I don't frequent this board often, but thought I would share some of what I have learned with my journey. I am now 54. I first had problems with anxiety, panic attacks, and depression at age 18. I had no clue what had hit me. It felt like a category 5 hurricane. After coming out of that in a little less than 2 years through the help of a good psychiatrist and meds I remained free of meds until age 27 when I experienced a second depression which has lasted to the present. I have been on meds since age 27. Both episodes were precipitated by emotional involvement with women. Until age 50 I depended upon meds totally to treat the depression and anxiety, but meds had not worked that well for me since about age 33 and it seemed nothing I tried worked. So at age 50 I began cognitive behavioral therapy, CBT, through a home tape and workbook course. I am ashamed to say that I have not worked regularly since age 47 due to a very irregular sleep cycle.
I learned a lot about myself through CBT and am still learning. I grew up with low self-esteem and lack of self confidence and have struggled with these issues since childhood. But it wasn't that clear that these issues were really a problem until my late 20s. At 16 and 17 I was mentored by a high school basketball coach. I grew up in a small town. Through hard work the coach led us to play for the state basketball championship in our class when I was 17. I was in the national honor society all four years in high school and had some good semesters in college as well, eventually being selected as one of three juniors to receive the designation of Distinguished Military Student in R.O.T.C. at my university. All of this served as a smoke screen so that I didn't see the problem with self esteem and self confidence.
Before starting CBT I was bed ridden much of the time and, though I didn't realize it, had slipped into a state of "learned helplessness". CBT has brought me about 75% of the way back to a normal life, but I still struggle with a normal sleep cycle. I had always taken 10 to 15mg of anti-anxiety med daily since 1977 until about 12 or 13 months ago when I was able to go off of them completely over a period of time thanks to CBT. In this same time my anti-depressant med has dropped from about 200mg daily to 85mg daily, also thanks to CBT. I believe that my messed up sleep cycle and lack of employment is also learned helplessness and am working to get back to normal. I quit working with CBT in December of last year and have regressed a bit this year. My belief is that my problem is all psychological. My doctor doesn't agree and he may well be right, but I have depended upon doctors and others too much for most of my life. Dependency is also an issue with me which I am ashamed of. What bothers me and shakes me to the core is feeling like I have no core when I am feeling bad. My wife is a very stable, good, and dependable person having achieved much success in her teaching career. I vacilate from belief in self to no belief. It makes it hard to do anything.
My theory is that it is my thinking which is causing the problems. Thinking creates emotions and brain chemistry, good or bad, that's why CBT has enabled me to come down on meds and go off of anit-anxiety meds. I think I need to work with CBT until I have changed to the point that I am no longer having severe problems. Considering how long I have suffered with this it may take several more years of consistent work before I arrive where I want to be, but I have experienced some remarkable improvement and so am enouraged to do so. That said, I'd like to suggest some areas for you to explore. These are simply suggestions, so take them or leave them as you see fit. Our recovery is completely up to us alone.
From your first paragraph of your first post it appears that therapy did you some good since you and your therapist decided to stop it. I wonder if the Paxil helped also. Some people can work with therapy without meds and some need meds along with therapy. What i think, and I could well be wrong, is that it is your thinking getting you into trouble, else, why would therapy work? I would suggest you go back to therapy and continue it for as long as you feel you need it and would also suggest considering going back on Paxil. I would never suggest you go on a med without working on yourself at the same time, though, believing that it is our thinking which is the root cause of our problems.
You said, "I don't want her to ask, 'Why on earth are you keeping [me] from my more pressing patients?'" Is this a lack of assertiveness on your part, asking for what you need, or is it a lack of self esteem and feeling like you don't deserve help, or both? You deserve to get well, completely, no matter how long that might take. You are paying the therapist, he/she is there to serve you and help you recover completely, not to put you down and make you feel less than human. You say, "I am unsure of everything right now. I don't know why I feel terribly." I've been there also. I am still unsure of things some of the time, more than I like to admit, but I know longer wonder why I feel terribly. I know why and it is all to do with my thinking. I am self aware of what is causing my pain and it is my thinking. If my thoughts are good I am not in emotional pain or depression, it's as simple as that. I've been through times when I had no clue why I felt the way I did, had no energy, no motivation. But CBT skills of journaling my thoughts, loving myself unconditionally, forgiving myself for failures, letting go of guilt, lowering expectations, exercise, etc. has made me much more self aware so that I know what is causing my problems. Even so, I still have to practice CBT in order to be relieved of the depression. It doesn't fall out of the sky into my lap. I have to work at it, even though I'd like it to fall out of the sky.
My question to you is, what are you doing on a daily basis to discover why you feel the way you do? What steps are you taking daily to self discovery? Or are you waiting for it to fall out of the sky? You need a plan, an organized way of going about self discovery. CBT provides that organized plan.
I've said all of this to try and help. I have not said anything to offend you and I hope nothing I have said has hurt because that isn't why I have said what I have. I do believe there is a way out of this even though I have not gotten it all together yet. Pat yourself on the back for continuing to work. I applaud you for that and hope you continue to. Several sources I would recommend for learning: several books out by Dr. David Burns, Feeling Good the New Mood Therapy, The Feeling Good Handbook, and Ten Days to Self Esteem. The tape course I went through and still work on put out by The Midwest Center for Stress and Anxiety called Attacking Anxiety and Depression. It cost $370 in 2000 and is well worth the investment. I am sure there are other good resources out there as well which can help you begin a journey of self discovery and find out why you are suffering. I think that we rely too heavily upon doctors and therapists to do work which only we can do. I want to repeat what I said earlier: our thoughts create emotions and brain chemistry. Good, healthy thoughts create good healthy emotions and brain chemistry and bad, negative thoughts create bad, negative emotions and brain chemistry. Take good care of yourself and don't beat yourself up. That's easier said that done. It's a life skill that can be learned from CBT. You deserve to fully recover. Be proactive and take the necessary steps.