I had my first psychiatrist appointment since January yesterday. I was going to write a short version of my history, but it got long.

Paxil when I was 15 (I'm 29 now). It was actually forced on me through some really ****** circumstances with my terrible family. Set me up for a lot of fear about medications, psychiatrists, and therapists in general.

Anafranil when I was 17 - diagnosed as OCD basically by the report of my family to the practitioner. My mother has OCD; I do not. I was more willing to take this med because I was struggling, but had a horrible reaction. Widespread eczema (people asked if I was on illegal drugs, it was that bad) and increased suicidal thinking. I discontinued it myself after I moved out at age 18.

Starting seeing a therapist at age 26. Diagnosed with adjustment disorder initially, but after a lot of time with him have determined I have PTSD and probably panic disorder at this point. Saw the psychiatrist in the same office last summer for the first time. Started out on Prozac. It made me feel like a zombie and didn't help my chief complaint of anxiety. Switched to Lexapro three months later. It made my anxiety worse, I also had eczema while on it (not as bad as the anafranil), and suicidal thoughts increased. Decided to try Pristiq in January of this year, but lost my health insurance after a divorce and could not afford it. He also prescribed Klonopin for the panic attacks. It would help me sleep, but honestly was **** for the panic/anxiety. It took so long to kick in and I would only get maybe 1-2 hours relief, and sometimes still had panic attacks.

My therapist switched offices in February/March, so while I have continued to see him, he no longer works directly with that psychiatrist. Not having health insurance has been a barrier to seeing the psychiatrist again as well (therapist sees me on a sliding scale).

So, I finally see him again yesterday. I've not been taking anything (even klonopin) since maybe May and my anxiety increased horribly through July/August with nothing to manage it. Even over the counter sleep aids weren't helping me sleep. He prescribed Xanax...and that's it.

I don't really know what to do. I struggle to speak up for myself, label emotions, explain what I'm feeling, etc. Therapy is helping with this, but in highly anxious situations, a lot of my energy goes into managing that - and unfortunately seeing medical professionals is a highly anxious situation for me based on my history. So, my therapist had suggested he would communicate with the psych beforehand (especially since they did have a prior working relationship - when in the same office my therapist even came into my first appointment with me) and we made those arrangements. So I thought I was walking in there yesterday with at least a starting point already formed. But it appears the psychiatrist never received the paperwork/communication? This threw me off and it was hard to manage the rest of the appointment. I was able to express that the panic had been worse and Klonopin hadn't helped - but not that I wanted to talk more about other regular meds to try. I am frustrated with myself and discouraged about how my own struggles make it hard to get help. I feel discouraged about meds in general anyway, so getting up the nerve for this appointment was a big deal - plus the financial burden of paying out of pocket.

I tried the Xanax last night and it is far more potent than the Klonopin was for me. Like - knock me out solid potent. I tried a half dose (.5mg) during the day today just to get an idea how it might affect me and for about the first hour and a half after it kicked in I was a dizzy zombie - felt like I couldn't move when I did finally wake up. I was more functional after the two hour mark, but definitely lethargic and sad. I can see using it to help me sleep at night, but if I can't drive or function, then I don't see how I can safely use it to manage the panic during the day. In contrast, I never had a problem driving or functioning when taking klonopin. I'm also extremely reluctant to do anything more than a "prn" use, though he prescribed me enough to use it multiple times daily. I just can't imagine doing that - it would feel so awful, and I have strong concerns about dependence (my father is addicted to narcotics).

I just feel so discouraged. I know there are so many more meds to try, but the side effects are super hard for me when I feel like I'm choosing between two really bad things. I feel like there is underlying depression at this point that maybe is being missed (even by myself until very recently) because the panic is so strong. So in theory maybe if the panic is reduced and I sleep better, maybe that will get better - but I get scared when the Xanax increases those depressed feelings. I'm struggling through a lot in my life (single mom, raised in a cult, estranged from family, trying to complete my education) and I don't have a lot of room for meds to screw me up even more.