Anxiety, or Autism?

Regarding Medications

“That’s it—I’m diagnosing you with Generalized Anxiety Disorder,” my therapist said, exasperated and determined, and much to my shock. What, me? Anxiety disorder? Naaah, I thought while internally looking back at my whole, short life. Sure, I was a worrier and a nervous fellow…but anxiety?* Wasn’t that for people who thought every little thing might end them or somehow cause chaos in their lives?

*The difference, in my head, between anxiety and worry is that anxiety gnaws and whittles away at one’s mind, but worry is a lesser thing. You might be worried that a plate may fall because it’s imbalanced, or that the washer won’t fully rinse away the plastic pod-packaging. Or you might be worried about the snow, hoping it won’t pile up to anything worth shaking a shovel at. Maybe it was a language issue, where I’d get quite irate at folks who claimed something was ‘giving them anxiety’ because no, how can it? You’re just nervous or worried. Alas, my own stupid bias would bite me in the long run…

But then I thought back to my panic attacks in Old Orchard. Working retail, given odd shifts from, say, 3-7 or 4-8, and worrying that if I couldn’t eat an early supper then I’d be in overload, and have no time to eat a proper meal. My panic attacks would surface mid-morning, and I’d have to sleep and stay home from work.

I thought of, more recently, how I’d smelled the scent of bleach in the microwave and couldn’t stop thinking about how maybe I’d inhaled some of the particles and it’d grow in my lungs, and I’d have to be intubated and hooked up to tubes and catheters and unpleasantness. I’d brushed my teeth, rinsed my mouth, and nothing; only after a deep and fitful nap did I feel better.

And too I thought of my journals, filled with worries and fears and conscious streams, unfiltered. I thought of my many uneasy moments regarding my parents; always wondering if I was being watched, when I’d be yelled at or struck or punished. Always wondering if my secrets would be discovered and then I’d be subject to their wrath and scoldings. Of all the things, these last are so embedded into my atoms that one wonders if I’d ever be free, no matter the distance or years. It’s a common experience for those with controlling and harmful parents.

“An anxiety disorder?” I asked my fiance as I returned from therapy, who rolled their eyes, knowing me better than I’d known myself. “Yes,” they replied with impatience. Thinking about all the times I’d been anxious about the car in winter, or if the music on my iPod had stopped at all during the day and needing to know what piece it was on. “But I already have autism*,” I said, defiant and stubborn because sometimes it takes time for things to settle in. “What if it’s really just…you know, all wrapped into that?”

*With autism comes the need for predictability, control, order, and general sameness in some cases. And one can have autistic anxiety too—that is, anxiety based around one’s autistic needs.

Back in 2012 I began a prescription for Sertraline (Zoloft?) because of, you guessed it, social anxiety issues. People were too much; I got burnt out from socializing, and got burnt out from worrying about people. It was high school and I was already in depression, but I had the stupidity to wean myself off from it over the summer because I was unemployed and wouldn’t be around people so there was literally ‘no need to worry.’ Modern problems require modern solutions. But just because I’d stopped taking the prescription doesn’t mean the illness wasn’t gone.

Where does anxiety stem from? Is it natural and embedded in our psyches and personalities off the get-go? And why are most folks who are neurodivergent also suffering from anxiety too? Could it be argued that CPTSD and PTSD just add onto the layer? Which came first, the chicken or the egg? It should also be noted that anxiety and depression and trauma shape the brain. But the bigger question: why does medication work on one issue, but not the other? Maybe it changes chemicals in one’s brain without changing the untouchable, inner-workings of one’s brain.

Along with therapy I also finally had a doctor. I told him of my therapist’s diagnosis, and the question of medications came up. “I see that in 2012 you were given Sertraline,” he said thoughtfully. “Tell me more!” And so I told him what I’d written above. But why was I so hesitant this time to consider medication? My family always had had a long history of mental illnesses; my mother’s side suffered from depression, alcoholism, maybe other things (not to mention NPD, BPD (rumored?) too. Was it because I’d had internalized issues and stereotypes about needing medications? Why was I wary?

“I’ll need to think about it,” I replied, and my fiance and I talked about it for a few days. It turns out that most folks on the spectrum really appreciate the benefits of medications; Zoloft, Sertraline, Adderall—just to name a few—offer more pros than cons. And it was the cons which I was afraid of. Loss in interests or appetite, or becoming a barely-functioning lethargic. Which gave way to more anxious thoughts: less energy and less food mean less work, which means less money, which means no groceries or house or auto payments—

Just because you need medication doesn’t mean you’re broken, or a problem. Just because medications work differently for you, or not at all, or you need more than one doesn’t mean you’re difficult or an issue to be managed. I know there are those whose experience is vastly different from mine, and they suffer from terrible side-effects, or their doses are too small so they need to be refilled every month. Or there are those who have doctors who simply won’t listen.

And I won’t say that it’s ‘good to be back on medications’ because it just didn’t count the first time. I wasn’t mature enough (in all sense of the word) for it to work, and it just wasn’t the right environment either. Life has to be manageable before I can fully manage my brain. To fall asleep tired but not exhausted is a gift; to face an issue and instead worry endlessly about the what-if and simply become defiant (or avoidant and dismissive, as I sense I’ve become) and say so-what? makes me more thankful than ever.

But here’s where the curiosity strikes, and hence my original title. The traits and symptoms of autism cannot be taken away or erased; they can be managed, but not deleted. Yet why is it that I feel fewer detriments, at times, due to my autism when my anxiety is nonexistent? Why is it that I can put up better with being low on spoons, or better at withstanding sensory overload (only for a certain timeframe, though)? Have I been misdiagnosed this whole time? Though, it’d not be the first time…

Does anyone else have the same experience regarding their neurodiversity and medications?

Thanks so much for reading! As always, til next time.