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I have a problem with anxiety and depression and have been constantly picking my head, biting my lips and mouth, or digging into my thumb with my nails for the last 5 or 6 yrs. I do not stop at all, doing the least noticeable in public. I have tried 3 different anti-depression meds under Drs. supervision (not for these problems, because I am too embarrassed to tell him), with no relief from depression. I was treated for severe panic attacks about 20 years ago with Xanax over a yr, with success. I am also an alcoholic and realize that these meds are less effective because of that. I have also been through several therapists, with some short-term benefits, but nothing significant. I'm not really sure what to do next.

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replied May 22nd, 2009
Anxiety and Stress Answer A6640
Thanks for your question. You sound as though you have a few problems in your life - poor thing. Let's try to deal with each one. Taken singly, we might be able to get a solution.

Alcoholism - I am assuming you are involved in a program to deal with this. AA or some local support group. Alcoholism is a disease and must be treated as such. Social support is part of the strategy of dealing with alcoholism. Part of the issue is to determine why - sometimes there are genetic reasons for alcoholism; sometimes there are developmental or personal reasons. So, let's get this one attended to as what comes with this disorder is shame. And shame can be part of the problem for the other issues you describe.

Advice 2 - share everything with your physician. Don't hold back. Professionals need to know all the information to assist a patient.

Your self-mutilating behaviors (picking, biting etc) seem more like obsessive-compulsive disorder (don't worry about the expression - OCD). OCD is driven by anxiety and that is what is happening here. There must be issues deep in your background that are causing you to feel anxious and to panic. You must tell your dr about the OCD behaviors - there are medicines specifically helpful for this disorder (note I am not making a diagnosis - just pointing out an issue).

I do not advise on medication but you should talk to your dr about an anxiolytic. Could be a big help.

Final advice - you need to have a sustained program of support from a psychologist. There is a lot of evidence about the benefit of medication with Cognitive Behavior Therapy with many of the symptoms you describe.

Keep believing in yourself and keep seeking the support of your family and friends. You can overcome these problems.

Best wishes
Dr Jeff

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