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Saturday, November, 21, 2009
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Just got out of the hospital after involuntary commitment --- Confused!

duranel
10/25/08

I am a 20 yr old college student who recently was discharged from a 4 day involuntary stint at my local hospital. I had a bad reaction to Paxil, an SSRI. It made me impulsive, aggressive, and fairly acutely suicidal. I have a history of both anxiety and self-injury, both induced from a rough childhood growing up around substance abuse, and both of which were worsened during the two week period I was taking the drug. I tried explaining this to the people prescribing me the medication, but they basically told me it was my psychopathology worsening, and that I should just "continue taking the medication." They also had me taking Ambien for sleep, and Klonopin on an as needed basis. I drove myself to the hospital last Friday. (I thought they would just take me off the drug, but because I was such a high risk they committed me.)

 

I am now back at school. It seems that the counseling staff here is ready to "wash their hands" of me so to speak, as I am an "intensive case" and no one wants to get too involved. In other words, I am back where I started before I began taking Paxil. Everything is flaring up because of family stuff, but also because the school made me begin therapy but hasn't been able to provide the level of support I so desperately need. I am having panic attacks whenever I feel a strong emotion attached to family life. I cannot sleep, and in fact am having problems with sleep paralysis whenever I do manage to get a few hours in here or there. The self-harm/suicidal urges are there but manageable, especially now I that I am off the drug.

 

Every clinician I've spoken to has told me that the ONLY option I have is to take meds. I was resistant to the idea before I took Paxil, and after that experience I really would like to explore other options. It seems to me that some kind of intensive psychotherapy, if I could find the right therapist, would be perfect. Finding that person is another story entirely. I know that long-term, intensive psychotherapy is hard-work, but I am willing to do it... It's just a matter of finding a clinician as committed to the cause as I am.

 

My panic/anxiety isn't typical or chronic in the sense that it happens all the time; It seems that whenever I'm feeling any intense emotion connected to home --- sadness, anger, etc. it almost instantaneously gets translated into panic. It is transient, but persistent. It's not really diffuse or specific worry, in fact it's not usually worry at all but typical physiological symptoms and extreme discomfort. My triggers are almost always related to family life, which is why I think psychotherapy would be really helpful. I don't drink or smoke, and I avoid caffeine, so it's not any external problems like that. Most clinicians I've come across view my resistance to meds as resistance to treatment in general though, and haven't given me many other options.

 

My Questions: What is the best way to get in touch with a therapist that will be committed to me as a client, and not get overwhelmed by the intensity of my needs? What do I need to ask potential clinicians in terms of insurance, etc? What is the standard medication recommendation if SSRI's don't work? Is there such a thing as a medication on an as needed basis (one of the docs suggested Lexapro)? Is it reasonable, or even plausible, to want to explore other options? What are some pragmatic suggestions to stopping the "panic cycle?" What about being able to feel emotion without transitioning to panic? Is it possible to get treatment that's middle-ground, between commitment to the hospital and dealing with this on my own? What is the student health/counseling services responsibility in all of this mess?

 

Thanks in advance for all of the thoughtful answers I am sure to receive. Any and all information will be helpful, as I am quite young and quite new to this whole thing.

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Jennifer L. Fee, Psy.D. Psychologist
Jennifer L. Fee, Psy.D. Psychologist
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I am a Licensed Psychologist who specializes in the treatment of

I am passionate about helping people overcome problems with anxiety...

Saturday, October 25, 2008

Hi Duranel, and thanks for writing in!

 

Hopefully I can give you some good input on some of your questions.  First, I appreciate your committment to therapy, so it makes sense that you would want to choose wisely.  Here are two places that you can start to look for a therapist:

 

1.  The Anxiety Disorders Association of America (ADAA) website

2. The Psychology Today Website

 

On the Psychology Today site, the therapists have profiles with some written information about them, so you can start to get a feel for who they are/how they work even before calling.

 

I'm assuming that you are concerned about finding a therapist who can handle the "intensity of my needs," because of the experience with your college counseling center.  Keep in mind that most college counseling centers work on a short term basis (like 10 sessions) and aren't designed for folks who need longer term work. I would hope, however, that they would communicate this to you if it is true and provide you with some local referrals.

 

In a consultation session with a potential therapist you can describe your history and what you think you need, and the therapist should give you feedback as to whether they work in that manner.

 

As far as insurance goes, you need to know what kind of plan you have.  If you have an HMO, you generally need to see a Provider who has a contract with that HMO company.  If you have a PPO you generally have a bit more freedom as to who you can see, but the amount that is covered varies with several different factors.

 

1. If the therapist you pick has a contract with your PPO, then you will know exactly what your co-pay is.

2. If the therapist you pick does not have a contract with you PPO, then you need to call your insurance and see how much they will cover and if you have a deductible.

 

On the practical side, you want to pick a therapist that you'll be able to afford to see for the long term, and in a geographic location that makes sense for you to travel to on a regular basis.

 

In addition to finding a therapist, it sounds like you need to find a Psychiatrist as well.

You don't need to see this person as often as your therapist, but again, you want someone that you can form a working relationship with to figure out what medication you need to be taking/not taking.  There are alternatives to SSRIs, if that indeed is appropriate for you.

 

You said that when intense emotions start to surface, panic ensues.  That suggests to me that you do not allow yourself to fully experience the intense emotions.  I write about this in one of my SharePosts about anxiety triggers.

 

I'm not sure that I addressed all of your questions, but perhaps some of the other experts will offer some opinions as well.

 

Regards,

 

Dr. Jennifer L. Fee

The Stress Masters


Dr. Fee is a Psychologist. Dr. Fee's answers are not intended to diagnose or treat any medical or mental disorder. Any information given in a post about medication is for educational purposes only, and primarily to aid you in having an informed discussion with your own Psychiatrist/Physician.

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