As a psychiatrist at a university, nothing brings me greater joy than when a patient who used to have terrible anxiety tells me they’re now able to make friends, give a presentation in class, or do anything else that previously felt off limits. But I also know that getting better when you have anxiety (or any mental health issue) is not only hard to do—for some people, it can actually be pretty terrifying.
If anxiety is a huge part of how you define yourself, what does it mean when those symptoms start to recede? Maybe this experience has thrown you for a loop, or maybe the fear of it is stopping you from seeking help for your anxiety.
Either way, I understand that not knowing where you end and where your anxiety begins can be disorienting. I promise it’s possible to work through the emotions that can come with treating your anxiety, get to know your new self, and get much closer to living a life that your anxiety may have made seem impossible. I know because I’ve seen it.
Why some of us feel defined by our anxiety
Take my patient Jake*, for example. When he first came to see me, he was struggling with day-to-day anxiety so badly that he had trouble focusing in class and couldn’t sleep. Of course, his grades were dropping. As a result, Jake stopped socializing. He was so worried that if he took time away from studying, he would do even worse in school.
I started Jake on a selective serotonin reuptake inhibitor, a type of antidepressant that is generally the first-line medication for anxiety. A beautiful thing happened: He started to get better. He could concentrate, he could sleep, and most importantly for Jake, he could get back to doing well in school and hanging out with his friends.
But feeling better came with unsettling aspects, too. Now that Jake was less worried about how he came off to people, he revealed his true, more sarcastic personality more often. He didn’t take as much time getting ready before he went to a party or asking as many questions before he dove into an assignment. Jake was in unfamiliar territory.
While he certainly liked his new ability to function without anxiety, Jake told me he felt like he was having an existential crisis of sorts. He didn’t know who he was anymore, wasn’t sure if others would like his “new” self, and wondered if he should stay on his medication.
Jake’s situation is unique but not entirely uncommon, and it doesn’t only happen due to medication, either. Even without medication, working on your anxiety in therapy can play out in a similar way: You might feel a little uncertain or scared about leaving behind anxious behaviors that have benefited you in the past. After years of living with anxiety, it can start to feel normal or even necessary for your success. If medication or therapy then reduces these symptoms or makes them go away entirely, it can absolutely raise questions about your identity.
Maybe you feel like your anxiety fuels your success at work, or you outwardly revel in being an introvert when you really stay home because of social anxiety. No matter the case, when you address the anxiety that propels certain behaviors, there can be some concern that you’ll lose the parts of your identity that seem so enmeshed with it.
Mental health stigma can also rear its ugly head here, making you feel ashamed that you need medication or therapy sessions to tame your anxiety. But anxiety is an illness like any other. Can you imagine someone with diabetes saying, “Even though insulin stabilizes my blood sugar, I don’t want to take it anymore because I feel more myself without it?”
The important thing to know is that this unmoored feeling of being someone new without your anxiety isn’t weird. It can be a completely normal stage of getting better, and someone like your psychiatrist or therapist can help you move past it or even delight in it.
How to talk about your concerns
In my experience, this conversation is actually most likely to come up before a patient even begins their anxiety medication. When I bring up the prospect, patients often ask me if it will change who they are or if, without anxiety as a driving force, they’ll stop caring about important things like studying.
I usually tell my patients that with proper treatment, you can expect day-to-day anxiety to go down but not go away entirely. Remember, anxiety has an evolutionary purpose. It’s meant to help you survive by motivating you to act in the face of a threat, whether that’s a bear outside your campsite or a looming deadline at work. That drive will not just disappear with anxiety treatment like medication and therapy.
If you feel unsure about navigating reality with lowered anxiety, tell someone like your doctor or therapist. As great as they might be, they can’t read minds! Please do bring up anything like this if it is affecting you.
Whoever you talk to will likely ask what exactly feels different about who you are with lowered anxiety (or what you’re nervous will feel different). If you’ve started on anxiety medication, that can help them make sure you’re not actually experiencing unwanted side effects, which could indicate that a different one might be better for you. If that’s not an issue, they can help you understand how you might have grown to attribute anxiety behaviors to who you are as a person, how those behaviors have helped you in the past, and what your worries are about not having them now. This discussion will be personal and may be difficult at times, but it’s one worth having.
You shouldn’t stop any mental health medication on your own without guidance from someone like a psychiatrist. That’s especially true with antidepressants, like the type you might have been prescribed for anxiety. Coming off them too suddenly can cause what’s known as antidepressant discontinuation syndrome, a cluster of negative symptoms like insomnia, dizziness, irritability, and even suicidal thoughts. This doesn’t mean you can never come off of a medication that isn’t good for you, just that you should talk to a medical professional about tapering off of it as safely as possible.
Your prescribing doctor or your therapist can help you weigh the pros and cons of staying on your medication. While I can understand concerns about feeling somewhat different as a result of medication, I also know how beneficial treatment can be for someone with debilitating, life-interfering anxiety. However, I would never tell someone what the “right” choice is for them.
How to navigate and appreciate your new normal
The goal of treatment is to be able to enjoy life more without anxiety symptoms like constant worrying, a racing heart, poor concentration, and insomnia. That’s what happened for Jake, who decided to stay on his medication and eventually settled into his new, improved, and much less anxious life. He even laughed about his initial feelings, telling me he realized he wasn’t really living his most full life before he started treatment.
Whether you’re on medication for anxiety, are addressing your anxiety through therapy, or both, know that it’s possible to get through the discomfort and relish being on the other side, like Jake.
Also, hey, if you’re worried your friends or family members won’t like this less-anxious version of you, you can always outright ask them. Chances are they’ll be thrilled that you’re feeling better overall and will be happy to offer some positive reinforcement. Hearing from them might help you feel a bit better. So might realizing how refreshing it is not to worry about a test for days and nights on end or being able to enjoy a party you’d otherwise skip out of fear. Eventually, as you adjust to your new reality, you’ll hopefully be able to worry less about feeling different and instead celebrate feeling better.
*“Jake” represents a composite of patients I’ve treated.
Jessica A. Gold, M.D., M.S., is an assistant professor in the department of psychiatry at Washington University in St Louis. Find her on Twitter @drjessigold.