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How can you tell the difference between depression and anxiety?
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How can you tell the difference between depression and anxiety?

I'm a 24 year old grad student. When I was 16, I was diagnosed with depression and, after some trial and error with different meds/dosages, have been functioning really well on 150mg/daily of Zoloft. Sometime last October (possibly September, I don't really remember), I asked my doc to switch me to something else to curb the Zoloft side effects that I couldn't deal with anymore. The week before Thanksgiving, with the draft of a major paper due in one of my classes, I apparently had a mini nervous breakdown: I started feeling really sick to my stomach, crying constantly, not eating, convinced that I was a failure who needed to drop out of school, the works. I hadn't felt like that since I was first diagnosed with depression, and since that's all I had to relate it to, I assumed that that was my problem. I went back on my regular 150 of Zoloft, and fairly quickly I returned to "normal" (for me, anyway).

I was fine for that month between semesters, but as soon as spring semester started I lost it again. Once again I'm doubting myself, convinced that my only hope is to drop out and abandon my hopes of doing well enough to get into a good Ph.D. program, etc. It's gotten to the point where even walking into the building where my classes are, doing my boring GA duties like photocopying, even *thinking* about anything school-related literally makes me sick. I start shaking, crying uncontrollably for no real reason. I've upped my Zoloft to 200 mg (DR approved), but it doesn't seem to be making a difference. My dad, who means well, has been giving me 0.25 mg of Xanax when the spells strike, but I can't tell if it's actually doing anything, or making me worse, or taking a while to kick in, or what.

Kind of like an alcoholic, I guess, I'll have moments of clarity in which I realize I'm being ridiculous. I'm good at school, I've got a great support system of family, friends, and my professors, I don't even have an especially difficult course load this semester. There is absolutely no reason for me to freak out to the point where at least once a day, I really, seriously consider dropping out. But it seems like those little moments are incredibly fleeting, and far and few between, and they're shattered the instant I think about anything related to school. Mostly I've just been really disinterested in everything, procrastinating and putting all my work off because I can't force myself to work on it, which of course only compounds the anxiety issue when everything starts coming due. But if I *do* try to work on it now, I start panicking again, start feeling dizzy and unable to breathe, sweaty, and the worst is that nauseous, cold feeling in my stomach that makes me feel like I'm about five seconds away from throwing up.

To make all of this even worse, the earliest I can get in to see my psychiatrist is mid-February. At this rate, I'm afraid I'll be completely cuckoo by then. My campus has a counseling center, but I went there last week and that didn't really help. She's the one who first put it in my head that what I was going through sounded more anxiety-related than depression, and my mom, who's had really terrible panic disorder for the past ten years or so, said the same thing.

I don't know what to do. I can't just up and leave in the middle of the semester: I have a graduate assistant position that I don't want to lose, and I'm terrified about what my professors and peers would think: that I'm not good enough, or strong enough, that I can't cut it, all of that. Moreover, if I *did* withdraw, I'm afraid I'd never be able to go back without that same sick feeling overcoming me again.

So, um, to actually address the question posed in the title: how do you sort out the depression from the anxiety? Is my Zoloft failing and the depression is triggering these panic attacks? Or have I developed a panic disorder that's making my depression worse? Which one am I supposed to treat first? I know antidepressants are frequently used to counteract anxiety issues, but what if I'm already on one and have *been* on one for about eight and a half years, and all of a sudden NOW I start having anxiety problems? Are they going to switch me to another medication? I'm terrified at the idea of going off my Zoloft, since switching from that to Cymbalta late last year happened at the same time as my breakdown (I don't know if the switch itself was responsible, or the paper from hades, or a long build up of stress, or *what*). I really, *really* don't want to end up back in that dark place I was when I first developed depression, but I seem to be slipping into it at least a couple hours a day now anyway, usually right after I wake up and start immediately panicking about everything under the sun.

So. If you're already on an anti-depressant and think you might be developing some serious panic issues, what's the next course of action?
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Avatar_f_tn
Hi, one thing about depression medications is that they tend to stop working for you after a period of time, and you need either a change of dosage, or a completely different medication.  Anxiety and depression can go hand in hand, and often do.  You should never take Xanax from your dad, you never know how you will react to it while on the Zoloft.  I think what happened may have been coincidental while switching medications.
So, to answer your question, go back to your doctor.  I know you said you can't get in until mid Feb., but call them and ask if there is any way they can see you sooner and tell them why.  If they can't, ask them if they will call you if there us a cancellation.  In the meantime stay on your Zoloft and when you start to feel nervous do the deep breathing exercises.  Slowly in thru the nose, hold for 1-2 seconds and release out of your mouth, at least 10 times. Try and prioritize things in your life, and keep reassuring yourself that you are only one person and will do what you can, and the world won't end if it all doesn't get done today. You can afford to coast a little until you see your doctor.  Make time to do things you enjoy, while not thinking about anything else.  Easier said than done, I know, I've been there.  Something that worked for me and lots of others I know is the rubber band therapy.  Keep a rubber band on your wrist and every time you start to worry or have a neagtive thought, snap it hard.  It will sting, that's the idea.  It diverts the thought process.  At first you will be snapping it like crazy, and then after a week or so, you notice that you're rarely snapping it.  It truly works.  If you look around you'll see people wearing a rubber band on their wrists, and this is why.  I once watched a nurse in the ER snapping away at hers. Stay strong, nothing is worth your health, and we're always here for support.  Take care...
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Avatar_f_tn
Depression is more like an uncontrollment of the body chemistry. You no longer control your actions ( moods, thoughts and behavior ). It's a chemical thing. Aniexty is the same , because it's control by the unbalance of the brain. They go hand and hand. Really they both deal with fear. The good news is that things we go thru can benefit us as well. How? well depression is telling you that hey , i dont like or didn't like alot things that Had or Has happen , so get rid of these things. So you learn from it and think about it. It's not about a fault, who , what, when , why and where. It's about how to deal that issue If it ever comes again. I believe that medication can help build that balance your mind needs and you can help it more than the meds. Trick your mind and not your mind trick you. tell that depression you are helping to destroy bad things to create a better and stronger person and truly believe that. Most importantly Always thank GOD for allowing you to get thru it. Anxiety is mis fire from the brain that makes you have a rush of fear. Breathe , relaxs and quote a bible scripture (23rd book of Psalms) everyday. Tell yourself ( speak it ) I am healed all day long if you can. God loves you. I hope that im not opposing on your belief. I really dont mean too if i'm am.
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Avatar_m_tn
Don't drop out of school. And if you're in the sciences, try to be more scientific about depression and anxiety, read the journals and research on it and you'll find out it's impossible to separate the symptoms so easily. Forget the "chemistry" for a while too and try to think of your life, what you want to do. I've been on your shoes, dropped out of a phd program and I regret bitterly. But life goes on, and it actually improved.
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