Effexor XR vs Effexor

[AmZ]

Hi all,

Went to the psychiatrist this morning bright and early. Arrived and the secretary said that she'd just called and can't make it to work so couldn't see her!
There was another psychiatrist there and the secretary asked if she could see me and she said OK. She just went to write out another prescription for another month without asking me anything asides from what I take and at which dosage so I said that I'd like if she had a minute to explain the situation. She said that 2 months is long enough to wait on the 225mg and was surprised that I hadn't been given the XR. Apparently there is a 75mg XR here but I'd been given the wrong info before. Anyway, I explained a little and she's said to go up to 300mg. So now I have 150mg XR x 2 a day to take.
She was quite nice and showed some sympathy which was nice for once (!) and said that 4 months at trying the same med is a long time and that she'd like to help me out to sort it out as soon as possible. She said rather than waiting now another month for the next appointment, that I should give it just 2 weeks at 300mg and if I don't feel an improvement/help from it within this time then they'll either switch to another med or add something else.
I've asked the secretary to find out if she speaks English so maybe I can go to her the next time so we'll see about that.

Any news, views, advice? Thx.

 

[Retired]

It sounds as though you feel comfortable with this particular physician...are you thinking about switching to this doctor for your continuing care? Is this doctor available to take you into her practice?

the 225mg has been doing bad things for my stomach, as much water and as I drink and fibre and a balanced diet I have, nothing seems to help

Are you saying you are experiencing the side effect of constipation? Constipation is a possible side effect of medications that affect certain neurotransmitters, affecting different people in varying amounts of severity. Some meds have no effect on some, while others affect the same people severely with no predictable common factors.

Constipation with SSRI/SNRI's has less to do with the food you eat than with the effect of the neurotransmitters on the the body process called peristaltic action, the physiological action that produces the urge.

You should certainly report this to the prescribing doctor, because sometimes the doctor can recommend the use of certain laxatives or other remedial medications known to counteract the side effect. Psychiatrists are usually pretty good at managing side effects of these types of medications because of their specialized understanding of the mechanisms of action of the meds and ways to deal with specific side effects.

So, your best course of action is to contact the doctor and explain the situation. Your doctor should be able to help with this.

 

[AmZ]

It sounds as though you feel comfortable with this particular physician...are you thinking about switching to this doctor for your continuing care? Is this doctor available to take you into her practice?

I'm looking in to it yes. I am not sure if she can take me and I asked the secretary to find out if her English is any better, because it's too difficult with the other one with the language. I can't explain enough as my vocab isn't that great when it comes to words like this that I've never used before! It's difficult enough in English to be honest - That's probably no surprise coming from me! So we'll see. If she can't take me, then I have another possible option that I found. But I don't want to keep switching psychiatrists. The secretary didn't call me back so I'll have to chase her up tomorrow and see if she asked.

Are you saying you are experiencing the side effect of constipation? Constipation is a possible side effect of medications that affect certain neurotransmitters, affecting different people in varying amounts of severity.

Yes, since I went up to 225mg. I'm trying to make sure that I take the meds in the morning with certain food that will avoid this as much as possible, but it's pretty much a daily unpleasant thing that hasn't gone away in the last 2 months as much as I try to eat different things and always take the meds with a lot of water... I wonder what the 300mg XR will be like? I guess there is no difference? I have XR pills and not capsules. I hope it won't be worse! Hmm.

You should certainly report this to the prescribing doctor, because sometimes the doctor can recommend the use of certain laxatives or other remedial medications known to counteract the side effect.

I was thinking of getting something yeah. I have some pills already that help but I don't want to take these on a daily basis all the time, as I don't think it's good to do that long term for my body. But I saw today in the pharmacy (but didn't have proper time to look) some different more 'natural' things like special powder that you add to drink (not sure what the ingredients were) which could help. I've been going to the same pharmacist to get my meds each month so he knows me now and seems helpful. Maybe I'll go in and ask him and see what he recommends first of all. I've kind of been coping with it most of the time and it's OK, but I don't think I should put up with it and try to find something to help. With a family history of stomach cancer and bad digestion (!) I think I will go tomorrow and investigate

Thank you very much Steve.

 

[AmZ]

Does anyone know which/if side effects could happen when moving to 300mg Effexor XR from 225mg Effexor?

I don't know if it's because I've been feeling a little worse the last few days or because of the dosage change, but for a few days now I can't fall asleep until 3am and then am waking up at 6.30-7am each day and can't seem to get back to sleep like I was managing to do before. I try to go back to sleep and I can hardly even lay there with my eyes closed and try, even though of course I am (still) tired.
I went up to 300mg on Monday.

Thanks.

 

[Retired]

Tell your doctor about it because it might be a function of the dosage increase in the way the medication is affecting adrenergic receptors in your brain chemistry. Although the mechanism of action of Effexor is very specific to serotonin and norepinephrine, there might be some "spillover" to other neurotransmitters as the technology may not be perfect. Therefore some people may experience some unwanted side effects at certain dosages.

It should also be said that many of these unwanted effects diminish with time as the body becomes acclimated to the new dosage, but your doctor would be the best authority to make those determinations beased on his/her clinical experience.

So, your best course of action is to let the prescribing doctor know the details of the sleep disruptions you are experiencing.

 

[AmZ]

Thanks Steve.

I really can't say that I am feeling too good now. Therapy tonight was hmm, a sense of hopelessness there? My therapist said that we'll carry on therapy but the medication is of main importance now to sort out and without it, it's making things not 'workable' in therapy. Can't say that makes me feel too positive and it kind of sucks that my thought about tonight was that she's going to bring up the medication again and she did, and went as far to say that. She said she feels that strongly about it that it would be "unethical", "unprofessional" and "not right" that she would carry on therapy without getting this sorted out by a psychiatrist that we know we can trust and that is going to take care of me properly.

The place I have been going to (with those 2 psychiatrists) called me back to say that the other psychiatrist can't see me as she has enough patients, so I am left with the one who doesn't ask hardly anything and doesn't speak English. So basically that place is out of the question to go back to. My therapist said that my only homework is to call up this other place that I found to see about it and already make an appointment for 1 1/2 weeks time (if it works out) so that I can go once I have been on the 300mg for 2 weeks, and if not working by then, then something will have to be done then and not wait any longer.

Totally bad of me, but I can't bring myself so far to throw out the leftover alcohol. That was my other homework also actually, as I didn't throw it out after last session. I know it would be totally wrong to have a couple of drinks to get me off to sleep for more than 3 1/2 hours tonight and if I succeed in resisting the urge, I will be very proud of myself. Doesn't look like therapy is currently workable anyway and the therapist was just annoyed at the end and did her frustrated 'thing' which I can see which doesn't make me feel very positive now waiting around for the medication to be sorted out and she could only suggest throwing out the booze (but that's a good one) and deep breathing.

---------- Post added November 26th, 2010 at 12:52 AM ---------- Previous post was November 25th, 2010 at 08:09 PM ----------

No AmZs were harmed after the writing of this post. No booze, other substances or any other actions occurred such as had happened on two previous Thursday nights which involved other things.
AmZ just feels :nah::help:

Goodnight.

 

[AmZ]

Hi everyone,

I had a question concerning side effects when taking Effexor at higher doses.

I've been on 300mg for about 3 weeks and since I started to feel better mid-late last week (and I can feel it helping a lot), I have had some side effects which I haven't had before (whilst taking it at 225mg for 2 months and 2 months before at a lower dosage).

Today when I got on the bus to work, all of the noises around me sounded so loud, I couldn't take it. It wasn't an anxiety-type thing/feeling, I just felt super sensitive somehow.
Also with other noises, even if they are not that loud, they really affect me.
I also feel extremely relaxed and calm, but kind of verging on feeling a bit floaty and 'too good'. I wasn't feeling like this 6 months ago, let alone in my whole life, so is a bit weird to adjust to. I feel like I'm kind of 90% 'here' or something (it's not an unpleasant feeling like I've had before but is a bit peculiar).
I know that it sounds a bit anxiety-like, but I'm a bit twitchy also and whilst I feel a hell of a lot less anxious and down, the hand counting (OCD) is still there and seems to be a little worse since I moved to 300mg. I actually didn't have it at all for a few weeks and in the last few days, it's returned.

So yeah, sensitivity to sound, feeling 'too good' (a bit numb and overly relaxed) and twitchyness/involuntary movements/OCD - I was wondering (and hoping) that I will either just get used to the way the medication feels and/or these are perhaps sounding like side-effects from the higher dosage that will eventually go off?

Glad to report that I'm still sleeping a lot better which has made a big difference. I'm still waking up once or twice (3am and/or 5am) but am going back to sleep and having a much better night sleep. My appetite has come back tenfold which I am not giving in to because I don't want to put on so much weight! But is a bit annoying to wake up at 5am with my stomach rumbling for food!

Thanks

 

[Retired]

all of the noises around me sounded so loud, I couldn't take it. It wasn't an anxiety-type thing/feeling, I just felt super sensitive somehow

AmZ,

From my understanding of Efx, I do not have sufficient clinical knowlege to give a useful opinion on what you experienced; however I would report it to the doctor and ask if this might be related to a side effect referred to as psychomotor agitiation.

Your doctor may consider modifying your prescription in that case.

 

[AmZ]

Thanks Steve.

I'm going to the psychiatrist in a few days so will see how things go between now and then.

I still feel more (than ever) relaxed and calm, but did have a little panic attack on the bus this evening which came out of nowhere and came hard and fast... I've only had it happen 3 times or so before but this was the most intense. Luckily had it under control within a few minutes so glad I managed to calm myself down.

Tonight I started thinking about self-harming... Not thoughts of doing it, but I don't know where it came from, I just started to look up about it on the internet. I know that's not good and am trying to see where this all came from this evening.

I'm still glad to be feeling and sleeping better though now after quite a few days. It's been a long time coming and still have some way to go I know. But for now, it's a relief, regardless of my bad evening I've had today. I knew it was going to get tough again and have bad times again some time, so... On I go.

Just at home now and trying my best not to get in this bad frame of mind and thinking.

 

[David Baxter PhD]

I still feel more (than ever) relaxed and calm, but did have a little panic attack on the bus this evening which came out of nowhere and came hard and fast... I've only had it happen 3 times or so before but this was the most intense. Luckily had it under control within a few minutes so glad I managed to calm myself down.

No medication can entirely control anxiety and you wouldn't want any medication that could do that. The fact that you could bring it under control so quickly should be reassuring. The next step is to learn to identify the early (remote) antecedents so you can predict an attack and intervene before it even hits.

Tonight I started thinking about self-harming... Not thoughts of doing it, but I don't know where it came from, I just started to look up about it on the internet. I know that's not good and am trying to see where this all came from this evening.

I suspect it's part of your OCD by now, automatic and repetitive.

 

[AmZ]

No medication can entirely control anxiety and you wouldn't want any medication that could do that. The fact that you could bring it under control so quickly should be reassuring. The next step is to learn to identify the early (remote) antecedents so you can predict an attack and intervene before it even hits.

For sure. I agree that of course I wouldn't want the medication to stop and take away everything... Otherwise I'll never come off medication in my life. My mum never did seek any professional help in her life for her anxiety and depression and still has daily heart palpitations (because of anxiety) to this day.

It's good that I managed to control it quickly and I know how it started - I was on the bus coming back from work and was stuck in traffic all the way home in the dark with heavy storms and rain outside. The bus was all steamed up and the air was humid and moist which I can't say was helping things. The journey took 2 hours rather than 50 minutes it normally takes. I started the journey by thinking positively and started to read 'Feeling Good' and thought that it was good that I was feeling relaxed and can try instead to enjoy the journey and take it as an opportunity to read the book and just get on with it. Even though there were obvious things that weren't so pleasant about the situation, I was OK for the first few minutes, then I had a tiny thought of 'I want to get off the bus' 'but I can't get off because we are on the highway', and then just straight away my whole body had pins and needles and I started to sweat and heart rate/breathing started to speed up. I just straight away put my book away, put my coat over my face, closed my eyes and did deep breathing for a few minutes until I was OK again.

Then luckily had an empty seat next to me so put my head down and slept for a while!

I was more than 50% there and it started off as a good CBT test for me, but that negative thought crept in and attacked!

I suspect it's part of your OCD by now, automatic and repetitive.

The therapist and I never linked it to the OCD really but can see other reasons as to why I have self-harmed or have the thoughts. I've maybe only thought about self-harm 6 times or so in the last 6 months and did it twice. I think there is definitely an element of what you say that must be true though as no doubt the obsessing about thoughts or urges I have make it worse and the release is the compulsion i.e. drinking, taking sleeping pills, self-harming. We haven't looked so much at all about the OCD yet really, so we'll see. Because it seems to show itself only in the hand counting thing and comes about from any anxiety I am feeling about anything, I guess we are more focusing on controlling the anxiety to start with and change the thinking there. Maybe there is something else to do with the hand counting, but it's not like I do it every time I feel anxious or is connected to a specific thought etc.

 

[tasha]

AmZ, I was only on regular Effexor for a short period of time then switched to the XR, which I've been on for years now. I can't really remember how I felt when I switched or when my dosage was increased, but I do remember there were some adjustments to get used to.

You sound very intelligent and very attuned to the differences your experiencing both physically & emotionally and I personally think that's a good thing. It's great that you're wanting to understand the "whys" and "whats" of your medications and your health issues. I guess what I'm saying is you're being proactive and that's fantastic! :2thumbs: I really hope you find a therapist that you're compatible with.

You mentioned a tingling or a twitching, I believe. From my own experience with Effexor-XR, I've experienced an "electric shock" sensation in my fingers if I've forgotten to take it, and I know others who have reported the same thing. If that's what you were feeling, maybe the same sensation happens to some people when their dosage is increased (or decreased)... just a thought. In my case, it's a reminder that I must have forgotten to take my pills that morning. :bonk:

 

[David Baxter PhD]

The therapist and I never linked it to the OCD really but can see other reasons as to why I have self-harmed or have the thoughts. I've maybe only thought about self-harm 6 times or so in the last 6 months and did it twice. I think there is definitely an element of what you say that must be true though as no doubt the obsessing about thoughts or urges I have make it worse and the release is the compulsion i.e. drinking, taking sleeping pills, self-harming. We haven't looked so much at all about the OCD yet really, so we'll see. Because it seems to show itself only in the hand counting thing and comes about from any anxiety I am feeling about anything, I guess we are more focusing on controlling the anxiety to start with and change the thinking there. Maybe there is something else to do with the hand counting, but it's not like I do it every time I feel anxious or is connected to a specific thought etc.

First, it would be rare for OCD to manifest itself only in one form. Indeed, your posts here show evidence of several different but related OCD signs, in my opinion. Second, OCD pretty much always gets worse as anxiety and stress levels increase.

 

[AmZ]

AmZ, I was only on regular Effexor for a short period of time then switched to the XR, which I've been on for years now. I can't really remember how I felt when I switched or when my dosage was increased, but I do remember there were some adjustments to get used to.

Thanks for letting me know about your experiences. It's great to hear.
I noticed a difference today with the sound sensitivity and morning weird feelings being a lot lot less so am hoping that it is just adjustments that I will get used to over time.

Thank you for the such kind words Tasha - That's really nice of you to say so I need a bit of a 'lift me up' right now so that helps!

their dosage is increased (or decreased)... just a thought. In my case, it's a reminder that I must have forgotten to take my pills that morning.

Hehe - Yeah, I'm trying my best to not forget to take etc. So far, so good, in 4 1/2 months I haven't forgotten to take my medication once and have taken it every morning within the same 3 hours of each day. I heard all about those brain zaps and all kinds of things that aren't too pleasant when missing a dose so am keeping that in the front of my mind!

First, it would be rare for OCD to manifest itself only in one form. Indeed, your posts here show evidence of several different but related OCD signs, in my opinion. Second, OCD pretty much always gets worse as anxiety and stress levels increase.

Agreed. Has just been a bit unexpected that having 5 days or so feeling much calmer and relaxed, and generally, have had less anxiety to deal with, that the OCD has been worse. I brought it up in therapy tonight and well, there are so many other things that we need to work on, that this is something that is the least of my worries (in a way) so this will be dealt with in the near future I hope.

I'd appreciate if anyone is around on the forum now or later, to offer me some advice about something. It's not like a mega urgent thing and I seem to pretty much have it under control so I don't think I'm going to do anything... But just need to get some advice and vent and welcome anyone's thoughts about the situation.
Therapy tonight was extremely uncomfortable. More than in any session I've had. The therapist asked me to do a narrative about something, then and there and straight away blood rushed to my head, I went bright red and totally tensed up and went mega awkward. I felt like an idiot to be frank and have lots of feelings about it all. I'm embarrassed at generally ' being me' and specifically being in this situation and being totally awkward and not being able to do something quite as simple as this, sitting in front of just one person. We talked about it and then I'm even more upset that it just brings more of my many issues out, more and more on the list that we need to address and have so much to work on. I feel totally messed up and am overwhelmed at just being me, again. So now it's all come out about me and my social anxiety basically. I'm not necessarily using it as a term of diagnosis, but regardless, it's something that I've always had problems with. Whenever I am in a group of people, say at a lecture, whether it's 5 people or 50, I find it extremely difficult to be the one asking a question or making a comment in front of people. In the past, I've forced myself to do it a couple of times and went bright red and the same thing happened basically and it was horrible. Hence, why I am always the quiet one and 95% of the time, the only one who says nothing at all in front of the class (was like that all throughout school etc, up until now). If I'm in a room full of people at an event for example, and everyone is mixing and talking with other people, then I have no(t much of a problem really) going up to one person and talking to them. It's just times where the focus is on me and maybe when it's more of an improvised or scripted/talk type thing that I've most of my life avoided doing these things. It was right at the end of therapy when this happened so my time was up and I just had to hold my emotions in because I knew the next patient was waiting. The therapist urged me to tell me what I was thinking and I just said that I am very embarrassed and upset. She asked what I was upset about or who. I said ' me'. So now I have to email her a thought log of all of this and like I say, it's another thing on the list that upsets me, the way that I am and something else to work on.

My body was aching as soon as I got up from the chair and I wanted to carry on crying because I feel a general self-dislike, frustration and general upsetness (I know that's not a word, but it works) about everything. I started thinking about the evening ahead and my self-destructive behavior options and was thinking that I'm going to do something and don't care if I do. Luckily 30 minutes in to my walk, I got to the stage of telling myself the cons of doing so and now feel like I'm not and don't want to do something... Then I think, 'ahh, just a tiny glass of alcohol', just to relax me a bit and numb out a bit... Then I think no and keep doing so. Because I can't go on like this.

Thanks. I v much appreciate it.

 

[David Baxter PhD]

Agreed. Has just been a bit unexpected that having 5 days or so feeling much calmer and relaxed, and generally, have had less anxiety to deal with, that the OCD has been worse. I brought it up in therapy tonight and well, there are so many other things that we need to work on, that this is something that is the least of my worries (in a way) so this will be dealt with in the near future I hope.

Well, your memory for how you have been feeling even a few days ago isn't very accurate. But even apart from that, think of OCD as an anxiety-based disorder where the thoughts/obsessions represent worries and anxieties and the behaviors/compulsions represent a defense against the anxiety.OCD intensifies when stress and anxiety increase, but to the extent that the OCD is successful in reducing anxiety you might sometimes see OCD up with subjective anxiety down. It doesn't really mean there is less anxiety, just that it has been transformed.

If you understand OCD this way, it's not different from the other issues at all. They are all interlinked.

 

[AmZ]

Well, your memory for how you have been feeling even a few days ago isn't very accurate.

I appreciate your reply Dr Baxter. I am being accurate here however. I started to sleep well from last Wednesday which has continued since then. I posted late Wednesday night (in my time zone) with some concerns I had but Thursday onwards after sleeping good on Wednesday I've been feeling very different like I've never felt pretty much, let alone in the last 6 months.
Shame something has clicked in me tonight though during/after therapy but I'm working on it as we speak. My heart keeps racing a bit even though I'm in bed and am usually very relaxed and have no anxiety (before mid-last week also). I hope that I'll be able to stop it before I go to sleep because from past experiences, the anxiety etc carries over in to my dreams and causes me a bad night sleep if I go to bed like this.

...think of OCD as an anxiety-based disorder where the thoughts/obsessions represent worries and anxieties and the behaviors/compulsions represent a defense against the anxiety.OCD intensifies when stress and anxiety increase, but to the extent that the OCD is successful in reducing anxiety you might sometimes see OCD up with subjective anxiety down. It doesn't really mean there is less anxiety, just that it has been transformed. If you understand OCD this way, it's not different from the other issues at all. They are all interlinked.

Thank you for that. It definitely helps me to have more of an understanding of how these things are interlinked for sure.

 

[Daniel E.]

I posted late Wednesday night (in my time zone) with some concerns I had

That's one way to put it

I've never thought like this before, it's never gone 'this far'....

...if we can just 'assume' here that I have been feeling worse and at the worst that I have ever felt before in the last 2 weeks, then that would be a good start.

http://forum.psychlinks.ca/members-only-private/25086-i-feel-like-i-simply-just-dont-care.html

 

[AmZ]

That's one way to put it

Lol. Are you guys out to get me or what!?
I don't even know why we're going off on this tangent here... So, I posted on the 8th that I was feeling v bad but slept 8 hours that night and 7-8 hours each night since then, compared to 3-5 hours in the last 6 months. On the 9th I woke up feeling very calm and relaxed and have felt like this since also with, I know, a bit of a difficult night last night (but I controlled within 3 minutes the start of a panic attack) and you guys and I know full well that medication doesn't take everything away... so why are you trying to prove me wrong here? You're trying to say that I am disillusioned somehow or? What advice are you trying to give me?

 

[Daniel E.]

I was hoping you would provide the clarification. You said on Wednesday night that I wasn't taking you seriously. And tonight you are saying you were just posting with concerns.

---------- Post added at 08:23 PM ---------- Previous post was at 06:05 PM ----------

You're trying to say that I am disillusioned somehow or? What advice are you trying to give me?

My point isn't primarily about what you posted last week but about what you have been posting for months. I read over some of your old posts. You seem to use the word "worst" and "worse" a lot -- which is the point I was making before about "awfulizing" and the recurring themes in your posts. Awfulizing also keeps OCD going: http://forum.psychlinks.ca/obsessiv...5-key-cognitive-errors-in-ocd.html#post175547

And, of course, acceptance (a.k.a. "high frustration tolerance") is the opposite of awfulizing.

 

[AmZ]

I was hoping you would provide the clarification. You said on Wednesday night that I wasn't taking you seriously. And tonight you are saying you were just posting with concerns. My point isn't primarily about what you posted last week but about what you have been posting for months. I read over some of your old posts... which is the point I was making before about "awfulizing" and the recurring themes in your posts.

Thanks for the reply.

I agree with you that I am guilty of many bad ways of thinking which don't help things in the least. That's what I am trying to work on so I hope that I will improve within time. It's all a learning process. On the other hand, even though I post a lot here and it may appear like I'm saying everything, that's not the case. I'm not trying to awfulize my life and situation here, I'm just saying that there is also an element of not being able to understand a person fully and know everything by me writing and you reading on a forum like this. If we take both things in to account then I think we'll be just about straight

BTW, tonight (last night) I was just posting with concerns. I didn't say that I was feeling awful again or anything like last week. I said that I'm happy about the medication helping me stay a lot more calm and relaxed in general and sleeping better, but that the session was difficult because it brought up another issue of mine (social anxiety) which was very embarrassing and difficult to deal with in therapy (last night). I could hardly look at my therapist and make eye contact with her for more than a second without awkwardly looking away all the time. I've been like this since I started to see her but last night was very difficult because of the situation of her asking me to do the narrative.

I didn't say it last night, but in general, I feel rather overwhelmed with everything and feel like there is so much to work on. Adding on now that my job that I've had for over 3 years is in a bad way, I'm trying to find another job that pays enough for me to pay my rent, bills, living, etc. Generally, I am trying, and have been trying for many years, to find some direction in life and it's bringing me now to a place where I've been in a good place in this job and got promotions etc along the way, without having any educational background (but it doesn't really require it) and have been very lucky. Now I am looking for jobs and they're all asking for a degree, etc, or are minimum wage and are shift work and not nice jobs - So it's difficult now because I know that I can't regret the past but I wish I had studied (finished) something at university and had a direction to go in. Anyway, so, yea, a bit difficult and I am trying to use the situation to make positive changes and look at other possibilities, but it's either a problem because I am not fluent in the language here and/or don't/can't get any financial support whether it be from family or money from the government because you can only use your benefits within 3 years of coming here and I've been here for 4 years. Now, at the age of 25, I really want to find something in life that interests me work-wise, it's not all about the money, as long as it pays enough to cover the necessities of what I need, then it's OK... Just have been searching for a long time and haven't found anything, and now am searching with the knowledge that I'd better find something before I get to a place where I can't pay my bills at the end of the month.

Sorry I went off on a little ramble. I know that the social anxiety thing and work issue has caused me more anxiety over the last 2 days, but I'm still a lot more calm than I have been before and feel OK - I'm eager to make the positive changes that I need to, but like I say, it's feeling a little overwhelming right now so I'm trying to break everything down into smaller parts and work on one thing at a time.