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Hi Doctor,

I am writing because during my senior year of high school I experienced some anxiety/depression with the transition of going away to college. I was put on Paxil (30 mg, now down to 10 mg), and basically I am extremely ashamed of being put on it, and freak out if I think there is a possibility that someone knows that I'm on it. I know I shouldn't be ashamed because I know tons of people that have been on it, but I just get anxious or extremely embarrassed/self-conscious when I feel that anyone has seen the pills (for example, in my bathroom), or even around my family (because they know). I am not sure why I am so embarrassed I guess because of the stigma that comes with mental illness. But it is really the only thing that is left of that road block in my life that still effects me from time to time. I'd like it not to effect me anymore. Any suggestions?



Hello, Tami, and thanks for your question:

My clinical experience suggests that Paxil and its sister SSRIs (medicines that work by supressing reuptake of seratonin, a neurotransmitter in the brain) often prove helpful in managing depression, and anxiety, and also help in treating various obsessive-compulsive problems. But as I have stated elsewhere, treatment with such medications must be part of a regime that includes counseling or psychotherapy, I am strongly opposed to the use of such drugs without at least occasional therapeutic meetings. I imagine that you are not receiving such counseling or therapy, for if you were, your fear of embarrassment at being "found out"as a Paxil user, would already be part of the therapeutic dialog, and you would not need to be addressing this question to me.

But in any case, the root of embarrassment, at least in many cases, is that a certain sense of self, a kind of ego-image which one wishes to maintain and protect, in which one wishes to believe, and which one wishes to project in the world so as to gain the approval of others, is called into question by behavior which does not support the ego-image. To take a strong, but not uncommon example, the fundamentalist preacher who from the pulpit rails out against sin and sensuality is certainly embarrassed when he is caught in a motel room with a prostitute or a married member of the congregation. Suddenly his "holiness"is seen to be a mask behind which is hidden his "real"character, and he is ashamed.

The "cure"for this kind of embarrassment is simple to state in words, but challenging to carry out in practice. What is required is to ask yourself why you do not want it known that you use medication to help manage your depression--but do not accept the first answer, just keep asking. Eventually, you will find that you are carrying around an image of yourself which does not square with the reality of who you are as a person (of course who you really are is, in my experience, something quite beyond personhood, but that's another story). Then you will be faced with a choice. You can keep on pretending to be something you are not, or you can relax and accept yourself as you are. I heartily recommend the second option.

Be well.

Dr. Robert,

Thank you for responding to my question. I realize exactly what your saying, but I really don't think I am trying to deny or "cover" who I am. I have accepted the fact that I went through a rough period in my life but got over it, and am now weaning off my medicine, which I really don't need anymore. I guess the reason why I don't want people knowing about that though is because I feel that they will look down on me, think I am crazy, or just judge me in general, AND it is none of their business :). I feel that this is something that I went through and is personal, which is why I don't want anyone to know.

I am still the same person I always was, who went through a rough patch and have moved on. I am proud to say that the anxiety/depression problem I once had is virtually gone, but am still somewhat hesitant and embarrassed around the people that already know (i.e. my family, a couple people who I feel have seen the medicine in my bathroom).

I do not know why I am so concerned about what people think...I guess it's the "image" thing like you said. Thanks for responding and feel free to respond to this email if you have time!

Also, do you know of a therapist in the Tucson, AZ area? I think it's time that I address this head on, you are right. Thanks!




I think the key to this is revealed in your words: "I am proud to say that the . . . problem . . . is gone." I mean the idea of being proud, as opposed to pleased, happy, relieved, or whatever.

In other words, you seem to have made getting over the depression and anxiety a source of pride as if it were an accomplishment. Once one takes pride in an accomplishment, one sets oneself up for anxiety that the accomplishment may be seen by others to be incomplete, to be insufficient, or to be less than one wishes it to be. In this case, someone among your family and friends might have noticed that you now seem more confident and happier than before (your "accomplishment"), but then, if that person saw your medicine bottle, he or she might think: “Well, I thought Tami really had beaten that depression with her great courage, determination, and strength of character, but now I see that it’s really just that drug she takes.”

If you can let go of pride, and simply accept each moment of your life for what it is—a moment in a human life—I imagine that you will feel much less embarrassment about anything, and less anxiety about performance and prestige too. This simple attitude that what arises in this moment simply is, and cannot be any different is what I call radical, non-judgmental self-acceptance, and I recommend it highly.

Be well.

p.s. I cannot suggest a therapist in your area, but I do encourage you to find one. Judging from your letters, a fairly short course of therapy focused on your feelings of embarrassment could help.

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