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.