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Suggest Ways To Cope With Intrusive Thoughts While Having Anxiety

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Posted on Tue, 16 Aug 2016
Question: Hello there.

I have a bit of a detailed question that requires some back up information.

I am a nurse and have been for the last two years. Upon graduating in my last semester I went through an extremely rough patch. I was doing a complex dressing change and my hands would not stop shaking due to nervousness. At first I was bothered however I thought I would shake it off and approach the situation again. This went on for weeks until the semester was done, however the intense anxiety did not subside. I feared being watched doing anything. I became depressed and lost approximately 15 pounds. Obviously I went searching on the Internet for answers and I don't know when it happened but somewhere along the way I developed intrusive thoughts about being a horrible person. I was in a state of absolute fear. I tried an antidepressant but this appeared unsuccessful. However I learned to understand what was happening to me through my belief in Christianity and through the use of propranolol I returned to clinicals, graduated, regained my confidence and everything returned to normal.

I went two years working on a medical ward with no intrusive thoughts and very little use of propanolol.

However recently with a couple stressful situations at work I find myself in the same boat. The odd thing however though is the almost exact same trajectory of what happened three years ago. For about a month I was just stressed out about work, I even tried to switch to a less intense form of nursing. I have been taking propanolol but to be honest the effects have been minimal during times of performance anxiety. This stress lasted for about two months and then boom just like that I had some of the intrusive thoughts return again. Naturally I now have entered into a state of depression and a pretty constant state of anxiety. I am having a very hard time being around others.

I guess my question is do I have a form of OCD? Or is it just extreme anxiety and depression manifesting in mysterious ways? I don't understand why it appears so out of the blue ...and ALWAYS from the trajectory of stress over my job. I have no compulsions. But now my fears are ALL over the place they don't really seem to focus on any one thing.

I am currently seeking treatment but just don't know where to go from here. Up until two years ago I had no prior history of anxiety ...I was a very confident outgoing person. No shyness , no crazy thoughts etc.

I appreciate you reading this.
Thank you.
doctor
Answered by Dr. Alexander H. Sheppe (14 minutes later)
Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

What you are describing is not OCD as there are no compulsions. The most appropriate diagnoses here are generalized anxiety disorder and major depressive disorder. Fortunately, with treatment these two conditions are very well treated. I would start with a combination of an antidepressant such as Lexapro or Zoloft with a long-acting benzodiazepine such as Klonopin. Once the antidepressant's full effects kick in, usually after 4 weeks or so, you can taper off the Klonopin and be fully treated with antidepressant monotherapy. Another useful addition would be cognitive behavioral therapy. I would seek out a therapist in your area. If there isn't one, I do offer text-based therapy on this website via my private link below. You will get better!

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Alexander H. Sheppe (28 minutes later)
Thank you for getting back to me so promptly.

I guess I just am wondering have you seen this happen in severe depression before? People's thoughts becoming very out of character.

I just get recurring streams where I feel like a horrible person ...and scared of all the horrible things I could do. It's just centres on everything I love in my life. It seems very characteristic of what an obsessive person would fear but to be honest I'm feeling a bit like a psychiatric hypochondriac right now. I just want to make sure I seek help in the right way.
doctor
Answered by Dr. Alexander H. Sheppe (34 minutes later)
Brief Answer:
Followup

Detailed Answer:
You're very welcome.

These types of negative self-esteem-related obsessive thoughts are characteristic of and very common in depression. These thoughts will stop once the depression stops, which is very likely with good pharmacologic and therapeutic treatment.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2236 Questions

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Suggest Ways To Cope With Intrusive Thoughts While Having Anxiety

Brief Answer: Consultation Detailed Answer: Hello, and thanks for your question. What you are describing is not OCD as there are no compulsions. The most appropriate diagnoses here are generalized anxiety disorder and major depressive disorder. Fortunately, with treatment these two conditions are very well treated. I would start with a combination of an antidepressant such as Lexapro or Zoloft with a long-acting benzodiazepine such as Klonopin. Once the antidepressant's full effects kick in, usually after 4 weeks or so, you can taper off the Klonopin and be fully treated with antidepressant monotherapy. Another useful addition would be cognitive behavioral therapy. I would seek out a therapist in your area. If there isn't one, I do offer text-based therapy on this website via my private link below. You will get better! Please remember to rate and close this answer thread when you are finished and satisfied. In the future, for continuity of care, I encourage you to contact me directly at my private link below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers