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New SNRI medicine
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New SNRI medicine

I have been prescribed Effexor 37.5mg for my anxiety and depression issues.
I have pretty bad social anxiety which really limits my daily life...leading to my depression.
I have never been on any real medicine like this and I am very nervous about starting it.
I am afraid of the side effects mainly.
I have also opted to go for the generic brand because I currently do not have insurance coverage.
I have "Teva-Venlafaxine XR 37.5mg" tablets and I plan on starting them in a few days.
What can I expect to feel like the first little while when starting to take these pills?
Since I am just starting with taking an SNRI will it matter that it is just the generic version?
Any thoughts on this?
I need some help and advice.
All of you must have been a bit nervous the first time taking these types of pills, so how did you feel the first couples of weeks? and did you notice a difference in your thoughts and mood?
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"The info that I received is that SSRI meds are used for the treatment of depression only. SNRI meds treat anxiety and depression, as studies believe that nepinephrine plays a part in anxiety."

I'm not sure where you're getting your info, but that's incorrect.  BOTH the SSRIs and the SNRIs are "classed" as antidepressants, but they are used to treat anxiety as well.  SSRIs are the primary, first line medication used to treat anxiety (aside from the anti-anxiety meds, like Ativan, Xanax, Klomnopin, ertc).  Zoloft, an SSRI is THE most commonly Rx'd med for anxiety disorders.  Here's a good article to read:
http://www.nimh.nih.gov/health/publications/mental-health-medications/what-medications-are-used-to-treat-anxiety-disorders.shtml


While people with anxiety DO take the SNRIs, they are not typically tried first, and are not the optimal choice, ONE, due to the fact that they can be quite activating and actually exacerbate anxiety, and TWO, they are historically harder to discontinue with more severe discontinuation syndromes (ie "withdrawal").

"I am also curious why you mention Prozac and Lexapro? Are these not just for depression? "
No, they are also used to treat anxiety disorders.  I think you're getting hung up on the term "anti-depressant" (which Effexor is too, btw).  Anti-depressants are also used to treat anxiety disorders.

Effexor may work wonders for you, but like Paxilled and I said, we think there are more logical starting places for you with meds, especially because you haven't ever tried any medication.  If you had tried several different meds with little to no effect, then Effexor would make a lot more sense.

All of the other things you are doing to treat your anxiety is WONDERFUL.  Those are the things that will help you keep anxiety in check for the long-term.

My honest opinion would be to reconsider the Effexor, and ask about trying one of the SSRis first.  My personal recommendation would be either Zoloft or Lexapro to start...they have a good success rate, and are easily tolerated by most people.  I understand you want to get the ball rolling, and I don't blame you, because all of these meds take up to 4-6 weeks to really start making a difference, the sooner you start something, the better....so my recommendation would be to ask the doc (your PCP)who Rx'ed the Effexor if he/she would be willing to try you on an SSRI first, then, when you're finally able to get into see the p-doc, he can take over your care from there.  Don't be afraid to have an honest convo with your doctor...it's YOU who has to take the medicine, and YOU is looking for the best outcome.  Some docs have preferences and will resort to Rxing a med that may not be the best choice.  This is also why it's best to have your care managed by a p-doc, as they understand the meds much better.  Your PCP can certainly get you started on the med, though.

That's my suggestion to you, since you haven't started the Effexor yet, I think it's best to proceed with asking the doc first about possibly trying a med that's easier to tolerate, and more appropriate for the treatment of anxiety.

Also, a lot of people are afraid to try meds, and obviously you are, since you've been hanging onto the Effexor for 2 months.  TRY to go into this with an open mind.  Yes, there can be some initial side effects, during the adjustment phase, but they are short lived, and you may not even have any at all...a lot of people don't.  If you're concerned about side effects, the best way to approach a medication is by starting out at a low dose, gradually tapering up to a dosage where you feel you are seeing good results.  Getting on and used to an AD takes some time, so it's very important to try to be patient, especially if you will be starting out at a low dose.  I know you feel lousy, and your life is being affected, but relief takes time, it doesn't happen overnight, unfortunately.

We will be glad to help you through the adjustment process, for whatever med you decide to try.  Understand too, that we're just giving you the correct information so that you can make an informed decision and have a discussion with your doc.  Hopefully I've cleared up some of your confusion and misconceptions about the meds used to treat anxiety.

Update us when you can!
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Avatar_m_tn
Did you see a doctor or a psychiatrist?  You say your main problem is anxiety, but snris are stimulating anti-depressants as they target norepinephrine as well as serotonin and are therefore not first choice drugs for anxiety.  They are for depression if that's your main problem, but you say it's not.  My guess is a psychiatrist would start you on a tricyclic or ssri, not an ssri.  I would also ask if you've exhausted non-medication modalities first, such as therapy and relaxation techniques.  These aren't magic pills and are only for those who have no alternatives.  Even if you take them you still have to get therapy if you ever want to fix it permanently instead of just cover it up.  Now, assuming you have exhausted other modalities and your life is so disrupted you can't function well at all, then you still need to approach medication on an easiest to take and quit first, since if that works it can spare you some difficulties.  That's why a good psychiatrist and a good discussion of the possibilities comes first.  My own opinion is that snris are difficult meds which have been hyped by the pharmaceutical industry because they're newer than the ssris and the tricyclics, and so general docs are more prone to know about them and think they're superior to older drugs, which they aren't necessarily.  I would think most psychiatrists would start with Prozac or Lexapro or a tricyclic such as imipramine, as they are better known, are easier to stop taking, and have been used more with anxiety than snris, and have fewer liver issues.  Gotta do your homework, can't expect hack docs to do it for you.  I'm sure others on here will disagree, however, so you'll get a range of views.  As always, this is only one opinion.
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Avatar_m_tn
Sorry, noticed I said ssri, not an ssri.  Meant latter to be snri.
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I have to agree with Paxilled.  (My opinion)....there are much better first line choice meds for anxiety.  While Effexor is a good med for some. it has a pretty big reputation for being a bear to come off of later, and it can be quite activating, which can actually make anxiety worse..  I'm assuming this med was prescribed by your PCP... as in your other thread, you said you were on a waiting list for a psychiatrist?

My HONEST advice is to call your doc, and ask what his reasoning behind the Effexor is, compared to an SSRI antidepressant, like Zoloft, Lexapro, Celexa, Prozac.  I strongly feel any one of those would be a much better choice for your situation, especially since you have never even tried any other medications yet.  It's a fair question to ask him...just tell him you did your homework, and you wanted to ask why he chose that, over the more other more commonly Rx'd meds for anxiety...that are typically much easier to tolerate and come off of.

I think there are definitely better options.  If he isn't willing to bend, perhaps wait until you can see the p-doc?  You need to keep up with your therapy (and increase the frequency if possible)...and start putting forth some effort to push yourself as much as you can.  I know it isn't easy, but it's paramount to getting this under control.

Let us know what you decided, and if you try the Effexor, keep us up to date.

Good luck!
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I have only seen my family doctor and a counselor at the mental health center. I made an appointment, and spoke with my counselor last week to discuss ssri and snri medications. The info that I received is that SSRI meds are used for the treatment of depression only. SNRI meds treat anxiety and depression, as studies believe that nepinephrine plays a part in anxiety.
I believe this is why my doctor and counselor's reasoning behind choosing Effexor.

I am also curious why you mention Prozac and Lexapro? Are these not just for depression?
I am definitely predominantly dealing with anxiety. My anxiety is really affecting my quality of life..making me feel down and depressed.

I understand no pill is a "magic pill" but I have exhausted all non-medical treatments..I have tried breathing, thinking positive thoughts, distracting myself, keeping track of all my positive experiences, I have talked to my counselor about anxiety's effect on my body..I have been reading on the internet for months and months about anxiety and treatments. Even if I try to clear my mind of all thoughts it still seems like my body just automatically reacts. I feel tense, body shakes, feel lightheaded, stomach rumbles..etc.
I could read for days..and talk to counselors and doctors for years..but when the stressful situation comes up...none of this "training" really matters.
I would love to wait to speak to a psychiatrist about medications, but I cannot wait months and months.
Also, I would not be just on medication. I am starting an anxiety support group at the end of this month through the mental health association.
This group will meet once a week and work with some CBT methods.

I hope that with taking some sort of medicine, attending my group therapy sessions as well as trying to push myself into uncomfortable situations more often that I will slowly begin to ease my anxiety.

I actually got prescribed Effexor 2 months ago but I have been too scared to actually go on it so I have been searching forums and reading up on it like crazy. It seems like it works for many people but the some side effects are bad as well as the withdrawal effects sound awful.
I was planning on starting this Venlafaxine tomorrow. Do you recommend I wait and see what my other options are? What do I do??
I need to start my road of recovery ASAP! I am so sick and tired of this.


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480448_tn?1397235344
"The info that I received is that SSRI meds are used for the treatment of depression only. SNRI meds treat anxiety and depression, as studies believe that nepinephrine plays a part in anxiety."

I'm not sure where you're getting your info, but that's incorrect.  BOTH the SSRIs and the SNRIs are "classed" as antidepressants, but they are used to treat anxiety as well.  SSRIs are the primary, first line medication used to treat anxiety (aside from the anti-anxiety meds, like Ativan, Xanax, Klomnopin, ertc).  Zoloft, an SSRI is THE most commonly Rx'd med for anxiety disorders.  Here's a good article to read:
http://www.nimh.nih.gov/health/publications/mental-health-medications/what-medications-are-used-to-treat-anxiety-disorders.shtml


While people with anxiety DO take the SNRIs, they are not typically tried first, and are not the optimal choice, ONE, due to the fact that they can be quite activating and actually exacerbate anxiety, and TWO, they are historically harder to discontinue with more severe discontinuation syndromes (ie "withdrawal").

"I am also curious why you mention Prozac and Lexapro? Are these not just for depression? "
No, they are also used to treat anxiety disorders.  I think you're getting hung up on the term "anti-depressant" (which Effexor is too, btw).  Anti-depressants are also used to treat anxiety disorders.

Effexor may work wonders for you, but like Paxilled and I said, we think there are more logical starting places for you with meds, especially because you haven't ever tried any medication.  If you had tried several different meds with little to no effect, then Effexor would make a lot more sense.

All of the other things you are doing to treat your anxiety is WONDERFUL.  Those are the things that will help you keep anxiety in check for the long-term.

My honest opinion would be to reconsider the Effexor, and ask about trying one of the SSRis first.  My personal recommendation would be either Zoloft or Lexapro to start...they have a good success rate, and are easily tolerated by most people.  I understand you want to get the ball rolling, and I don't blame you, because all of these meds take up to 4-6 weeks to really start making a difference, the sooner you start something, the better....so my recommendation would be to ask the doc (your PCP)who Rx'ed the Effexor if he/she would be willing to try you on an SSRI first, then, when you're finally able to get into see the p-doc, he can take over your care from there.  Don't be afraid to have an honest convo with your doctor...it's YOU who has to take the medicine, and YOU is looking for the best outcome.  Some docs have preferences and will resort to Rxing a med that may not be the best choice.  This is also why it's best to have your care managed by a p-doc, as they understand the meds much better.  Your PCP can certainly get you started on the med, though.

That's my suggestion to you, since you haven't started the Effexor yet, I think it's best to proceed with asking the doc first about possibly trying a med that's easier to tolerate, and more appropriate for the treatment of anxiety.

Also, a lot of people are afraid to try meds, and obviously you are, since you've been hanging onto the Effexor for 2 months.  TRY to go into this with an open mind.  Yes, there can be some initial side effects, during the adjustment phase, but they are short lived, and you may not even have any at all...a lot of people don't.  If you're concerned about side effects, the best way to approach a medication is by starting out at a low dose, gradually tapering up to a dosage where you feel you are seeing good results.  Getting on and used to an AD takes some time, so it's very important to try to be patient, especially if you will be starting out at a low dose.  I know you feel lousy, and your life is being affected, but relief takes time, it doesn't happen overnight, unfortunately.

We will be glad to help you through the adjustment process, for whatever med you decide to try.  Understand too, that we're just giving you the correct information so that you can make an informed decision and have a discussion with your doc.  Hopefully I've cleared up some of your confusion and misconceptions about the meds used to treat anxiety.

Update us when you can!
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Avatar_m_tn
Agree with above, and just want to add, in all my years of seeing psychiatrists, the description is the other way around -- snris are more anti-depressants, though if anxiety is caused by depression they can also help with anxiety, and ssris are both for people who are anxious and those who are depressed (and let's face it, most of us suffer from at least some of both).  Norepinephrine is involved with anxiety -- it causes it.  It's another word for adrenaline, which is cortisol, which is what those of us with anxiety problems try to get under control.  That's why snris aren't generally first line for anxiety first problems and why we keep saying on here not to do this with your general doc as a general rule.
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Thank you very, very much Paxiled and Nursegirl. You have really helped me out more than you can imagine. I have an appointment booked with my PCP this week so I will speak to him about a less intense drug to start off with, as you suggested. I will mention Zoloft and Lexapro and see what he has to say about those, and I will let him know all the points you have informed me on.
You have made great points and cleared up a lot for me.
Thank you again. I will keep you updated in this post.
I appreciate your time reading and responding to me, as this is a really rough time for me and I do not have anyone to relate to.
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I just read the article you posted.
There are so many different types of medications that it makes it really confusing. What about tricyclic antidepressants or benzodiazepines?
It says that those are specific for anxiety, but you are suggesting Lexapro and Zoloft SSRIs. Is this because they are easier to deal with?
Just curious, I always have more questions because its so overwhelming.
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480448_tn?1397235344
The SSRI's are the most commonly Rx'ed meds for anxiety, because they are easy to tolerate, and for a good bit of people, work.  The tricyclics are older ADs and while they can be great, they can be a little harder to tolerate, and there are some other considerations.  SSRIs have largely replaced tricyclics, even for depression treatment.  They aren't usually a first choice medication for someone who has never tried anything..an SSRI would be the first choice.

Try not to overwhelm yourself by reading TOO much.  An SSRI is a great starting place..I would ask your doc specifically about trying one of those.  The two I mentioned have the best track record...both for ease of tolerating the med, and for a positive outcome.  The only med I would recommend steering clear of as far as SSRIs are concerned is Paxil.  It has its own track record.  

Benzos, like Ativan and Xanax are habit forming when used regularly.  They are a great kind of med to help ease anxiety, but they are best used only "as needed" (like a rescue drug, when anxiety is at its highest) or for short term courses (a few weeks).  A lot of docs will Rx a benzo, like Ativan or Xanax for a short term period, in conjunction with an SSRI, at the start of the SSRI treatment, to help ease any side effects, and until the person starts seeing some results with the AD.

I wouldn't get too crazy with this doc, as your primary goal is to have your treatment managed by the p-doc...for now, you just need the PCP to help you get the ball rolling by starting you on a med...hopefully an SSRI.  Just tell him you've done your homnework and have a lot of reservations about the Effexor, that you feel more comfortable with an SSRI to start.  You have every right to express your concerns...an educated patient is a good thing.  Your doc should appreciate that you've taken the time to do some research, and that you want what's best for you!

Let us know how the appt goes, okay?
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Avatar_m_tn
Benzos aren't just habit forming, they're addictive, and have to be taken regularly if you have a chronic problem since they don't last long in their effects, whereas anti-depressants, though they too have to be taken regularly and can be hard to quit, aren't technically addictive and last all day.  I would say that some people will tolerate tricyclics well, and that's where they started me.  They are easier to stop taking than ssris and don't seem to affect the brain long term as much, but the side effects were certainly more annoying.  And they're not all created equal -- only some tricyclics are used for anxiety, and some, such as clomipramine, have a horrible side effect profile, whereas imipramine is much easier to take.  Just as with ssris, Paxil and Luvox are much more difficult to take and quit than the others, and Prozac is the easiest.  That's why it's good to discuss this with a good psychiatrist who takes the time to show he or she truly knows and cares about the difficulties with meds and they aren't all created equal.
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I just saw my GP and basically I told him I refuse to take effexor or any other ssri/snri. I asked him to refer me to a psychiatrst, which he did right away.  He also told me my condition is pretty bad and he thinks I need medicinal treatment. I told him that valium had worked for me in the past. (I had a fear of the dentist for many years and  they gave me valium and it really calmed me down.) So my doc perscribed me ATIVAN 0.5mg to use for my most stressful situations.  Do you think this is good to use while I attend my group therapy and push myself to be in more stressful environments? ? And wait for a psychiatrist. I'm trying my best to avoid strong meds.
I would only take as needed. What do you think?
Im
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3581773_tn?1349125510
I just saw my GP and basically I told him I refuse to take effexor or any other ssri/snri. I asked him to refer me to a psychiatrst, which he did right away.  He also told me my condition is pretty bad and he thinks I need medicinal treatment. I told him that valium had worked for me in the past. (I had a fear of the dentist for many years and  they gave me valium and it really calmed me down.) So my doc perscribed me ATIVAN 0.5mg to use for my most stressful situations.  Do you think this is good to use while I attend my group therapy and push myself to be in more stressful environments? ? And wait for a psychiatrist. I'm trying my best to avoid strong meds.
I would only take as needed. What do you think?
Im
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480448_tn?1397235344
Ativan is a benzo, like we talked about above.  It's a good medication when used here and there...but to use it every day, there will be some issues.  To use "as needed"...yes, it will be helpful.

"I'm trying my best to avoid strong meds. "
Again, I think you're a bit confused about the medication issue.  


Why have you decided against taking an SSRI too?  I think you're limiting yourself by not having an open mind when it comes to using a medication like an AD to help you.  

Wait to see how your appt with the psychiatrist goes, and listen to him/her with an open mind.  With as severe as your anxiety seems to be, I think an AD medication would help you tremendously.  When do you see the psychiatrist?
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I was just about to get on Lexapro..as you suggested but it seems the most people I speak with tell me to avoid any and all these types of medications. They say it will ruin my stomach (which is very sensitive already) and they will possibly bring on a whole new batch of side effects to deal with.
I was not planning on getting ANY new prescriptions with the doctor today but he wanted to offer me some help..so I decided it would not hurt to have something available for those really stressful times.
Am I not correct with saying that an SSRI or an SNRI will take a much bigger toll on my brain and body? rather than a situational medication like lorazepam?
I do not want to have to take a pill every day to keep me functioning for the rest of my life, and I do not want to deal with the side effects or the withdrawal symptoms afterwards.

My GP mentioned talking to the psychiatrist and is he/she recommends a medication than I should definitely take it.
I will now have to wait, months (up to a year) and then I can speak to a psychiatrist about my situation and medications.

For right now, as I am working towards confronting my fears..going to group therapy and visiting a psychiatrist, wouldn't a situational medication be better suited for me while I get over this big hump?
or do you still think I should be leaning towards Lexapro?

AND..you are very right...I am totally confused with all this.

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Here's the best advice I can give you....quit overanalyzing this so much, and quit talking to so many different people.  You will get all KINDS of different advice.  

The bottom line is,. SSRIs are very effective in helping to manage anxiety.  Like I said, I was literally housebound, and Zoloft allowed me to function again, and leave my home without having a panic attack.

Go to the psych appt with an open mind.  You can certainly try just the Ativan and therapy to start, but I think an SSRI would benefit you greatly.  You certainly don't have to be on it forever...but on the other hand, if it's something that ended up helping you, who CARES if you have to take a pill every day to have a better quality of life?  If you had high blood pressure and needed a med, you wouldn't be thinking so hard about it...you would have already started it, based on the advice of your doctor.

As for coming off a med, with a proper taper, you wouldn't necessarily have any issues at all.  I never had any problems coming off an SSRI with a taper (at different times, I've been on Zoloft, Prozac, and Lexapro).  Usually the people who run into problems either just stop taking it without tapering, or they taper too fast.  There ARE some meds that have a reputation of being a little more difficult to taper off...the big ones would be Effexor and Paxil.

Don't make any decisions based on these preconceived notions you have..and don't feel like you shouldn't need a medication.  You're helping yourself, and there's nothing wrong with that.  Again, best thing you can do is just try to stop overthinking this so much.  You have enough basic knowledge to make an informed decision at this point.  
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Thank you nursegirl6572.
I am really taking all of your advice to heart and appreciate your responses so much! You make many valid points and I hate the fact that I am over analyzing everything!! Its just the anxiety talking.
I will be sure to keep you updated.
My group therapy starts next week so that will be a good solid step.

Thank you again.
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480448_tn?1397235344
You make many valid points and I hate the fact that I am over analyzing everything!! Its just the anxiety talking.

Yes, that IS the anxiety..don't feel badly, a lot of people do the exact same thing.

My group therapy starts next week so that will be a good solid step.

Absolutely!
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Avatar_m_tn
If I could step in again, I'm pretty anti-med for anyone who is still functioning fairly well in life.  The reason is that your concern about these meds is well founded based on user experience and research, but mainstream medicine loves drugs and will prescribe them for any reason or no reason -- it's all docs have, really, since they know nothing about diet, natural medicine, therapy (it's a rare psychiatrist these days who does any therapy, and regular docs don't study it at all).  But if your life gets to the point where it isn't worth living, drugs are there and can be helpful.  I got there, and I took them, but I also paid for it, so I urge caution.  But as Nursegirl says, and as I said, not all drugs are created equal.  Snris are notoriously difficult to quit, as is Paxil, but any drug that affects the brain can be a problem -- even coffee.  So if you can get your desired results without medication, do it; if you can't, they will always still be there.  But I would add that group therapy, while helpful for many, isn't the best thing necessarily for anxiety -- I think most would agree your first try should be CBT, or cognitive behavioral therapy.  It's not that it works more of the time, but that when it works it works much more quickly.  So I'd give that a look.  Also, psychiatrists who take insurance are often hacks who won't take any time to get to know you or the meds they prescribe, in my experience.  Unfortunately, the best ones can make more money not taking insurance and they get to spend as much time with you and their practice as they want, and tend to be easier to get appointments with.  Just a thought if you can afford it.  
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Thank you Paxiled for your comment.
I am functioning pretty well day to day. I prefer not to face the world, but I do and I am fine, depending on what needs to be done.
On more stressful instances I will have to deal with my heart racing and stomach upsets..but I get by.
Its more of the new, unknown situations that get me. Such as starting college(going back to school) for the first time in 10 years. WAY too big of a step for me right now..and it overwhelmed me.

Anxiety is definitely impacting me..but as of lately I have been fighting back and trying to ignore it. I am taking it step by step and putting myself out there, and I have to say, so far so good..without any medicinal help.
I really do not want to take any meds so that in itself is a good motivation.

The group therapy I will be attending actually does incorporate CBT as well. They informed me that we will be working on coping techniques and changing thought patterns. I will definitely let you know more after I attend the first meeting.

On a situation like that (attending a group therapy, in a strange setting, with strangers) is really going to stress me out and my anxiety is going to go crazy. That is why I wanted to try a situational drug (lorazepam). Once I attend a few meetings I will be more comfortable and will not need them.

As for the psychiatrist. The one I will be seeing is covered by my Ontario Health Insurance Plan so it is of no cost to me. I cannot afford to pay anyone to see me as of right now, since I am out of work..and trying to wrestle my anxiety into submission!

Ill keep you posted. Thank you so much!
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