Q. I am doing better with my anti-anxiety drug. Do I need counseling?

Hello doctor,

I am 45 years old and working as a senior level finance professional in a multi-partner practice owned by all of us. After going through the high levels of anxiety for several years, I consulted a psychologist who is my friend. After few months of showing little improvement, he put me on Escitalopram 10 mg. For about 2 years I took this medicine and was generally fine. When my friend moved out of the country, I shifted to a new doctor and he is a more senior person. He changed the drug to Paroxetine 25 mg which I have been on for the last nine months. I would probably say I am doing better now than before. The issue is regarding further counseling. While my friend did not feel that there is a need to continue counseling once he put me on the medicine. But, the new one seems to feel that I should resume counseling. Based on his advise, I went back to the counselor I originally saw, but somehow she seems to feel that I do not need any structured counseling. I am generally a religious person and try to follow certain regular spiritual practices like visiting a temple almost every day, reading at least a little from any scripture and do some chanting. At the same time, I still have the little odd feelings of discomfort too at times, though it does not trouble me so much like earlier. Specific cause of worry now is mostly the side effect of the long-term medication I take for anxiety, BP (Telmesartan) and for GERD (Esomeprazole). The primary concern now is that on most days I have a general feeling of boredom as though there is not anything much to do. Generally, I try to avoid associating with any new demanding assignments because I do not feel comfortable about doing things unless I am fully sure about the work. On the other side, it is also my dream to be a successful writer of fiction novels. I have finished one book, but that has not found any worthy publisher so far, which is disappointing. So, even though I have been working on my second book, I do not have too much confidence that my writing will reach anywhere. I am not a social type person and like to spend time at home. I will also confess that by nature I am known as a negative thinker, both at work and in the house. But my relationship with people are generally very cordial, because I try to lighten issues and also try my best to avoid any sort of conflict. All this leaves me with a general sense of dissatisfaction, although I am very clear that I do not want to stick my neck any further out either. Though at times, I fantasize about career and location change. I do not dare to think anything seriously, because I am sure that I will not get such a comfortable position again. But, to conclude the issue which is confusing me right now is, do I need counseling again? I am far from clear, what can I hope to achieve from therapy which I cannot get from my religious and spiritual practices? I note that online therapy is also an option on this site. Is that as effective as direct counseling?

Hi doctor,Many thanks for the answer, which takes towards a new course of thinking now. I am glad that you too feel that my biggest issue is the lack of a proper direction or goal in life. It leaves me wanting to try many things without really knowing what or how. Do you think that my present dosage of Paroxetine 25 mg high? If I have understood correctly, my doctor plans to keep me on this dose for at least some time more before considering any reduction or stoppage. In fact, he mentions the need for counseling in that long-term context. For now, I have convinced myself to trust him entirely regarding dosages to avoid making it another matter of anxiety. What exactly do you mean by saying that the absence of anxiety or motivation is more troublesome? Most importantly, there seems clear advice from you that counseling will not help me. May I ask why you feel so? Also, you have suggested CBT/NLP/coaching as the solution. I am aware that CBT is a form of therapy delivered by a clinical psychologist. But I am not sure what exactly NLP/coaching is and who can offer such support? Please guide me, as to which professional expert should I try to seek help from?