Hi,

25-year-old healthy male. Great diet and regular exercise/yoga. I don't smoke, drink alcohol or take drugs, and I also avoid caffeine and high sugar foods. I started having panic attacks in October '13, which gradually turned into periods of time where I'd be anxious for days on end and break down completely. My anxiety was a still bit all over the place though. Some days I couldn't leave the house and other days would be totally fine.

I started on 20mg of citalopram four weeks ago for anxiety and depression. I felt it helped me a fair bit in the first three weeks, but the fourth week has been really bad for anxiety. How long should I give the citalopram before I think about upping the dose or trying to new medication?

Anyway, I've been having the most trouble lately with derealization and existential panic. Derealization has been common during the last few months, though the existential thoughts that accompany it now are awful. What is all this? Why am I here? Am I real? Is the world real? Is it all my imagination? What is the meaning of life? etc. etc. I can't get a break from them and it's making my life extremely difficult! It feels like I don't know who I am anymore. It also feels like I'll never feel normal again. It's like the thoughts have been so awful and disturbing that I'll never be able to feel alive and normal agan.

I know the thoughts are irrational and unresolvable, but that doesn't make them go away. Is this just a symptom of my anxiety? The derealization seems to be at its worst after periods of high anxiety. I don't have any history of OCD behaviour in terms of rituals or actions, but the thoughts themselves feel very obsessive. I've had the same existential thoughts plenty of times before in my life, but they didn't cause me any pain.

I guess it'd just be nice to hear from people who've had similar thought patterns and come out the other side. It's such an isolating experience to go through these feelings. Any advice would be great.