10 replies to this topic

[killz]

hi folks!
i need some advice. i feel totally crappy and depressed.
to make a long story short i am afraid of final exams which basically decide over years and years of studying.
all the time while i was studying i was afraid of them. this has been going on for YEARS!
years of fear and depression. and the fear is only getting worse. even thinking about having to take the exams makes me feel like giving up.
i mean i am so damn scared of them. scared that i simply can't make it due to my huge anxiety which has been building up so long.
to me it really feels like life or death.
i have been to a therapist who gave me crappy advice which didn't help my anxiety at all. other students who i study with also have slight anxiety
but nothing compared to me. my anxiety is much bigger because i have GAD and also because of my personal situation. i am much older than them
and for me this is basically all or nothing. there is no plan B. i cannot afford to fail. family members also tell me this.
i can't count the nights where I cant sleep and lie in bed and my heart is pouding and i think about the exams and feel so strongly that i simply cannot make
it, that i simply cannot withstand this pressure. i mean the exams are months out and even when i think about them now i become totally afraid. i dont know
what to do.
i have already seeked psychiatric help. i was on celexa,remeron and valdoxan. none of this stuff helped against anxiety or depression.
what makes the whole issue much worse is that i cannot even estimate how bad my anxiety really is. i mean the past few weeks i was feeling moderate
and now the last few days i got such a huge anxiety. i'm actually shocked by this. the last few days i experienced such a strong anxiety that i'm now more
discouraged than ever. i really see no way for me to do the exams with this level of fear.
i also do not see myself lasting until the exams.
with this huge anxiety i dont even think that i can even withstand the pressure before the exams where i have to learn. what also makes the whole
thing worse is that there is a great deal of insecurity. students have to discuss topics with the professor and then they are given a usually pretty long literature
list and that's it. you basically have no way of knowing what's important and what the professor might ask. and i also talked to students who said that they were
asked stuff which wasn't even part of the discussed topic!
all this stuff is making my fears even worse.
other people who don't have anxiety and who're more relaxed can probably pull this off but for me this is pure torture. i mean when i sit there for example and
have to read an article then i'm so damn worried all the time of missing something important or if i come across something i dont understand then i directly
feel so discouraged and just want to give up.
i have written personal summaries of articles where my summaries were basically half as long as the article itself because i had to write down every detail cause
i simply can't really decide what's important and what not. it's a mixture of fear and obsessive behavior.
you probably also heard people say that when they had to study for exams they left out stuff and only focused on a few topics and took a risk. i could never do that
because of the fear.
the fear is the biggest issue.
it's so absurd because i know that being so afraid lowers my chances and at the same time i cannot not be afraid. i mean there is no way for me to get some relief
and to release the pressure.
how do you deal with that? i feel like a surgeon who has to do brain surgery on his own wife or child. when the stakes are so high then you cannot stay cool.
i also dont see how a therapist could help me. the situation is damn serious. there is no way around this. so how could a therapist help me?

my psych told me that i could simply take a benzo on exam days but i dont know if a benzo would even be strong enough. even if it is strong enough what if it impaired cognition? and what do i do the whole time before the exams to control the anxiety?

i feel so awful. i wish i could just escape this pressure. this pressure is destroying me. at night i cannot sleep or i wake up during the night and feel totally oppressed.

i really wish there was a drug against this but i'm disillusioned. i highly doubt that a different antidepressant would work or that it could do much against such a fear.

[KimberCT]

Ahhhh, college. To this day I still have nightmares of it.

Yes, a benzo would knock out your panic. Of them, I really recommend diazepam. I would try them ONCE before exam day to assess tolerance. Most docs want to start patients at 2mg. I needed 10mg. Keep in mind that, with this type of anxiety, tolerance and dependence develop extremely fast.

Other suggestions... strict alcohol avoidance, no caffeine after noon, melatonin for sleep, and (really) eat something green every day.

[jakord]

If you have problems with the somatic aspect of anxiety, you might want to consider taking a beta blocker for it, now and for the exams. If you're that afraid, I think there is no other way than taking something stronger in addition to beta blockers while the exam. You should be more afraid of the impaired cognition caused by anxiety than anything else. I wouldn't go for diazepam, as it is too sedating. There are better options for anxiety relief. I'd go for etizolam or alprazolam. Of course, you have to test how you react to it before your exams.

For now, the situation is much harder to handle. Your first priority should be to find a therapist with experience in treating anxiety disorders with CBT, or if possible, ACT. Both have shown good effects on anxiety levels. Although you might not feel so, therapy will help you if you find a good therapist.

Therapy alone will probably not be enough in your case, so you should look out for medication that can be taken long-term. From what you describe, I'm not sure if you really (only) have GAD, it might be some form of primarily obsessional OCD, as it seems you have those repetitive thoughts and can't stop obsessing about your exams. As SSRIs didn't help you much, you might be one of those who benefit more from targeting the nmda-system. My advice is: Try taking Memantine, which has shown to be effective in treating GAD and OCD. You maybe add inositol to that, 18g/day. Inositol has helped many with anxiety who didin't get relief from ssris, there are some double blind studies that show it is as effective as ssris.

Edited by homopharma, 09 December 2013 - 02:41 PM.

[Next]

I've got bipolar and OCD an anxiety although I take nothing for anxiety.

L-theanine is great, omega 3's are great (DHA).

Man just interacting with people does wonders.

Honestly though, study your ass off before exam week, millions of people have graduated from college... many have had mental disorders too.

[Bateau]

I don't know how much they'll help your particular condition but Kava, Ashwagandha, high dose Inositol (~18 g daily), and lavender (80 mg orally, e.g. 'Calm Aid') are the 4 most potent anxiolytic supplements with lots of human trials and data to back them up. Bacopa really deserves an honorable mention with its additive beneficial effects GABA receptors. A great plus to all of these supplements is that if anything they improve cognitive performance rather than impede it like your basic benzo. The Kava and the Bacopa specifically have lots of scientific evidence and anecdotal experience pointing to having an accumulative effect, sort of a reverse-tolerance if you will, r.e. anxiolytic effects. The more you take them, the better they work. This is due to their unique potential to increase GABA receptor density and ligand binding sites.

When it comes to promising supplements that haven't proven their worth in human trials yet you have Honokiol, Uridine and Lithium Orotate, but again, no human trials, no data. None should hinder cognitive performance or have addictive potential.

Other proven and effective (albeit less so than most previously mentioned) supplements are Picamilon, Gotu Kola, Theanine, Lemon Balm and Fish Oil. Ive tried all of these, Theanine and lemon balm are the only ones acutely potent enough for me to notice their immediate effects from a single dose. Theanine gives me a minor ego boost, Lemon balm is the only one mentioned that might have some negative effects on aspects of cognitive performance, it makes me feel a little slower.

For my personal experiences Kava, Ashwaganda and Bacopa have turned out to be rather helpful for my social anxiety. For me the reduction in social anxiety has been long-term, has definitely been accumulative (reverse tolerance), and has not been just an acute decrease in anxiety while I'm on them. Just started taking Uridine so its too soon to tell, haven't tried the others that i didn't mention personal experiences of.

p.s. Sorry I normally provide references but it'd take forever to reference all of this.

Edited by Bateau, 11 December 2013 - 02:31 AM.

[blood]

Print out your post, and show it to your therapist. Otherwise, he/ she will continue to grossly under-estimate just how big of a problem this exam anxiety is for you!

Do you have any options for "special consideration" if you do get a bad result? (E.g., if you can show to the university that you do have a quite severe problem with anxiety and depression, which you obviously do, can they do anything to help you, like let you sit a make-up exam, etc?) Maybe start investigating these options now. Also, maybe speak with a counsellor at university about your severe anxiety issues, to establish a paper trail.

Do you do any exercise? Vigorous exercise (e.g., jogging) seems to build resilience to/for other kinds of stress in life. At least that is my experience.

Not sure if there is any decent evidence for this, but I am convinced that Vitamin B Complex and Vitamin C supplements are helpful during periods of mental stress.

Edited by blood, 11 December 2013 - 08:04 AM.

[gnappi]

Try nasal spray of oxytocin. Anxiety disappears in minutes.

[killz]

Thank you all for your replies.

I want to add a few important things. Thanks for the recommendations of herbs but I don't think this will work for me. Once I take herbs I can't go to a doctor
anymore for help cause he can't tell me if herbs mix with prescription drugs. Kava Kava for example was banned in a few countries cause of side effects.

I do not want to go down the herbal/self-medication road. Too risky. Cause if I go on herbs then I cannot take prescription drugs. The interactions would be incalculable.

Memantine sounds interesting but I don't know how established this is in GAD/OCD. I mean I have both. I also have OCD. But if this is something which isn't established in psychiatry
then I doubt that my doctor will be willing to try out anything unusual.

I also don't know how safe memantine is? My grandmother took it against dementia. She didn't tolerate it cause it raised her blood pressure too high.

And could memantine be combined with antidepressants,benzos,z-drugs?
Or would going on memantine mean that you are very limited in what else you could keep taking?

Another issue would be if mematine has really scary side effects then I don't think I would even be able to take it. I was already too afraid of zoloft!

Nasal oxytocin? Does this exist as prescription drug? Again, the issue is that my doctor will only prescribe established drugs.
If oxytocin doesn't exist from a pharma company against psychiatrist issues then I have no chance of getting it.

I have ativan at home. I took 1mg once at night when I felt really bad and I was disappointed. It really wasn't very strong at all.
My fear is far bigger than just the exams themselves. I mean the exams are what my fears now revoled around but it's so much more.
I have been having fear my whole life. And now it's like all fears concentrate on this. I feel like my life depends on it and if I fail then it's all over.
The fears are so huge that I really don't know at all if it's even possible to bear.
Usually when it becomes dark I already become afraid. I have a lot things on my mind which cause anxiety. It's always this fear of losing everything.
When I was younger I was afraid of losing people. Then I was afraid of diseases and germs. My fears always shifted. And now everything is really
depressing. I mean my personal situation is already very depressing. But then I also worry about my parents and their health. To me it feels like everything
is coming to an end. Everything decays and I cannot stop it. When I think about my youth and how different life was back then it's almost unbearable.
What I have no is really no kind of life it's mostly suffering. I feel like I'm standing in front of an abyss. I mean I think about how am I going to survive in life
and I really have no idea. I'm not mentally strong. I feel so damn scared like an anxious child which just wants to hide. Other people in my age are different.
I know someone who moved with his family to a foreign poor country to help the people there. I have no clue how he can even do this. I'd be way too scared
to do something like this. Or how can people have children? I'd be so scared all the time of them dying. I really can't imagine how people can do this and not
worry all the time. I always worry about losing things. Family events are always totally depressing to me cause on such days like christmas I become so melancholic
and only think about how fragile everything is. It has always been this way. I'm so sick of it. But I don't think there is a drug which can just make this all go away.
I mean this is how I am. I have always been depressed and afraid. I cannot imagine anything else. Even the short times where I wasn't depressed I was afraid of losing it.

Sometimes I wake up at night and can't sleep anymore and then I feel such a strong oppression that I really worry about losing my mind.
I have been to therapists but found them useless. Many didn't even show much compassion and empathy.
To them I was simply a source of money.
Or one therapist who said he did CBT but then did something else just told me that I just have to think to myself that even failing the exams wouldn't be so
bad. How does this help me? It would be bad! Diplomas are all that count. Being able to prove that you studied something for years isn't worth anything.
Such advice really don't help me at all.
I don't even know what a therapist could tell me to help me. I cannot think of anything. The situation really is bad there is no denying this.
Most "good therapists" also have long lists of patients waiting for appointments. Usually you have to wait several months!
And then again there's the issue that I simply don't know if there are ANY good therapists where I live. After my bad experiences I am scared of trying
out new ones. I also don't even know what kind of therapist I should go to. They all offer different things like EMDR,hypnotherapy,CBT etc.
A therapist can also have a long list of specialities where you think he must be good but then he still sucks.

I'm also not happy with how it goes when I go to my psych. I have been to different psychiatrists and usually they have not much time to talk. They don't even really
know me very well. I mean you simply notice when it's time to stop when the doctor looks at his watch and then that's it. I'd want to explain more and talk more but it's not possible. Usually a visit last maybe 10-15 minutes. In such a short time I can't even describe my issues or give them an impression how huge my fears really are. And they also don't ask that much. Many times I really wanted to describe my feelings but got no chance because they didn't ask or there simply was no time. A psychiatrist who only has 10-15 minutes each time can impossibly really get to know a patient.
Usually I go there and say that a drug didn't work and then they make a new suggestion and that's it. I also feel like I can't really say how bad it is. I
am scared to.
And what's also shocking is that I also don't have the same anxiety level all the time. The last few months I was doing so-so. And then within just a few days
when I realized that the exams are coming closer again my anxiety got so bad that I felt like there is no way I can ever withstand this anxiety. It was a shocking
experience for me. What this basically means is that there is no way for me to even tell if a drug works or not!
I may feel mediocre and think the drug works and then once the exams come closer again my anxiety could go thru the roof again and I notice that the drug didn't
help at all! This makes it almost impossible to even tell if a drug is potent enough or really helps me.

The worst is I can't even talk about this with my parents even though this would probably help me more than talking to a therapist but I simply cannot.
They have enough own problems. I know I cannot bring this up even though I want to but I cannot. It would drag them down so much and then I'd feel even guiltier
for causing them more sorrows. It's really terrible.
It's like I have this gigantic burden on my shoulder unable to share it with anyone. If I told to my parents how bad everything is then I really have no idea what would happen.
It might even put their health in an acute danger. Years ago when I was already having issues with studying I once tried to bring it up and it was terrible. My father only told me
that if I can't get it done then it's all over and I could as well kill myself and that was years ago! Now the situation is even worse cause now there is even less room for a plan B cause of my age.

> blood

I don't think something like this exists. I cannot expect to get any advantages simply because I have strong anxiety.
I don't even know if I should bring this up to any of my professors who are going to test me. What if they don't understand this or think I just want an easy way out?
I also heard many times stories that professors didn't stick to agreements and then asked questions about topics which were NOT discussed in advance. This makes my anxiety much worse and these aren't just rumours. I know students who this happened to and they were tested my profs which I will also test me!

Edited by killz, 15 December 2013 - 07:07 AM.

[blood]

> I don't think something like this exists. I cannot expect to get any advantages simply because I have strong anxiety.

What happens if someone at your university is physically ill and their academic performance suffers or they miss an exam? Are there not options available to such students to minimise the impact on their grades?

---

Propranolol possibly won't be much use for the anxiety you are experiencing day to day - which is clearly severe - however a single dose of propranolol might help prior to exams:

http://www.ncbi.nlm..../pubmed/1879101

Clin Pediatr (Phila). 1991 Jul;30(7):441-5.
The effect of beta blockade on stress-induced cognitive dysfunction in adolescents.

Faigel HC.

Source

University Health Services, Brandeis University, Waltham, Massachusetts 02254-9110.

Abstract

Test anxiety is severely disabling to students whose fear of examinations causes cognitive dysfunction that paralyzes their thinking the way stage fright impairs actors ability to act. In studies using subjective evaluations among actors and musicians, beta-blockade relieved stage fright and has been used informally to treat test anxiety in students without objective measures of effectiveness. The Scholastic Aptitude Test (SAT) was chosen as an objective test instrument to confirm the effect of beta-blockade on test anxiety and performance. Thirty-two high school students who had already taken the SAT before enrolling in this study and who had stress-induced cognitive dysfunction on exams were given 40 mg of propranolol one hour before they retook those tests. Mean SAT scores with beta-blockade were 130 points higher than on the initial SAT done before entering the study without medication (p = less than .01). A single dose of propranolol immediately before the SAT permitted improved performance in students prone to cognitive dysfunction due to test anxiety.

Edited by blood, 15 December 2013 - 08:14 AM.

[killz]

I am not sure. If you're sick and miss an exam you can probably repeat it if you have a confirmation from a doctor.
As far as I know the final exams can only be repeated once which is really harsh. I don't know what happened if you failed and then said you were sick.
But even if you could repeat them more than once then this would still not help with the fear. I mean if you fail once and then know you have only 1 more chance
then the fear would be even worse.

Propranolol could help with some anxiety symptoms but my anxiety is more in the head. I doubt that taking a beta blocker would help that much. I have taken
them in the past a few times before going to a doctor where I was afraid but this is really not comparable.

I also looked a bit into memantine. I dont think that this drug is officially allowed for depression or anxiety where I live. I don't know if I could even get it.
To be honest I also have NO idea what to do. I mean everything could be false. Should I get more into drugs and try out more of them with the risk of side effects
or should I rather call it quits? I really don't know. So far nothing which I took helped me at all.
To me it seems absolutely incalculable. Nobody knows what happens if I go on a certain drug. What if there are side effects or what if I get off it and then I'm still
mentally impaired? I mean these drugs do things in the brain and I have no clue what could happen. This is really damn scary.

It's a very different situation from someone who simply has anxiety and depression and who has no exams. Such a person can try out stuff and even if she gets side effects or feels impaired it's not that bad. But what if you have to function? I can't go on something which could affect cognition but many drugs do.
I wish I knew what to do. There are so many drugs and combos and I can't try them all out. I do not have years time to find something which works.
I can't tell what would be best in my situation. Going on a drug which bears too much risk or is too incalculable wouldn't be good for me.

And my doctor only knows what I tell him. If I don't say that I have ocd for example then he doesn't know it. It's not like he asks many questions.
But how shall you find the "right drug" for someone when you don't really know all of the things he struggles with?
I also have very low stress tolerance and feel hyper very often. Even going to forums such as this one can make me feel totally stressed out because it's simply
too upsetting for me. For example when I ask a question and then many people reply and they all give different advice or recommend different drugs then this
sends me into this restless mode. I just feel like I have no control over my situation and can't even figure out what to do or which drug to consider.
It's like guesswork or throwing a dice. If I go to my doctor and say I'd like to try a certain antidepressant he might say ok but how do I even know which one is
good or not? I also really don't have the nerves, like other people, to read up on all kinds of antidepressants and then figure out what they needed to be taking.
For me actually having access to the internet is a major source of stress. I usually end up surfing the internet til the early morning feeling totally miserable and more
upset than before.
I have experienced this uncountable times. Something happens which scares me or upsets me like for example I get an invoice from a bank which isn't correct and then I instantly become so upset and restless and I can't turn this off. I mean it's like my mind is racing. I can clearly tell that it's a different state of mind. In such a situation I feel as if the world around me is distant and I also can't focus on other things. Once I drove back from the doctor and he scared me with some of his comments and this worried me so much that I felt totally restless. I was driving in the car and could hardly focus on the traffic it was as if I was intoxicated.
Or another example, I am already in bed and then a thought comes to my mind like an important question which I have to email someone. Usually I cannot stay in bed but I have to act upon this thought right away in order to find peace again.

Edited by killz, 15 December 2013 - 08:50 AM.

[gnappi]

killz, oxytocin is a very potent anxiolytic, very easy (and cheap) to find:
https://www.google.c...3&bih=602&dpr=1