I wish I could see a therapist and talk about these instead of writing about them here but, in my country, there are no reliable therapists and people do not emphasize higher study at all. People do not deal with anxiety here, some ignore the symptoms and others who know keep it a secret because it is seen as a weakness. So there are no help or support groups here. Two years ago, when the mild anxiety started because of stress at my first job, I sought medical help but I think I was wrongly treated with medicine and I think this contributed to insomnia or worsen the anxiety, whatever it is. This experience has gotten me fearful of seeking professional help too.

I have been struggling with anxiety for more than two years since I first started my job but did not know that it was anxiety. Recently I got to know about it and made lifestyle changes like leaving my job and moving back home. The anxiety is less now because of having no job stress. But the application time for the fall 2018 semester in the US is approaching and I really need to make a decision right now. I feel like I do not know much about this illness or how to cope with it. I don't know if it is insomnia or anxiety, but because of it, my performance was suffering in the job and my manager was unhappy with my performance before I left. For these reasons, my confidence level is zero, I feel like I won't be able to keep up with a Ph.D. program and also work as an RA or TA since I do not know how to deal with the boss. Also, my anxiety reaches its extreme when I start working seriously and can't sleep enough for days. The condition at home is very poor, all of my family members are suffering from illnesses and since I do not have any friends right now, seeing them suffer breaks my heart. I feel like running away from home so that I do not have to see them suffer. If I could help them financially it would be very useful for them and so it is a source of pressure too.

So right now, I am fearful of my potential adviser (if he turns out to be unsympathetic to students), seeing a therapist here in my country, getting fired from my Ph.D. program when I get into one or staying at home with the risk of worsening my anxiety for not having any help.

I have options like going for the Ph.D. program in the US and see a therapist over there. It's a benefit that they have enough data about people like me. But I do not know how to work with a therapist and if I'll be able to help myself and also keep up with the grueling schedule of a graduate program. There will be other challenges like a new culture, not having anyone to talk to, etc., and I'm not good at making friends. So I don't know if it will be the proper step. I have been trying to get into a Ph.D. program for four and a half years now, so if I get fired it will emotionally crush me and take a huge toll on my confidence.

So what should be a rational step in this situation? I am willing to do anything to improve my mental health condition to get a Ph.D.

Thank you for being patient with this long post.

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    Do not give up on professional help just because the first attempt did not work for you. From experience of people I know, the technology does not yet exist to reliably know what prescriptions will work for a given individual. You should go back to the doctor, report the effects, and let them try something else. – Patricia Shanahan Sep 17 '17 at 1:03
  • Note that the problem of knowing what will work for a given patient applies even to simple physical problems. I'm on my third medication for atrial fibrillation, and my second blood pressure medication. – Patricia Shanahan Sep 17 '17 at 1:05
  • I do not have issues for the medicine not working out. I am terrified because he didn't explain what I had and that it was just stress that I needed to handle. It looked as if he didn't know much about this illness and prescribed the medicines just to get rid of me. He told me to give up preparing for PhD which was the most important thing for me that time. Now if I go to a professional, I will probably have to stay here a year and it is quite possible that he will advise me to give up PhD, which I can't do. I feel like there is no proper guidance here. – alu Sep 17 '17 at 1:14
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    I've voted to close on the grounds that an answer to the question depends very much on the exact details of your situation in a way that won't generalize to other prospective students. I will comment that access to mental health care is often quite limited on university campuses in the US and you may be overly optimistic about what would be available to you. – Brian Borchers Sep 17 '17 at 4:08
  • Unfortunately, mental health is not generally paid as much attention as it should worldwide. This said, looking at what some friends have gone through (small sample, though), the situation here in Sweden is much better than that in the US and the UK. Do your research before choosing a place, and consider your health, you only have one. – Davidmh Sep 17 '17 at 12:30

I voted to close because this is highly individual; however, I have something to contribute that will fit better into this box than the comment box.

If preparing your application makes you feel worse, don't do it.

If preparing your application makes you feel the same or better, then go for it.

You don't need to attend just because you are accepted.

Anxiety and insomnia are often related to each other like the chicken and the egg. When one is anxious, one is more likely to lose sleep; when one is chronically short on sleep, one has a harder time dealing with difficult situations and is more likely to feel anxiety at an impairing level.

There are some conditions, such as obsessive-compulsive disorder (OCD), that tend not to go away unless a very specific treatment protocol is followed (exposure and response prevention). However, many other types of anxiety do get better with more ad-hoc treatment approaches. Even OCD does sometimes improve by itself, or through self-treatment, or through a less-than-ideal therapeutic approach. And sometimes, finding someone who is a great listener is all that's needed. So, why not look for someone you feel comfortable talking to? Even if the therapist's formal studies haven't been hugely impressive, you still might find that it clicks, and talking with the person you found is helpful for you.

I'm not sure why you are concerned about the medications you were given. I'm guessing maybe you're concerned about getting habituated and/or addicted.

The internet is a great place to find out about a particular medication's potential risks and side effects.

I have no idea what is at the root of your problems, and I don't even know what your symptoms and patterns of symptoms are. Even a doctor wouldn't be able to match up medications with your needs after reading your post. But what I can do is to share a list of medications that are sometimes helpful for anxiety and/or insomnia, tend to have a relatively low profile of side effects, and are relatively mild. I'll include a tiny bit of information about each one.

Melatonin: over the counter (no prescription needed). It's best to use the smallest dose that is helpful -- some people start with 1 mg and increase gently only if needed. I have heard recommendations that the starting dosis be tiny, tiny -- by counting drops of the liquid form of the medication.

Zaleplon: 5 mg is the smallest dose (in the U.S). This helps one relax and drop off and takes on the order of 20 minutes. This is a relatively mild sleep aid and has a short half-life. Some people are able to take it if insomina strikes at 5 am and still get up alert and ready for the day two hours later.

SSRI: sometimes helps for other conditions besides classic depression. It can take up to six weeks to see an improvement after beginning to take it. To be effective it has to be taken every day, religiously. Dosages that are helpful for OCD are much higher than the standard dose for depression. One has to ramp up slowly, with careful medical supervision.

Ativan or Xanax: these are in the Valium family and in small doses can help an anxious person stay on a more even keel. Watch out, this is a medication that might be incompatible with operating machinery such as a car. Note, one can cut the tablets up into pieces with utility scissors.

Zaleplon, Ativan and Xanax can be habit forming, especially if they're taken every day.

Regardless of where you are living, a big part of self-care involves building a support network. It is generally more difficult to do this in a strange country. However, maybe you could use the next 11 months to get better at building a support network, as practice.

Another good general coping mechanism is exercise. You might find it helpful to start getting into good exercise habits now, if you don't already have them. There are lots of ways of getting exercise and each person just has to find what's fun for them.

Now, about graduate studies: sometimes a person is able to feel better about him or herself when involved in a major endeavor, such as graduate studies.

It really is incredibly individual.

Note. Just because the culture where you are is to hide anxiety, that doesn't necessarily mean you have to hide yours.

A little more:

Any therapist that tries to send you to grad school or prevent you from going to grad school is the wrong kind of therapist.

I want to share one possible non-medication intervention for insomnia: listen to a book on tape or a podcast that you have already listened to at least once before so that it won't be too exciting. Set the timer feature on the mp3 player so it will turn itself off after 20-30 minutes.

There are also meditation or mindfulness tapes out there for insomnia but if you don't like them you might have better luck with what I described.

  • It is the most informative and helpful response I have found regarding my problem so far, I can't thank you enough. My sleep quality was way better before I took the medicines, so I might've developed insomnia after taking the medicines or I may be habituated/addicted. If it helps, I am off them for 10 months. Or it could be other events in my life which have caused this, but I'm not really sure. You know it's very hard to be sure about anything if you have anxiety. – alu Sep 17 '17 at 11:44
  • I do zumba dance, it is the only thing that makes me happy these days, also writing :). And I feel good about myself if I'm involved in a major endeavor like graduate studies or working on writing a paper, but the problem is there is authority involved in this and I'm not sure if I'll be able to meet their expectations with my very poor communication skills and the impairing health problems. – alu Sep 17 '17 at 11:44
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    @alu - Yes, anxiety can make a lot of things difficult. Very true. I thought of one more thing that can help you prepare for grad school: developing a positive identity by focusing on the flip side of disability/difference, e.g. the classic example of the blind person having extra acuity for hearing. Another example might be a person with OCD having a great deal of patience with some technical aspect of their work. // It sounds like you've got some positive strengths to build on, including self-awareness. – aparente001 Sep 18 '17 at 17:19
  • I have been meaning to ask, do you think my symptoms suggest that I have OCD? Or you are saying that in case I have OCD then these should be done? – alu Sep 20 '17 at 8:08
  • Take a look at the OCD checklist at tourettesyndrome.ca/forum/… // you can fill it out and deliver it when you se a medical provider. – aparente001 Sep 21 '17 at 3:46

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