Treatment For Severe Cognitive Anxiety

July 28, 2019 9:43 AM

I have tried tons of treatments for my severe cognitive anxiety but am not getting better. Do some people never get better?

I am a middle aged man and I have had anxiety and depression as far back as I remember. My mind races with obsessive thoughts every waking minute of my life. I am able to function and appear normal from the outside, but inside I am a nervous and anxious wreck.

My anxiety is not subject to circumstances. I could be sitting on a beach and my mind goes to work on making me anxious and depressed. I have OCD and depression. I think that my depression comes from OCD.

I have been trying medications for two years in addition to therapy. Nothing has worked at all. I googled other treatments and TMS and ketamine come up. They both seem very expensive and ketamine looks like it doesn't work for long.

I currently meditate for 10 minutes a night and try to stay active and eat healthy. I have tried 15-20 different medications and haven't gotten any relief, only side effects.

Where do I go from here? What can I try? Is there a specific type of medication that I should ask my DR about that is especially good at quieting the mind?

I have also done CBT, DBT and ERP...

I don't have tons of money and I am trying to figure out where I should put my resources. Therapy? Medication? I know that the mind and mental illness are very complex. There isn't a consensus on what the cause or treatment is. I would see a doctor and they would tell me not to eat gluten and that meds don't work. I would see a psychiatrist and they would tell me that that is not true and that meds are the answer. Neither of those approaches helped....

posted by Alvin80 to Health & Fitness (21 answers total)

In your therap(ies) have you worked on trauma and/or the autonomic nervous system? Have you tried acupuncture? Bio/neurofeedback for heart rate variability and breathing? A traumatized ANS can be perpetually in fight or flight mode (in other words, a pre-cognitive issue). There is some science around these modalities re-patterning that response, might be worth looking into. The Body Keeps the Score by Bessel van der Kolk would be a good place to start.

Good luck.
posted by 10ch at 9:51 AM on July 28, 2019 [4 favorites]

I’m currently in EMDR therapy for insomnia caused by anxiety, and although it’s known best for helping PTSD, it has proven to help with panic and anxiety disorders. I’m very early on so can’t give a personal recommendation, but I researched it a lot (including on here) before agreeing to it.
posted by ellieBOA at 9:56 AM on July 28, 2019 [2 favorites]

You mention that you "try to stay active," but ramping this up to more intense exercise could help, both in duration (working up to running for more than half an hour, for example) and shorter bursts of raising your heart rate. It looks like there are studies supporting this both for OCD and anxiety in general.
posted by pinochiette at 9:58 AM on July 28, 2019 [1 favorite]

I have not tried this.

In a radio interview, Michael Pollan spoke about his latest book, How to Change Your Mind. He interviewed people who report a profound sense of calm after taking drugs - and the sense of calm lasting long after the drug trip - days, even years.
posted by at at 10:18 AM on July 28, 2019 [4 favorites]

I'm basically in the same boat as you, but with more money to work with right now. My depression is largely treated via medication, but my intrusive thoughts and anxiety are still a problem. I don't technically meet the OCD diagnosis, but I probably fit PTSD despite not really having any trauma. Here's some thoughts:

I started taking CBD oil regularly (25mg/night via concentrate oil from Blue Bird) and it's helped a lot with the physical side effects of anxiety. I'm much less irritable and snappy when I get my anxiety and this has helped a lot in social situations. This is costing me around $30/month so it's not exactly cheap, but it's worth it. But, it doesn't help me at all with the actual cognitive part of the anxiety.

I'm currently focusing more on my meditation, as it's definitely the cheapest thing to work on. 10 minutes/night is fairly light, everything I read says you need to do around 30 to get much sustained benefit. I'm currently having issues with getting deeper into meditation because my anxiety causes me to over-analyze my meditative process, but I've read stuff from people who made it through that and it definitely seems possible. I'm currently doing mindful/quasi zen meditation but I've thought about switching to a more Mantra-based method as it might go better with anxiety. I definitely think there's further both you and me can go with meditation.

I've given myself around 6 months for meditation improvements, and if that doesn't work I'm going to bite the bullet and try ketamine. It's not cheap and insurance almost never covers it, but if it actually works it would be worth sacrificing other things in my life for it. It's "short term" in the sense that you need to keep getting treatments every month or so, but I've also heard reports of a few months of therapy giving people enough perspective to help deal with their cognitive issues.
posted by JZig at 10:23 AM on July 28, 2019 [2 favorites]

One of my brothers tried TMS for treatment-resistant depression he'd been trying to conquer for 15 years with various medications and therapies, and for him it was like a MIRACLE. A+++ would have magnets aimed at brain again.
posted by Eyebrows McGee at 10:25 AM on July 28, 2019 [3 favorites]

I spent years trying every variety of CBT and DBT you could think of. No dice. ACT is the modality that works best for me.

My diagnoses: Panic disorder, OCD, bipolar disorder, skin picking disorder, hair pulling disorder, social phobia, agoraphobia, claustrophobia, arachnophobia, and whatever "I have a panic attack when I talk on the phone" phobia is called.

I thought I was on a good medication cocktail, until my kidneys tried to kill me last month and my primary care provider told me one of my meds was SUPER hard on the kidneys. So I get to go back to the drawing board here in a couple weeks. I'm about as excited as you can imagine.

But anyway, CBT and DBT are all about chancing your thoughts. Which works great for some people. ACT is about identifying your thoughts and accepting them. This video was my first introduction to ACT. I came across it on 7 Cups of Tea (affiliate link - all I get are points. The points have no actual value. It's like Who's Line Is It Anyway) - a peer to peer mental health support site that might be of some use to you.
posted by The Almighty Mommy Goddess at 11:13 AM on July 28, 2019 [5 favorites]

Have you tried different medications? The first one you try doesn't always necessarily work. I have OCD and panic disorder. I worked through fluoxetine, amitriptalyne, and citalopram before finding that sertraline worked really well for me, without side-effects.

Stick with the meditation, it really does help!
posted by New England Cultist at 11:26 AM on July 28, 2019

I have some similar issues. Ask your doctor to review all your meds for side effects. While you are looking for more robust answers, there are some best practices that can help a bit and maybe more, and do not hurt. I make an effort to build all of this into my life and it makes a difference.

autonomic nervous system There is some evidence that Vagus Nerve Stimulation is helpful. -more -more -more. Check with your doctor, the Valsalva maneuver can make you pass out, and it's contraindicated for some conditions, but it provides quick, temporary relief. You do not have to have a device, there are several ways to stimulate the vagal response.

Vitamin D - lots of anecdata here on MeFi.

Get outside in nature. Lots of evidence that nature is helpful for mental health. If you like animals, walking a dog or petting a cat is great.

Increase meditation to twice a day.

Get more exercise, both aerobic/ cardio and weight-bearing, esp. with Music. I dance once a week with people I like and music that's awesome. Good exercise for my body and brain.

It's hard, modern life seems ill-suited for humans, and I wish you the best.
posted by theora55 at 11:48 AM on July 28, 2019 [3 favorites]

I have been trying medications for two years in addition to therapy.
I have also done CBT, DBT and ERP...
I have tried 15-20 different medications and haven't gotten any relief, only side effects.

If I'm reading your timeline right, it's possible you are expecting some of these things to have results at a pace faster than they are effective. Therapy can be a long haul experience, where it gets worse before it gets better. It took me a year of one therapist, weekly, with a focus on CBT, before I felt there was progress that really had any impact on my quality of life. I have a lot less experience with medication, but some of it may also take a longer adjustment time, especially with dosage variables. Now, of course, I don't know all you particulars, so I don't know how long you tried something, or what drove you to try something new, but it may be something to consider.
posted by wellifyouinsist at 11:50 AM on July 28, 2019 [5 favorites]

FWIW: my panic disorder started in my mid-twenties. I am now 44. I still get panic attacks on the odd occasion, but have learned to manage them and recognise them for what they are. I go through bouts when my anxiety spikes, even on meds, and I'll be clenching/grinding my teeth and feeling on edge. It does seem that anxiety disorders are something that one tends to retain after developing it.

Agree wholeheartedly with getting out in nature. Do it as often as you possibly can.
posted by New England Cultist at 11:57 AM on July 28, 2019 [1 favorite]

I used propranolol in the past. It's a beta blocker (blood pressure med) that's good for anxiety. A lot of people take it for performance anxiety type stuff. I can't take it anymore because my blood pressure is too low. It's an old med and pretty cheap. If you haven't tried it, it might be worth a trial.
posted by kathrynm at 11:57 AM on July 28, 2019 [1 favorite]

Stop meditating. It exacerbates anxiety for some people. I didn't start having full on panic episodes until after I started meditating. I started looking into it and this is not uncommon.

Have you tried 10mg escitalopram?
posted by thereader at 12:00 PM on July 28, 2019 [3 favorites]

I am as square as can be but I am in a similar situation as you and have experienced profound change from magic mushrooms. I microdosed for 6 months and now just do a "perceptible" dose every 3-4 weeks. If I had it to do all over I would probably do a full trip followed by a mild monthly "trip" right from the get-go but I was a big chicken at the time.

Mushrooms can literally create new connections in your brain and is an amazing meditation tool.

Good luck to you!
posted by i_mean_come_on_now at 12:44 PM on July 28, 2019 [6 favorites]

Obligatory I am not your psychologist/therapist. Some people find CBT and DBT to be really helpful. Others don't. Those who don't like cognitive/behavioral methods sometimes find ACT (acceptance and commitment therapy) or EFT (emotion-focused therapy) helpful. These approach anxiety from a pretty starkly different angle, which you may find useful if it feels like you've been beating your head on the cognitive/behavioral treatments for a while. For people who are overly cognitive--e.g. spend a lot of time thinking about their thinking--sometimes focusing on their thoughts more, even in service of changing them, can be counter-productive. Focusing either on acceptance, or on emotion rather than thoughts, can sometimes provide greater relief.
posted by brook horse at 1:00 PM on July 28, 2019 [6 favorites]

It usually takes several weeks to ramp up and and several weeks again to ramp down from anxiety medications, so I'm surprised that you've managed to try 15-20 different anxiety meds in just two years.

CBT is supposed to really work for OCD, which seems to be your particular predominant flavor of anxiety. But seeing as it hasn't worked for you, have you considered psychodynamic open-ended exploratory therapy? That modality also seems to show excellent outcomes for OCD. It will take a lot more time than you are used to devoting to any of these therapies, however. Expect to commit to a year of weekly therapy at least. If you find a good therapist that you gel with, it is a very rewarding and worthwhile experience.
posted by MiraK at 2:16 PM on July 28, 2019

check your memail
posted by elgee at 2:50 PM on July 28, 2019

I have had dreadful bouts of anxiety with obsessive thoughts for many years, going back to my early teens when the "pure O" form of OCD had not even been recognised as a thing. It is awful and debilitating and has caused me no end of anguish, so I do understand something of what you are feep. The ONLY thing that has kept me going has been citalopram, taken long-term at a high enough level to knock out the evil ruminations. I have tried some other medications and CBT, and they did nothing. I also found some relief in gardening, funnily enough, whereby simple, mindless activity like weeding or tidying was enough to keep me occupied physically and mentally without being too taxing. It gave me a break from myself.
posted by Martha My Dear Prudence at 2:56 PM on July 28, 2019

I was too late to edit my comment above but I microdosed mushrooms for 6 weeks not 6 months
posted by i_mean_come_on_now at 3:13 PM on July 28, 2019

hi, I have experienced severe anxiety, depression and PTSD. (Disclosure - I'm not sure 100% what my official diagnosis is, partially because I don't care that much to get a specific label, partially because I'm still in intensive short term care and haven't been set up with long term outpatient mental health team yet.)

I'll just tell you a few things that have improved over the last month or so, and then what (it seems) has helped.

- better overall mood
- less SI
- clearer, slower, more normal paced thoughts
- less obsessive tendencies
- less rumination
- less willingness to put up with bullshit. definitely cutting out bad juju from my life.

things that I think have helped with this:

- Daily, aka 5 days a week, 5 hours a day DBT. for ~4 weeks, at a partial hospitalization program (it's covered by my insurance). definitely echoing the comment above that if you're cycling through short periods of different approaches, you may not really be setting yourself up to succeed at any of them.
- taking 3 months off work to focus on my well being (I'm extremely lucky and got paid disability for this time off, but would have taken it off anyway)
- having someone I trust come live with me for about a month to assist with daily routines and a sense of structure/support
- lots of daily medication (antidepressant: 30 mg citalopram 1x a day, anti-anxiety: 10 mg propranolol 2x a day, mood stabilizer: 20 mg ariprizole 1x a day, sleep aid: 50 mg hydroxizine 1x before bed)

wishing you the best! memail me if you want.
posted by seemoorglass at 3:47 PM on July 28, 2019 [1 favorite]

Have most of your meds been SSRI or SNRIs? If so, Lamotrigin has done wonders for me where those did not. MAOIs are also really helpful but the pill form means a lot of diet restrictions and I couldn't afford the patch that has no side effects bc my insurance sucks. Worth a try if you have normal insurance tho. Give either of these at least a month.

A supplement my psych prescribed that works great for intrusive thoughts is Inositol. I get it from Pure Bulk online (its OTC) and take 9000 mg a day, split into two doses. It tastes slightly sweet and I mix it in water and drink it.

Also B12 sublinguals, vitamin D supplements, more exercise, and lots of time in the sun / forest really do help, even if it seems like a bother. Good CBD tinctures are also helpful if you live in a place you can get them.

I've also been on a big herbalism kick, which may sound woo but I am super against woo and would not say this if I hadn't found some plants that actually for real have a noticeable effect on my mood and physical wellbeing. Passionflower, milky oat, and valerian tincture have been startlingly useful. Like, within a week. Also ghost pipe for severe episodes. I used to take xanax for panic attacks and now I take a few drops of this tincture and stuff is just...less distressing. I can function. Or sleep. The first time I used it I felt so much better I couldn't believe it. I've has panic attacks literally last for days and this has been life changing.

Worrying about never getting better is part of your anxiety talking. Depression and anxiety lie. Ignore as much as possible.

Best of luck. PM me if you want more specifics on anything I've mentioned.
posted by ananci at 4:12 PM on July 28, 2019 [2 favorites]