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Anxiety Or Going Crazy?

Question:

I have been on medication for a while now because of my anxiety. I recently had a baby and now I feel like every type of problem out there, I have. I fear I have OCD, anxiety, depression, all of it. My doctor just raised my dosage of my medication and to me it doesn’t seem to be getting any better. It just cut down my number of panic attacks. I’m not sure if it’s just my anxiety getting to me or I’m going crazy. I’m getting married soon and I am completely afraid I’m going to go crazy and make a fool out of myself. I need to know what I can do to get better or help or something.

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  • Dr. Dombeck responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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Answer:

Problems like anxiety and depression are what psychologists call "bio-psycho-social" in nature, meaning that they are not clearly due to any single sort of cause, but rather are affected by a wide range of causes, including physical and genetic causes, psychological causes and interpersonal and social causes. If we look at your situation (based on the short report you’ve provided), you’re dealing with a pre-existing anxiety condition and a whole lot of new stress (given the recent birth of your child).

Psychologists who study personality have described a personality trait variously known as neuroticism and emotional stability. This personality trait describes a predisposition that some people have to become anxious and depressed. People who demonstrate high-neuroticism are prone to anxiety and mood issues, while people who are low-neuroticism tend to be more laid back by nature. There is evidence to suggest that neuroticism is in large part based on inherited genetic predispositions.

Given your history of anxiety issues, I’ll venture a guess that you tend to run towards the high-neurotic end of the neuroticism spectrum. This would suggest you may be more vulnerable to the impacts of stress than some other people in the world, and that your characteristic response to stress would be anxiety or depression.

In the face of the vulnerability, you have entered into a high stress time of life. You’ve probably heard of post-partum depression. This is a form of depression that becomes a problem in the wake of giving birth. It seems to be brought on by the strong biological fluctuation associated with pregnancy and birth, and the physical ordeal (e.g., lack of sleep and nursing concerns) associated with taking care of an infant. Not all women experience this issue, but a significant enough minority do. And even in the best case scenario (with a placid, easy baby who sleeps through the night early and no nursing issues), the arrival of a new baby demolishes existing routines and reshapes family life in dramatic ways. No mother I’ve ever spoken to described caregiving for very young infants to be a walk in the park.

On top of caring for your newborn, and dealing with the hormonal issues that may have tweaked your vulnerabilities, you’re also planning a wedding. Wedding planning can be a terribly stressful activity, particularly so if you are planning a large wedding with all the trimming. So we need to add this to the stress sources you are coping with at present.

All of this is to say that you are probably not "going crazy" (whatever that means), but that you probably are more vulnerable than many others to developing anxiety and depression problems in the first place, and that you are under enough stress now to activate those existing vulnerabilities. Perhaps a good way to think about what is happening to you is that you’re in the middle of a "flare up" sort of like some people get with acne, or Lupus or MS, only this particular flare up has to do with your emotions. Mental Health professionals tend to call this sort of thing an "Adjustment Disorder", although it is not clear that is what you are dealing with specifically.  Only your personal doctor can make a diagnosis that is meaningful and valid. 

It is a very good thing that you have alerted your doctor to your increased reactivity and mood problems, and a good thing that he or she is responding by altering your medication regime. And it would appear that the increased dosage has helped. It is not insignificant that your panic attacks have reduced in number. Still, if you want more help, it is appropriate for you to go back to your doctor and ask for additional help. Additional help may come in a variety of forms:

Your doctor may add additional medications, change medications, or alter your dose of existing medications.

You may wish to pursue psychotherapy for your anxiety and depression. An excellent, widely available, side-effect-free and scientifically validated form of psychotherapy that is useful for helping people to better manage anxiety and depression symptoms is known as Cognitive Behavioral Therapy, or CBT. Ask for it by name, because not all therapies are alike or equally helpful. Perhaps your doctor can recommend a therapist who specializes in providing this form of therapy.

You may also consider that, what with your new baby and impending wedding, that you’ve taken on too much and need to find ways to simplify your life. If you can reduce the demands you feel are weighing on you, chances are that you will feel some relief.

There are a variety of self-soothing and relaxation strategies that you can learn to practice on a regular basis to help manage your emotions. You may wish to consult our free self-help book, Psychological Self-Tools for further information.

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