Anxiety: When Treatment Feels Ineffective and Life Becomes Overwhelming

Anxiety disorders can lead to significant disruptions in daily life, and treatment may often feel ineffective?

Hello, Doctor.
Thank you for taking the time to answer my questions.
I am a university student, and during high school, I put a lot of pressure on myself regarding my studies (I still do this now; if I don't perform well on exams, I self-blame and have an unusual insistence on every test, being very sensitive to grades.
People around me say it's a bit excessive).
Additionally, my mother has a history of suspected bipolar disorder (she had been seeing a psychiatrist for a while, but she doesn't let me know the specifics).
Now, whenever I talk to her or live under the same roof, I feel a lot of pressure and discomfort (her way of speaking and lifestyle habits make me feel stressed, and she often speaks loudly when communicating with me).
Her relationship with my father is also not very harmonious, and overall, the family atmosphere is quite tense.
I have been in this environment for over twenty years without realizing anything was wrong until I went abroad as an exchange student last year.
After living independently for a year, I discovered that I was afraid to go home and fearful of my family.
Since living abroad, I have started experiencing poor sleep, rapid heartbeat, significant weight loss, mood swings, and persistent negative thoughts about self-harm or wanting to leave this world.
I even found it difficult to attend classes and felt anxious in crowds, dreading going out.
Just thinking about having to go to class the next day would keep me awake all night.

Due to the severe impact on my life and frequent outbursts of anger or crying in front of others, I sought help at a mental health clinic with encouragement from friends.
I started treatment in early March, and the doctor diagnosed me with anxiety disorder due to family pressure and perfectionist personality traits.
The doctor prescribed me Youjet and Sertraline for treatment.
After about a month and a half of treatment, I initially thought my condition had improved, but it has not changed at all and may even be getting worse.
I sometimes break down in tears while having normal conversations with those around me, and I can't sleep the night before school or any planned activities, constantly thinking about how to execute each task and what backup plans I might need.
I spend the whole night unable to sleep, experiencing chest tightness and palpitations (even if I do fall asleep, I have nightmares, resulting in poor sleep quality), which leads me to frequently request leave from school.
However, my parents still believe this is due to my irregular lifestyle, so whenever I take leave, they scold me and nag me all day (they don't know I have been seeing a mental health professional; I'm afraid that if they find out, they will be even harsher on me).

More seriously, during the midterm exams two weeks ago, I was anxious about the crowded bus at 8 AM.
The night before, I frantically checked bus schedules to find one that would minimize my chances of being late and have fewer people.
Ultimately, I was so worried about being late that I forced myself onto the most crowded bus.
At first, everything seemed fine, but halfway through the ride, I suddenly broke out in a cold sweat, my heart raced, and I felt like I was going to faint.
I quickly found a seat and rested for about ten minutes before feeling better.
When I arrived in the classroom, the noise from my classmates made me sweat again, and it was only when a friend arrived that I was able to shift my focus and completely alleviate my symptoms.
I researched online and found that this could be a panic attack related to anxiety disorder.
Therefore, every time I have an 8 AM class that requires taking a crowded bus, I become very anxious the night before, and I have developed a fear of public transportation with many people (even so, my mother still forces me to take the subway and insists that I get a driver's license but forbids me from driving to school).
I understand she wants to protect me from accidents, but right now, I cannot handle taking crowded buses or subways to school.
As I write this, I am experiencing rapid heartbeat and tension throughout my body due to excessive worry last night, and I can only take another day off from school to rest.
However, during my rest, I fear that this will negatively impact my teachers' impressions of me and result in lower grades, creating a vicious cycle.
My mental state is deteriorating, and people around me say I look haggard.
Although they want to help, they can only suggest I rest at home, and they offer to help with my assignments.
Even so, I still feel immense pressure every day, and during breaks, I sleep all day.
Activities I used to enjoy, like drawing, music, and games, no longer appeal to me; I just want to sleep all day to escape my life.
I often have thoughts of self-harm or devaluing my life, and I find myself crying secretly or experiencing emotional breakdowns almost daily.
However, in the eyes of my parents and teachers, I still have to play the role of a gifted student with excellent grades, which is truly tormenting.
I really want to leave this world.
I am also gradually losing the ability to feel emotional connections with others, and I no longer have any affection for idols or characters; I feel completely disconnected from the love and kindness of friends or partners.
Living each day feels like being a walking corpse.
I would like to ask the doctor if it is normal that my symptoms have not improved after more than a month of medication? Is this issue solely related to anxiety disorder? Besides medication, what other methods can help resolve this? Thank you for your guidance, Doctor.

Lin Tongxue, 20~29 year old female. Ask Date: 2024/04/30

Dr. Wu Enliang reply Psychiatry

A netizen would like to ask the doctor if it is normal to still feel no relief from symptoms after taking medication for over a month.
A: The medication may need to be adjusted.
Is this issue simply anxiety disorder? Besides medication, what other methods can help resolve this? A: There may also be depression involved.
In addition to medication, I recommend considering individual psychotherapy, and if possible, increasing physical activity.
Dr.
Wu Enliang

Reply Date: 2024/04/30

More Info

Dear Student,
Thank you for sharing your experiences and concerns so openly. It’s clear that you are going through a very challenging time, and I commend you for seeking help and trying to understand your situation better. Your symptoms and feelings are significant and deserve attention.

From what you've described, it seems that you are experiencing a combination of anxiety and possibly depressive symptoms, which can often coexist. The pressure you feel from your academic environment, compounded by family dynamics and your mother's mental health history, may be contributing to your current state. Anxiety disorders can manifest in various ways, including excessive worry, physical symptoms like heart palpitations, and emotional distress, which you are experiencing.

You mentioned that you have been prescribed Youjet and Sertraline for your anxiety. Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat anxiety and depression. It can take several weeks for SSRIs to reach their full effect, and it’s not uncommon for individuals to feel little to no improvement in the initial stages of treatment. However, if you feel that your symptoms are worsening or not improving after a reasonable period, it’s crucial to communicate this with your healthcare provider. They may need to adjust your medication or explore additional treatment options.

Your experiences of panic-like symptoms while using public transportation are indicative of anxiety, possibly related to specific situations (known as situational anxiety). The physical sensations you described—sweating, increased heart rate, and feeling faint—are common in anxiety attacks. It’s essential to address these symptoms not only through medication but also through therapeutic interventions.

Cognitive Behavioral Therapy (CBT) is an effective treatment for anxiety disorders. It focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. Since you mentioned that you have been keeping a record of your thoughts and feelings, this is a great start. However, it might be beneficial to work with a therapist who can guide you through this process more effectively. A therapist can help you develop coping strategies for managing anxiety, particularly in situations that trigger panic or discomfort.

Additionally, practicing mindfulness and relaxation techniques can be beneficial. Techniques such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation can help reduce anxiety symptoms and improve your overall emotional well-being. Engaging in regular physical activity, maintaining a balanced diet, and ensuring adequate sleep can also contribute positively to your mental health.

It’s concerning to hear that you are experiencing thoughts of self-harm or feeling detached from your emotions and relationships. These feelings are serious and warrant immediate attention. If you ever feel overwhelmed or in crisis, please reach out to a trusted friend, family member, or mental health professional. You deserve support, and there are people who want to help you through this.

Lastly, it’s important to have open communication with your parents about your mental health, even if it feels daunting. They may not fully understand your struggles, but sharing your experiences with them could foster a more supportive environment. If you feel comfortable, consider discussing your feelings with a school counselor or a trusted faculty member who can provide additional support.

In summary, while it’s not uncommon for anxiety symptoms to persist despite medication, it’s crucial to address these concerns with your healthcare provider. Exploring therapy options, practicing self-care, and seeking support from trusted individuals can help you navigate this challenging time. Remember, you are not alone in this journey, and there is hope for improvement.

Take care, and I wish you strength and healing.

Best regards.

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