs used in anxiety disorders, the researchers concluded that pregabalin is highly effective in generalized anxiety disorder. At the same time, as the authors note, the drug showed a low risk of adverse effects with long-term use and did not have a negative effect on cognitive or psychomotor functioning (Perna G. et al., 2016).

Also published this year are the results of an analysis of several randomized clinical trials that evaluated the effectiveness of pregabalin in the context of pain reduction and improvement in various areas of functioning. The authors note that taking pregabalin led to a significant reduction in pain, improved sleep quality and physical functioning. The analysis also assessed symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). On the one hand, no significant differences were found with the control group (placebo), on the other hand, the study sample consisted of individuals with a low initial level of anxiety and depression, which did not reach the level of clinical significance (6 points each on the HADS anxiety and depression subscales at the threshold level ≥8 points and clinically significant ≥11 points) (Sadosky A. et al., 2016).

The problem of anxiety is also relevant for patients undergoing surgical treatment. This disorder often accompanies these patients both in the pre- and postoperative period. In addition, anxiety about the upcoming operation and pain has a negative effect on surgery and anesthesia. A new clinical trial conducted in 2016 demonstrated the effectiveness of pregabalin adjunctive therapy for bone surgery. In this study, patients of the experimental group were premedicated with pregabalin in different dosages before blockade of peripheral nerves. The control group did not receive any additional therapy. According to the results, the use of pregabalin significantly contributed to the maintenance of hemodynamic parameters during the intervention at a normal level and greater patient satisfaction with the quality of anesthesia. When using pregabalin at a dose of 150 and 300 mg, a significantly shorter duration of surgical intervention was also noted compared with the control (76. 5; 68.0 and 83.3 minutes, respectively).

Conclusions

Anxiety disorders are a common problem of our time, one of the main characteristics of which is a high comorbidity with both somatic and other mental disorders. The gradual discovery of new drugs and the study of additional properties of already long-term use has replaced benzodiazepines from the first-line therapy recommended in current guidelines for patients with anxiety disorders. Highly effective drugs are not limited to the SSRI and SNRI group; Today, there are other effective medicines classified as anticonvulsants and atypical antipsychotics. In particular, the study of the additional properties of pregabalin has demonstrated its high efficacy in generalized anxiety disorder, which is reflected in the most significant clinical guidelines and recommendations of the European Medical Agency. Experts conclude that pregabalin can be used as a first-line therapy for this disorder, and it may also be the best pharmacological alternative to SSRIs when they are ineffective or poorly tolerated. This drug occupies a special place in anxiety in patients with a neurological profile and those undergoing surgical interventions, since, in addition to the effect on anxiety, it reduces the intensity of pain and improves postoperative outcomes.

List of references

Correspondence address:
Vitaly Grigoryevich Bezsheiko
01030, Kyiv,
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Ukrainian Research Institute of Social and Forensic Psychiatry and Narcology

causes, symptoms, diagnosis, treatment, therapy and drugs

Anastasia Somova

I worry a lot

Author profile

I have suffered from anxiety since childhood , and at 22, a psychiatrist diagnosed me with generalized anxiety disorder.

I am now 24 years old and have had severe anxiety since I was 15. I was treated for vascular dystonia, headaches, sleep problems, low blood pressure.

In the eleventh grade, at the peak of my preparation for the Unified State Examination, I fainted at school and ended up in the hospital - in the children's neurological department. There, too, no one suspected a psychiatric diagnosis and problems with mental health. But they prescribed a whole list of non-working drugs - nootropics and the like. At that moment, I myself did not know anything about mental disorders.

Explain how I got the correct diagnosis and how I live with Generalized Anxiety Disorder.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

What is Generalized Anxiety Disorder

The International Classification of Diseases has an entire section on anxiety and fear-related disorders.

Generalized Anxiety Disorder in Adults - Uptodate

Generalized Anxiety Disorder in Adults: Management - Uptodate

Generalized Anxiety Disorder is the most common among them. In addition, this disease is generally one of the most common mental disorders.

Why Generalized Anxiety Disorder develops is not yet known. Perhaps this is due to a disruption in the production of a number of neurotransmitters, that is, connections due to which brain neurons communicate with each other, or to a change in metabolism in some parts of the brain. There is also a link between increased anxiety and a large number of traumatic situations, especially in childhood.

Generalized Anxiety Disorder - NHS

Generalized anxiety disorder can begin at any age. For no reason, a strong anxiety appears that prevents a person from living and working normally. Anxiety attacks can be accompanied by bodily manifestations: a feeling of lack of air, a strong heartbeat, numbness of the limbs, and others.

The disease does not pass without a trace, not only for the psyche. According to some data, increased anxiety increases the risk of coronary heart disease and hypertension, and also increases the risk of death from cardiovascular diseases in general.

I believe that my disorder began to manifest itself in childhood. I grew up with a constant feeling of anxiety, which became stronger with age. My father is a very specific person. He could at one point just stop talking to me and mom. I collected my things and "moved" to another room - the apartment was big enough. I don’t know why I, a small child, fell under this “torture by silence”. Colliding in the corridor or at the front door, we did not say hello.

I also had constant headaches from the age of six. I was examined, but the reasons were not found. Neurologists prescribed glycine, physiotherapy and pain relief according to the situation.

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Now, after going through therapy and many hours of soul-searching, I realize that almost every interaction with my father went through anxiety.

For example, with a good family income, you had to beg for clothes, choosing the time when he was in a good mood. Trips - no matter to the country or abroad - have always been nervous and stressful.

I wasn't taught to recognize emotions, so I didn't know it was anxiety. I felt it as a restless state in which everyone lives in one way or another - that's how it seemed to me then.

Headaches, by the way, disappeared with the start of taking antidepressants. The psychiatrist said that most likely they were one of the symptoms of the disorder.

Symptoms of generalized anxiety disorder

Kirill Sychev

psychiatrist, psychotherapist

The main difference between generalized anxiety disorder and other disorders is that anxiety in it is not limited to specific situations. That is, anxiety lasts for a long time - a month or more, for at least two weeks, and does not depend on what the person does.

The main signs of pathological anxiety are intense, constant, almost uncontrollable, and appear without clear causes. A person with an anxiety disorder usually feels fear, distress, and impending danger most of the time.

Anxiety becomes a constant companion: a person wakes up in anxiety, worries all day for a million different reasons and without, falls asleep for a long time and sleeps badly because of anxiety. At the same time, he cannot cope with this feeling on his own.

Life before diagnosis

Anxiety did not recede in adolescence, and then it only got worse. After school, I entered St. Petersburg State University, where I really wanted to go. However, as a result, I was expelled at the end of the third year - I did not even pass the session to get an incomplete higher education.

Six months before that, there was a period of constant causeless anxiety, absolute powerlessness, inability to sleep and unwillingness to get out of bed. Most of the time I didn't go to university. The people around attributed everything to laziness, but in fact, sometimes I physically could not force myself to get out of bed and go to study. In fact, I did everything to be expelled: I didn’t have the strength to reach the administration and refuse to study myself. And the alarm would not even allow me to enter the faculty building.

It was not customary in my environment to talk about problems with mental health. Perhaps if I had come across a person, video or text with recommendations to go to a psychiatrist with my symptoms, I would not have been expelled and life would have turned out differently.

After leaving the university for two years, I lived in a state of anxiety. I had a constant headache, ten painkillers were enough for a week. I went to a neurologist - he prescribed muscle relaxants and nootropics, and advised melatonin for sleep problems.

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My body has never been relaxed. Every little muscle was tense every second. Massage trips always took place with the requests of the master to relax. I didn’t sleep well, I could wake up at night and lie awake for several hours.

Anxiety arose even because of everyday trifles and was incommensurable with the problem. For example, dirty dishes in the sink in the morning, which the boyfriend had to wash, became the cause of terrible anxiety for the whole day. Even fixing the problem - washing dishes - did not change the state.

I think it comes from childhood - my father constantly scolded me for what I thought was a mess. It seemed to me that the dirty dishes in the sink meant that I was useless, you couldn’t love me, you had to leave me as soon as possible. In those moments, I did not recognize such thoughts as strange and illogical.

There was a similar situation with spending money: I bought something expensive, spent the money, so you can’t love me, you have to leave me alone. At the same time, my boyfriend and I have been together for a long time and have never quarreled over expenses that fit into the budget.

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In general, I had a clear set of anxiety triggers. These are dirty dishes and the floor, spending money on something relatively expensive, buying coffee to go, talking with your father. And if before the trigger, anxiety was background, then after it began to grow to the size of an entire planet.

At this time, popular science books came into my life. In the summer I bought a book by Daria Varlamova and Anton Zainiev “Go crazy! A Guide to Mental Disorders for a Big City Resident. One of the chapters is devoted to anxiety disorders - and it was about me, and so precisely that it became scary. At the same time, I learned about the Beck test for determining the level of anxiety, passed it and got almost the maximum score.

Beck's Anxiety Scale in Russian

However, I still didn't think about the urgent need for a psychiatrist. To go to the doctor, I had to make an effort and admit that I have a problem. I didn’t want to do this - I was afraid to be unnecessary and unloved again. After all, you cannot love a person with mental problems. My logic, of course, was wonderful.

First visit to a psychotherapist and diagnosis

One day I went to the market where I bought Uzbek tomatoes for 800 R per kilo. They were insanely delicious, fit into the budget, that is, the purchase should not have caused me discomfort. However, anxiety didn't think so. She covered me as soon as I left the market building.

The anxiety was so strong that I did not remember either the way to the house or how I spent the evening. I was shaking, at home I locked myself in the toilet and sobbed sobbing. I was suffocating, I was terribly out of breath. The night did not sleep, every second I thought about the price of tomatoes. One obsessive phrase was spinning in my head: "Tomatoes cost 800 R per kilogram."

/psychotherapy-search/

How to choose a psychotherapist

In the morning I began to google a psychotherapist. At that moment, I did not know about psychiatry according to compulsory medical insurance, as well as about the division of doctors into psychiatrists, psychotherapists and psychologists.

Can a psychologist work with anxiety disorders

Anna Shilova

psychologist

For a psychologist, the first meeting with a client is a diagnostic one. On it, we find out whether it is necessary to connect a psychiatrist. I ask questions about the quality of sleep, the level of libido, eating habits and appetite, chronic and current diseases, fatigue, somatic manifestations of anxiety, if any.

When I complain about anxiety, regardless of the data that I collected during the first meeting, after it I send a diagnostic questionnaire - it allows you to determine the likelihood of a diagnosis.

As a psychologist, I have no right to make diagnoses - this is beyond my competence. This part of the work is done by a psychiatrist. If, according to the results of the questionnaire and the collection of information, there are symptoms of a disorder, I send the person for a psychiatric consultation. I do this even with the slightest suspicion, because only a doctor can comment on whether it is necessary to connect medication to psychotherapy.

I chose my first psychotherapist based on reviews and the ability to see me on the same day. The appointment then cost 3500 R. At the clinic, I was met by a pleasant doctor, led to the office, where he asked me to tell me what was bothering me. I told him about the tomatoes, the inability to sleep well, and my relationship with my father.

3500 R

cost one appointment with a private psychotherapist

Before the appointment, I made a checklist for myself, where I wrote down the main causes of anxiety. It helped me a lot - due to the large flow of emotions at the reception, it was difficult to focus on my thoughts. The psychotherapist asked me questions, led me to reasoning, as a result, he diagnosed me with generalized anxiety disorder, and prescribed treatment.

Diagnosis of generalized anxiety disorder

Kirill Sychev

psychiatrist, psychotherapist

For a doctor to make a diagnosis, a person must have the following manifestations:

difficulty in relaxing, constant tension, fussiness. Sometimes even headaches due to this tension;

The DSM-5 American Diagnostic Manual also emphasizes that a person must have at least three of the following symptoms: feeling “on edge”, easy fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance.

Treatment of generalized anxiety disorder

Anxiety disorder is treated with psychotherapy, in particular cognitive behavioral therapy, and drugs, most commonly antidepressants. Psychotherapy can sometimes be used as the main method of treatment - it depends on the severity of anxiety and the patient's capabilities, since not everyone can regularly visit a psychotherapist.

Pharmacotherapy of Generalized Anxiety Disorder in Adults - Uptodate

Generalized Anxiety Disorder in Adults: Cognitive Behavioral Therapy and Other Therapies - Uptodate

My doctor recommended antidepressants at my first consultation. He told about their work and how to properly start a reception.

I really liked the metaphor about crutches and broken legs. Crutches are antidepressants. They will not help the leg grow together, but they will make life easier and make it possible to walk while the leg in the cast grows together. Gypsum, on the other hand, is therapy and its own work. You can walk on crutches for a long time without a cast, but nothing good will come of it.

We also went through therapy with a psychotherapist. Then I didn’t know about different methods and schools of psychotherapy, so I can’t say exactly what technique he used. Most likely, it was one of the variations of cognitive behavioral therapy.

I was prescribed an antidepressant from the group of selective serotonin reuptake inhibitors, or SSRIs. Simply put, these drugs increase the concentration of serotonin in the brain, which improves mood and relieves anxiety. However, in the first weeks of taking such medications, they can cause the opposite side effect - increased anxiety. Therefore, in addition, I was prescribed a tranquilizer. He also helped to sleep well.

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When I first handed the prescription to the pharmacist, I felt like I was buying something forbidden and scary. In the countries of the former CIS, antidepressants, it seems to me, do not have a good reputation, but in fact there is nothing wrong with such pills, let alone prohibited.

Tranquilizer relieves symptoms almost immediately. For a long time I lived with the feeling that someone stepped on my chest and I couldn’t breathe normally. The feeling of relaxation and calmness that I got after the first use of the medicines is hard to forget. It's like taking off uncomfortable shoes after a hard day's work or unzipping your jeans after a heavy meal - only ten times better.

Taking an antidepressant was easy enough for me. A month later, I again went to a psychotherapist and received a prescription for six months. In addition, I was also prescribed one of the neuroleptics for sleep. It took about 900 R per month for pills. We also discussed the issues that worried me again, they mainly concerned behavior patterns.

900 R

on average I spent monthly on pills

Summer and early autumn after the first dose were among the best for me in several years. I lived the life of an ordinary person, I had enough strength to work, go to the gym, take long walks. If earlier I started shaking at the sight of a dirty plate in the sink in the morning, now it worried me much less.

How generalized anxiety disorder is treated

Kirill Sychev

psychiatrist, psychotherapist

Treatment of generalized anxiety disorder usually begins with cognitive behavioral therapy, if the person agrees to it and is ready to do it. If it does not help or this option is not suitable for a person, we use pharmacological treatment.

Antidepressants are usually prescribed first - selective serotonin reuptake inhibitors and selective serotonin and norepinephrine reuptake inhibitors, i.e. SSRIs and SNRIs.

Antidepressants are well-researched and effective drugs. This is the same adequate treatment for mental disorders as insulin for a person with diabetes or a painkiller for a fracture. They restore the correct functioning of the brain and thinking, give the patient the necessary resource to fight the disease.

Antidepressants are not addictive. From a medical point of view, addiction is a craving for use, accompanied by a constant increase in the dose of the substance taken. When taking antidepressants, there is no such craving. The patient does not need to constantly increase the dose. However, at the stage of selecting the drug, the doctor can increase it.

There are concepts of the minimum and maximum therapeutic dose - the first is not always enough, but the maximum is never raised above. And then the patient drinks the medicine in the required amount until the end of the course.

In the treatment of depression and anxiety disorders, antidepressants should be taken for at least a year from the moment the condition noticeably improves. So the risk of relapse is lower.

The first unsuccessful attempt to get to a doctor under compulsory health insurance

In the fall, a few months after the start of treatment, I decided to visit a psychotherapist again. The anxiety went away, but the dream began to go astray, there were questions that I would like to solve in therapy: I still transferred the patterns from the relationship with my father to the relationship with my boyfriend. At that moment, the price of seeing a paid psychotherapist increased to 5,000 R. I could not afford it and for the first time decided on CHI therapy.

At that time, a list with numbers of free psychological help roamed the Internet. There was also a number of a free psychotherapist in St. Petersburg, where I lived. Everything turned out to be not so simple: at first, I called the reception desk of one of the PNDs for about an hour, and they told me to call another phone number. By the second number they gave me another number. As a result, after a couple of hours, I got through and made an appointment. They asked me for my name and age, gave me the address and name of the doctor.

/psychotherapy/

How psychotherapy works

The office was in one of the clinics in my neighborhood. I arrived for the session at nine in the morning. At the registry, which was separate for a psychotherapist, they took my address of residence, passport number, compulsory medical insurance and SNILS, then I went to the doctor.

The first question the therapist asked me was if I was working. At that moment, I had problems with this, I honestly answered that I didn’t, and my boyfriend helps me with money. Here he began to scold me. He said that I had no right to apply for help under compulsory medical insurance, that I had to go to a paid doctor, that I was a parasitic and all that. And also that I can’t come to him, because this is an office not in my place of residence. After that, I didn’t want to open up to the person, I shrunk in my chair and almost cried. But I needed to extend the prescription - this is the only thing that kept me from escaping.

After somehow telling what I take and what my diagnosis is, I asked for a prescription. He shook his head and began to tell me that I needed to leave Russia and there was nothing for me to do here. Then he recommended taking Phenibut, a drug that is available by prescription, but does not have proven effectiveness.

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I left the office in shock. Fortunately, this did not affect my psyche - from the very beginning I managed to build an armor between me and this pseudo-psychotherapist. By the way, in the end he wrote out the prescriptions I needed. However, the experience was unsuccessful, so until the next year I was afraid to even think about psychotherapy.

Treatment by a psychiatrist in the district dispensary according to compulsory medical insurance

In winter, I went into remission - this means that for a long time I felt like a healthy person at the therapeutic dosage of the medicine. Then I decided to reduce the dosage. A paid psychotherapist told me about the correct exit from treatment in one of the first sessions, so it seemed to me that I understood how to do it.

Back then, I was actively sitting on a mental health forum where people share their stories of illness and treatment. You can also consult a psychiatrist there. Such a consultation will not replace treatment and face-to-face sessions, but it can help in situations where you need an answer to a small question, but you don’t want to pay 5000 R for a session.

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I asked a question on the forum about the abolition of pills and received general recommendations. The dosage of the antidepressant was reduced very slowly, reaching 1/8 tablet. It was hard, because out of ignorance I did not take anything to alleviate the symptoms.

Of course, stopping antidepressants on my own was a big mistake. When taking any medication, you do not need self-activity and advice from the Internet. I decided to stop taking the pills too early - it was necessary to take antidepressants for at least a year from the improvement of the condition, best under the supervision of a doctor.

Why you can’t stop drugs or change the dosage yourself

Kirill Sychev

psychiatrist, psychotherapist

You can’t stop psychiatric drugs on your own, because there is a high probability that side effects or a withdrawal syndrome will occur.

It is best to be in touch with your doctor during dose changes or withdrawals. So you can choose the right withdrawal tactics, add other drugs for this period that will remove side effects, change the rate of withdrawal, taking into account the reaction of the body.

In the spring of 2020, the COVID-19 pandemic hit, and I again developed severe anxiety. The social and medical problems associated with the coronavirus bypassed me, there were no objective reasons to worry. And I was worried.

And it happened all of a sudden. I could do yoga and in the middle of the practice lie on the floor with a rapid heartbeat due to sudden unreasonable anxiety or suddenly cry. It feels like a sudden wave: it covers your head, you can’t run away from it anywhere.

About two months had passed since the end of taking the pills. I tried to cope with anxiety non-drug - meditation, dynamic relaxation according to Jacobson, freewriting about experiences. It did not help. The prices for therapy at that moment rose again, and I needed, if not psychotherapy, then definitely crutches in the form of pills.

/shizofreniya/

How much does it cost to support a relative with a mental disorder? To do this, I found the address of the district PND in the issuance of a search engine, called the registry office and found out what was needed for admission. Everything turned out to be simple:

1. You need to come to the PND, apply to the reception. There, give your passport, policy and SNILS, give the actual address of residence. At the reception, they will issue a card and call the office number.
2. People go to the office in a queue. Each section has its own psychiatrist. You cannot sign up for a specific time, as it happens in a regular clinic. It is better to come early, then you will get there faster. Arriving 15-20 minutes before the doctor started the appointment, on average I was third or fourth in line.

At the appointment, the psychiatrist asked what was bothering me. I told my story, he offered me several antidepressants to choose from, talking about the pros and cons of each. He also prescribed a tranquilizer to remove the primary side effects.

The antidepressant was from the same group as the first time, but different. The packaging cost me 800 R, in total I bought two of them. I was told to come back in three or four weeks. This is necessary to understand whether the medicine suits me or not, whether the dosage needs to be adjusted. The diagnosis remained the same - generalized anxiety disorder.

A month later, I came back to PND. At that moment, another doctor saw me, because my district police officer fell ill. During my visit to the dispensary, I talked with four different psychiatrists - and I had no problems with any of them. No one humiliated me, everyone spoke politely and professionally, they really tried to help.

The pills did not help me this time, so the psychiatrist suggested trying to be treated in a hospital. With a residence permit in St. Petersburg, I could be hospitalized in a neurosis clinic. However, there was no registration, so they could only offer me a day hospital at the hospital named after. Kashchenko.

You can get to the hospital only in the direction from the PND. The doctor appoints a day, issues a referral with which you need to come to the hospital. They make a card there, and then send it to the primary appointment with the doctor.

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Treatment in a hospital according to compulsory medical insurance

In total, I was treated in a day hospital twice. I don't have a single negative memory associated with it, I liked this place, I liked the people there.

Treatment is quite simple. After an initial conversation with a psychiatrist, medications are selected. You also need to consult with a clinical psychologist, make a cardiogram, if necessary, visit other doctors - for example, a cardiologist or endocrinologist. This can be done either in the hospital itself, or in the clinic in the direction.

Clinical psychologist gives tests for attentiveness and memory. Together with him, we also filled out several questionnaires - for the level of anxiety and the presence of depression.

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There is a psychotherapist in the hospital, and a psychiatrist also makes appointments with him. Usually these are one-hour sessions once or twice a week. You can also go to a theater or art studio, to bibliotherapy, dance therapy, adaptive yoga. All this is free.

Studio teachers really want to help patients. People in the hospital are different, with different diseases, different states of mind, but it was very comfortable to work with everyone.

I went to psychotherapy twice a week, every other day I went to the psychiatrist. I wanted to go to yoga several times, but it was early in the morning, I woke up every time.

The way psychotherapy sessions go depends on the methodology that the therapist uses. I wanted to do cognitive behavioral therapy, one of the techniques supported by evidence-based medicine. This was not the case at the hospital, but my doctor offered to help me find a good private therapist working in this direction if I wanted to.

The pills prescribed by the doctor were dispensed by nurses in a special room. You need to go to the hospital often - at first every day, then every other day, at the end at least twice a week. The drugs are given in the amount they are needed for the time while the patient is not in the hospital. The nurses are sympathetic and sweet, they call everyone by diminutive names, they remember them in just a couple of days.

They provide food in the hospital, you can have breakfast and lunch. The food is ordinary hospital food, but I liked it: I love simple food, especially all sorts of stews.

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“It was like a strict regime sanatorium”: how much I spent on treating depression

During the pandemic, consultations with psychotherapists were moved to Skype, and visits to a psychiatrist were once or twice a week, sometimes more, depending on the state.

Due to frequent visits, any changes in the condition are easily monitored and the dosage of drugs is quickly adjusted. For example, once I was unsuccessfully prescribed a drug. The next day, I told about it at the meeting - and it was canceled for me.

Treatment in the hospital continues until a stable condition is reached. For example, in my case it was the disappearance of constant anxiety for at least a few weeks.

Both times I left the hospital myself because I got tired of visiting it so often. But before that, the doctors selected a treatment for me, and it worked. I had to try several schemes. As a result, we came to my very first medicine, only at a dosage 2.5 times higher. I still take it.

My experience only describes a particular hospital. The system of psychiatry in Russia is imperfect, it is difficult, but possible, to find a competent doctor for CHI. The biggest problem in this situation is not to run into a specialist who will only make things worse. However, incompetent specialists are also found in the commercial system.

How I currently live with Generalized Anxiety Disorder

I am still undergoing compulsory medical insurance. It will soon be a year since I follow the latest version of the therapeutic regimen. Once every three or four months I go to a paid psychologist, a consultation costs 3500 R, but now I don’t need regular therapy.

Increased anxiety is still in my life, but it does not immobilize me, does not deprive me of freedom. I still have problems sleeping, and the crowd is filled with terrible anxiety and lack of air. Mostly somatic manifestations remained: muscle tension in trigger situations, a feeling of lack of air and headaches if I am very nervous.

On the other hand, I learned a lot during the treatment period: talk about problems, look for solutions, work with anxiety, and even relax. Both psychotherapy and antidepressants helped me with this.

/psychotherapy-pros-cons/

Pros and cons: is it worth spending money on a psychotherapist

I spend 28,250 R per year on the treatment of anxiety disorder

Psychotherapist appointment

Cost

From 3500 R per visit

Total for the year

14 000 R

Antidepressants - in a pack of 100 tablets, I have enough for 40 days

Cost

1200 r for a pack of

Total for the year

Cost

1100 R per pack

Total for the year

3300 R

What helps me to work with anxiety

I will talk about books, applications and other things that are helped me before and help me now, but do not replace therapy and taking pills:

1. Mental health diary application. It is built on the principles of cognitive behavioral therapy. Helps to recognize automatic thoughts and rationalize them, makes it possible to become more conscious. The application has a diary of automatic thoughts, where you can write daily what worries you. My favorite feature is the destruction of negativity, try it.
2. Robert Leahy, "Freedom from Anxiety". A must have book for all anxious people. The author is a doctor of psychology, adheres to the methods of cognitive therapy. You can read in order, or you can only read the chapters of interest. It will not replace therapy, but it will help to understand where the anxiety manifestations come from, teach you how to work with the disorder.
3. Spiritual balance forum. As in any other forum, the audience there is different, so the information needs to be filtered. However, it was there that they supported me when I was very ill. Here you can also consult with psychiatrists, read useful articles and case histories of other people.
4. TED Talks about psychological first aid and emotional hygiene.
5. Lindsey K. Gibson, Adult Children of Emotionally Immature Parents. One of my favorite books that helped me understand and let go of my relationship with my father. The book has interactive tasks to help work through the questions.
6. Muscle relaxation according to Jacobson. I like a particular video, but there are many options on the Internet.
7. Application for meditation Insight Timer and meditation by Valery Veryaskin. I tried a thousand and one meditations, but only Valery's audio helps me relax and fall asleep in the evening. My favorite is The Practice of Relaxation.

Remember

1. If you feel that anxiety interferes with your life, you should go to a psychiatrist. For self-examination, you can take the Beck test.
2. It is better to ask for help - to the doctor, relatives, friends, people on the forum. Anxious thoughts are much easier to deal with if you speak them out.

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