Help fix my crazy
April 10, 2013 7:38 AM   Subscribe

What techniques can I employ to help deal with crippling anxiety and bug-phobic behaviors until I can afford regular therapy appointments? Ugly details inside - apologies for the length.

I recently started seeing a psychiatrist who diagnosed me with Major Depression and Generalized Anxiety Disorder, along with symptoms of PTSD and OCD (though not necessarily a full-on diagnosis of the latter two disorders).

As a psychiatrist, his only role in helping me cope has been to prescribe a cocktail of meds, and about three weeks in I don’t feel much different than I ever did. The doctor prescribed me a daily dose of 10mg Lexapro in the evening, 150mg Wellbutrin in the morning, and emergency Ativan for panic attacks.

Even though I am one of the few people lucky enough to have great insurance, I have a fairly low-paying job and can’t afford a ton of regular co-pays every month. For that reason, it may be a few months until I can begin regularly seeing a psychologist (when I can afford it, I would like to focus on Cognitive Behavioral Therapy as treatment).

One of the biggest ways the anxiety affects my current day-to-day life is my phobic behavior surrounding insects. I had a really terrible experience this past summer with an awful apartment that had a centipede infestation, and that combined with all the other issues the apartment had, it turned into an anxiety shitstorm the likes of which I had never experienced before. I had many, many panic attacks, my depression flared up, and after a few months of this I attempted suicide before heading to a walk-in clinic and then an ER.

After moving and getting things together, I still am struggling to deal with the anxiety-laden behaviors I engage in to quell my fears about bugs. My current place has a large window basically at ground level and so I get little critters wandering in that way – especially with the recent onset of spring. I see the odd silverfish, spiders, and this morning some kind of worm I found belly up on the kitchen floor.

I know logically this is simply no big deal, but my logic doesn’t have much say over my anxious brain. I get really upset every time I find a bug, because it sends me into a self-hate spiral and I start the inner monologue of being a failure because I live in an apartment that “has bugs”. It can really depress me for days and I get stuck in cyclic behaviors – checking the walls all night, being unable to sleep, waking up in the middle of the night, generally being paranoid about cracks around the window, the a/c unit, etc. I feel physically sick when I find an insect and worry obsessively that I will be forced back into the situation I was in at my previous apartment.

Additionally, I have never had bed bugs, nor has my building, but I feel compelled to check my sheets on a daily basis and occasionally have to pull the sheets up to check the mattress at some odd hour of the night because if I don’t I won’t be able to go back to sleep. Every time I find an insect in my place my throat closes up a bit and I get really paranoid that it’s a roach, or bed bug, or representative of some terrible infestation hiding in my walls.

When I catch myself in these behaviors, it depresses me further because I start realizing that this is what my life has become and I don’t know how to get better and let these things slide like normal people seem to be able to.

I understand that part of the reason the psychiatrist diagnosed me with OCD symptoms is my deep-rooted belief (that I'm trying to change) that everything in my life must be perfect, and anything less means I am a total failure. I get looped into this thought process daily and really end up hating myself an inordinate amount of the time because I did not do everything 100% perfectly and to the highest ideal. So when I find an insect in my place, I immediately think that I should have done something to prevent it, or that if I had done a better job of bug-proofing, I wouldn't be so anxious. This is dumb, I know, but it happens nonetheless.

So until I can afford a therapist – can you offer me any suggestions on developing healthier coping strategies/ways to deal? Any help would be much appreciated.
posted by woolly to Health & Fitness (16 answers total) 10 users marked this as a favorite
This will probably not help you immediately but remember that drugs like Lexapro take at least 6 weeks to even begin to do something. It took me more like 3 months to really notice that I felt any different on it.
posted by joan_holloway at 7:58 AM on April 10, 2013 [1 favorite]

I don't have therapy/anxiety answers, but this might help with the bugs.

We despise bugs at our place too, and yes, sometimes they do get in. However, we have a do-it-yourself pest control place, and we buy bug spray, and a sprayer from Home Depot, and when it gets warm, we spray the outside of our house, including all windows and doors. I also use something called Orange Guard on the inside of the windowsill (we have a bird and dogs, so while we can spray outside, we cannot spray anything toxic inside), and it helps with the ants that come in.
posted by needlegrrl at 8:01 AM on April 10, 2013 [1 favorite]

Lexapro is amazing. For me. I'm calm almost all the time. Give it some time.

Have you searched for a community health center in your area? Most cities/areas have them (assuming you're in the US) They generally charge you on a sliding-fee scale. Or, check into what services your local government provides. My county has a mental health program that charges, but they'll keep seeing you even if you don't pay.
posted by thylacine at 8:42 AM on April 10, 2013 [1 favorite]

If you have a university near you with a graduate program in psychology, that could also be an option for low/no cost therapy.

While I strongly recommend working with a therapist (and CBT is an excellent way to address anxiety), you might find some of these books and workbooks helpful as a starting point to introduce you to the theory and skills you'll encounter in CBT. You might be able to find some coping strategies to help you through the wait, too.
posted by goggie at 8:48 AM on April 10, 2013

Does your workplace have an Employee Assistance Program? That can be a way to get a few therapy sessions for free if you're in crisis. I've never used mine directly, but I believe at one point I was able to apply my annual EAP coverage to my regular therapist and get a handful of free sessions that way.

Also, you might want to look into EMDR, which is used for PTSD and phobias. I found it helpful in dealing with some insect-related phobic reactions that were connected to my PTSD. It's not designed to be a long-term therapy.
posted by camyram at 8:58 AM on April 10, 2013

Maybe get some diatomaceous earth? It's completely non-toxic to people and animals to the point where you can eat it, but it is like a billion knives of death for insects: they will die and/or go away. You can dust your bed, all the cracks and crevices of the house, and spread a giant heap of it outside and inside of that troublesome window. If you know you're probably going to go overboard with insect control while you arrange for therapy, at least this stuff won't hurt anything except bugs.
posted by steinwald at 9:02 AM on April 10, 2013 [2 favorites]

Best answer: Forgive me for recycling my comment from a previous thread, but I think this will help you. This works best if you have someone lead you through it, but you can try doing it on your own.

Imagine you are sitting in a cinema. You are the only one in the cinema. In front of you is a blank screen. Above and behind you there is a projection room.

You're sitting in a seat near the middle. See yourself sitting there, waiting for the show to begin. Next, imagine floating out of your body, and up into the projection room behind you. From there in the projection room, you can see the screen, and you can see yourself sitting down there in the seat in the middle of the cinema.

Now imagine that a film begins to play slowly. The film is of a situation in which your phobia manifests. If you feel frightened or distressed you can stop it instantly.

From the projection booth, watch yourself watching the film.

Change the film to black and white. Now make it very small on the screen. Now try adding a comic element, maybe some goofy narration, or a Monty Python-esque foot coming down and stomping everything.

Start the film again, and let it be a little bit longer, to show you a little more of your phobia. Again, if it causes you any distress, you can stop it. Remember: you are watching yourself from the projection booth.

When you get to the end, run the film backwards. You will see everything happening in reverse: people will walk backwards, things will move backwards. Run the film back to the start.

Now run the film forward, but do it really fast, taking only one or two seconds to do it. Then run it backwards just as quickly.

If you need to you can run the film again and again, each time changing something about it until you feel comfortable thinking about the phobic situation.
posted by Specklet at 9:29 AM on April 10, 2013 [10 favorites]

Best answer: So when I find an insect in my place, I immediately think that I should have done something to prevent it, or that if I had done a better job of bug-proofing, I wouldn't be so anxious.

I also have bug-related OCD. I don't want to coach you through exposure therapy over the internet, because I think having real-life support and feedback on that is necessary.

Some things that worked for me:

-Your statement above: that's your OCD right there. I mean, before you get to the core beliefs about inadequacy and perfection - the thought process that reacts to a bug by saying "I should have X" is OCD. Trying to prevent your anxiety by avoiding bugs is OCD. This was a revelation to me.

Prior to realizing this, I spent a lot of my time convincing myself that my bug-related and other fears were illogical. Like, "It's ridiculous to assume that because I have a hive that there are bed bugs, and here are 18 reasons why I don't, and here's 10 reasons why even if I do, it's okay, and --" and I had to stop. Because that whole comforting and avoidance and logic mechanism was a huge manifestation of my OCD. Now, I have to stop, recognize that thought as OCD, and then just...let it go. Which is impossible, except now that I'm on medication, I can actually do that.

-Some thing that will not work for you is trying to prevent the bugs by following people's advice above. I mean, that just won't work except temporarily. Because (and I'm just assuming from personal experience here, so replace "you" with "I" as needed) you will try more things to convince yourself that there cannot be bugs but then there MIGHT be a bug or you aren't SURE that there's a bug or you don't BELIEVE there isn't a bug so you have to do more things and more things and etc, ad nauseum.

-The book Brain Lock.

-Pills, both taking them and having them. The knowledge that I did have the ability to not die from my fear by calming myself down pharmaceutically was a huge relief without even taking the pills themselves. But also I'm on a daily SSRI which has really, really helped.

-Therapy is good but terrifying. There are times in the exposure-therapy stuff that I have almost not gone back. It helped me to make a promise to myself that I would give therapy a six-month trial, with the understanding that I could always go back. I could always go back to being terrified of bugs, of germs, of spiders, of whatever, if they really did present a danger. Not surprisingly, I have decided that they do not present such a danger that I should stop therapy at this time. But it's hard, and I had to force myself to show up some weeks. It's worth it.
posted by quadrilaterals at 9:50 AM on April 10, 2013 [2 favorites]

For years I was absolutely mortified by electricity (after sticking a key in an outlet at an early age)...the only thing that ended up helping was learning electronics. Learn as much as you can about bugs and they'll seem a lot less scary/gross/dirty/etc. Nature phobias usually subside when treated with a little knowledge.
Know your enemy.
posted by sexyrobot at 9:54 AM on April 10, 2013

Response by poster: Thank you all for your help, I truly appreciate it.

I kind of want to stay away from doing any more insect prevention stuff, just because (as quadrilaterals mentioned) it feeds into the OCD behavior, and there's no amount of preventative measures that stop the anxieties from being present. Thanks for the suggestions though!

I will look into sliding scale/university/EAP options for therapy. Do any of you have any insight as to whether they will accept someone who does have insurance coverage for mental health, but can't even afford the co-pays? I would like to be able to do a sliding scale for the co-pays, or maybe build them up and do a bulk payment at a later date. I'm trying very hard to be responsible with my budget as I have no safety net, and adding $20/week in co-pays adds up quick for me.

One of the hardest aspects of all this is to keep a front up and maintain some kind of normalcy in my daily life, as I have no one in my area to support me and am operating on a pretty basic level of "just get through the day" most of the time. Luckily I haven't been through a serious depression for about a year and it helps to not have the depression at the same level of intensity as the anxiety at the same time. Hopefully this can allow me to use the CBT books/workbooks mentioned and try to be productive in getting better.

To be honest, I spend a lot of time wondering if it's even true that I'm actually clinically depressed, or if any of the diagnoses are valid - I guess that is the ultimate irony of self-denial occuring within depression, though.

Thanks again for your help and any/all further suggestions and ideas welcomed.
posted by woolly at 10:24 AM on April 10, 2013

In my case, yes the clinic slides the co-pay if you are insured.
posted by thylacine at 10:52 AM on April 10, 2013

And in my case, I get therapy from a psychologist through EAP for free, even though I have insurance that would cover some sessions with a psychologist.
posted by looli at 11:34 AM on April 10, 2013

I also have OCD (though not bug-related) but I can totally relate.

I know it is out of favor, but I have gotten the most relief from traditional "talk" therapy. CBT didn't really help me, despite trying many times. Mostly, when I feel my anxiety/obsessions acting up I kind of have to figure out what I am REALLY worried about or feeling. A lot of times, anxiety becomes such a habit, it just becomes an automatic go-to feeling. I find myself obsessing when I'm subconsciously trying to avoid thinking about or feeling something else or some more "real" issue. Does that make sense? Some aspects of CBT and ERP did work for me, especially in terms of controlling compulsions, but I didn't really feel like I was getting better until I started to think about my real feelings and worries that were at the bottom of my obsessions.

I think your instinct to not focus on insect prevention is a good one. When you're obsessing, everything seems like a reasonable preventative step. That can spiral out of control pretty quickly.

Good luck. Anxiety and depression suuuuucks.
posted by Katine at 12:29 PM on April 10, 2013 [1 favorite]

Things Might Go Terribly Horribly Wrong isn't a workbook, exactly, but it might help you work through some of the anxiety and learn how to live with some of it. Also, if you don't have a lot of support, I'd recommend reading The Bloggess -- she writes humorously about her problems with depression, anxiety, medication issues, and so on. If you read through the comments, you'll see how many other people are reading and sharing about their own issues. It feels really good to know you're not alone. (And if you have anyone in your life, but are worried about sharing this, I think you'd be surprised how many people know a lot of these feelings. And there's nothing like being able to share tips on managing anxiety with a friend.) Good luck.
posted by Margalo Epps at 8:39 PM on April 10, 2013

You're not on very high doses of either the Wellbutrin or the Lexapro. If you're not feeling any relief yet it would be completely reasonable talk to your doctor about increasing the dose. I'm a pharmacist and I commonly see people taking about twice as much (20 mg Lexapro a day, and Wellbutrin 150mg twice a day). The doses you are on are common starter doses but usually people move up to higher doses.

If you can't afford a lot of doctor visits, I would call the office and ask to speak to the nurse, or leave a message for the nurse. Explain that you are not feeling any different and ask if they think increasing the dose might make sense. Or ask if it might make sense to try different meds. They might call in a different prescription for you, or at least they will tell you how long is reasonable to stay on the current meds/doses before trying something else.

Psych meds take a LOT of tweaking sometimes, and the doctor probably expects to adjust either the dose or the meds till you find something that works for you. Just be persistent -- it is SO WORTH IT to find the right meds for you.
posted by selfmedicating at 9:05 PM on April 10, 2013

Response by poster: Thank you for the book/blog suggestions, as well as the medicine advice.

I have an appointment to see the psychiatrist again in a few weeks, and will ask about having the doses increased then. I've tried Prozac before but it worsened my migraines significantly, so we switched to Lexapro and Wellbutrin. It certainly helps to know that I have an emergency supply of pills if I start to feel a panic attack coming on - my doctor suggested just carrying a pill in my pocket for a placebo effect, even if I never actually take it. I just still have that daily feeling of either numbness and then the anxiety/OCD stuff that never seems to back down.

Thanks again for all the advice.
posted by woolly at 7:25 AM on April 11, 2013

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