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?